AccountId: 011433970860
ContactId: 80ce72ff-6bb4-44d1-ab42-a860a572380f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 383750 ms
Total Talk Time (AGENT): 100795 ms
Total Talk Time (CUSTOMER): 118547 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/80ce72ff-6bb4-44d1-ab42-a860a572380f_20250326T15:36_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Uh yes hi [PII]. This is uh [PII] calling from my office to check a claim status.
[AGENT][POSITIVE] I'd be happy to assist with claim status. May I have the policy number please?
[CUSTOMER][NEUTRAL] Uh yes, sir, just a moment.
[CUSTOMER][NEUTRAL] Uh yes, policy number is D as in Delta 43,302,090.
[AGENT][NEUTRAL] I believe that's their wellness policy number. Do you have a social?
[CUSTOMER][NEGATIVE] Uh, no, sorry. I don't.
[AGENT][NEUTRAL] What's the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Come
[AGENT][NEUTRAL] [PII]. And do you have a um address?
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] And that is [PII].
[AGENT][NEUTRAL] And the date of service for the claim?
[CUSTOMER][NEUTRAL] Yes, date of service is.
[CUSTOMER][NEUTRAL] Uh, [PII], total charge is $900 even.
[AGENT][POSITIVE] Thank you for that information.
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK, I'm showing the claim denied because anesthesia is not covered under the policy.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEGATIVE] Anesthesia is not good on the patient policy, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the patient plan, right?
[AGENT][NEUTRAL] It's a hospital indemnity policy.
[CUSTOMER][NEUTRAL] Mm, is this, uh, this policy not cover any surgery cost?
[CUSTOMER][NEUTRAL] Or any anesthesia group?
[AGENT][NEUTRAL] It's not covered. Would you like the claim number?
[CUSTOMER][NEUTRAL] Uh yes, please. When the claim is received also.
[AGENT][NEUTRAL] Claim was received on [PII]. Claim denied on [PII]. Claim number is 356.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] 1913.
[CUSTOMER][NEUTRAL] 13. OK. Uh, so you said this is an intimate plan. So this is HMO PPO type plan?
[AGENT][NEUTRAL] Um, yes.
[AGENT][NEGATIVE] Um, no, it's not a PPO plan. No. It's a hospital indemnity plan and it, it does not cover anesthesia, which is why it was denied.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Uh, OK. Uh, so I have one more question. Uh,
[CUSTOMER][NEUTRAL] So you have any authorization to check uh
[CUSTOMER][NEUTRAL] Hospital claim on the same date of service for the same location.
[AGENT][NEUTRAL] I don't see any other claims for that data service.
[CUSTOMER][NEUTRAL] Mm, this is a hospital clinic for.
[CUSTOMER][NEUTRAL] Same location.
[AGENT][NEUTRAL] Is it the same date of service?
[CUSTOMER][NEUTRAL] Uh yes, for the same date of service, any hospital.
[AGENT][NEUTRAL] OK, I don't have any, I don't have any other claims for the this data service.
[AGENT][NEUTRAL] So if you would like to submit it, you can.
[CUSTOMER][POSITIVE] No issue. Thank you.
[CUSTOMER][NEUTRAL] Mm, OK, no issue. What is your time defering limit? A time finding limit?
[AGENT][NEGATIVE] There's no timely filing, there's no timely filing.
[CUSTOMER][NEUTRAL] OK, no issue. What is your mailing?
[AGENT][NEUTRAL] Uh, mailing it, OK, one moment. It's just, OK, can you hold for me one moment please.
[CUSTOMER][NEUTRAL] For a.
[CUSTOMER][NEUTRAL] I just. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for your patience. I'm showing that the mailing address for the claims will be IMA.
[CUSTOMER][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] What about.
[AGENT][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Also, you have any fax number?
[AGENT][NEUTRAL] 877.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, can you provide me call reference number for our discussion?
[AGENT][NEUTRAL] Reference is just my name [PII] last [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] Uh, no, thank you, [PII]. Have a great day. Bye.
[AGENT][POSITIVE] Thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] So