AccountId: 011433970860
ContactId: 95cb63ef-62e5-4400-8738-0aa41401cad2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 164059 ms
Total Talk Time (AGENT): 94697 ms
Total Talk Time (CUSTOMER): 62294 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/95cb63ef-62e5-4400-8738-0aa41401cad2_20250416T14:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hey this is [PII] over in customer care. How are you doing this morning?
[AGENT][POSITIVE] Doing well sir thank you how are you?
[CUSTOMER][POSITIVE] I'm good. I just have a quick question I'm hoping you can help with. I have an insured on the line who has an indemnity, excuse me, indemnity policy.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And they're asking me if a heart catheter is considered a surgery or like just a procedure.
[AGENT][NEUTRAL] What type of can you tell me the policy number? like what type of uh indemnity do they have? Go ahead and.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Provide that
[CUSTOMER][NEUTRAL] Uh, the
[CUSTOMER][NEUTRAL] The policy number is 201.
[CUSTOMER][NEUTRAL] 0635.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And give me one moment to take a look at their benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Cause yeah, when I pulled it up their plan it looks like it just has a surgery benefit and she's wanting to file some claims and I wasn't sure if it was just a procedure.
[AGENT][NEUTRAL] I believe normally it would so what happens under these is that usually that procedure code um that would.
[AGENT][NEUTRAL] Uh, drive it, you know, drive that benefit. Now normally, um, it doesn't come through if it's being, and this is kind of a little bit deeper probably than you wanna be, but um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If the procedure, usually it's billed under the facility and they don't put it under surgery, so usually it is considered just a procedure, um, you know, because they don't bill it as a surgery.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, normally it will come in, um, on that claim form and it will be in like the, um, it will be a different revenue code other than a surgical revenue code if that makes sense.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Right, right, right.
[AGENT][NEUTRAL] So it's, it is technically considered a procedure as opposed to a surgery I believe. I mean that that's usually like I said, the way they come in under that um billing is that they would come in as a um under that.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Procedure.
[CUSTOMER][NEUTRAL] I'll yeah I'll just advise her of that and then of course tell her if you wanna go ahead and file it you can but this is the general consensus.
[AGENT][NEUTRAL] Yeah, absolutely. And yeah, she can, uh, by all means go ahead and have her, you know, just submit the claim, um, but just so that she is aware that it, you know, it could be uh denied for that reason, right. Mhm.
[CUSTOMER][NEGATIVE] Denied, right.
[CUSTOMER][POSITIVE] OK awesome thank you so much for your help this morning I appreciate you.
[AGENT][POSITIVE] You're so welcome sir any time have a great day.
[CUSTOMER][POSITIVE] Have a good day.