AccountId: 011433970860
ContactId: 9a5b555f-860b-4715-8662-b824538263c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272730 ms
Total Talk Time (AGENT): 106933 ms
Total Talk Time (CUSTOMER): 91714 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/9a5b555f-860b-4715-8662-b824538263c7_20250424T14:19_UTC.wav
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[AGENT][NEUTRAL] Morning, thank you for calling JPL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah, this is [PII] calling from the provider's office checking on a claim status. Last name initial [PII]. May I know your name and last name initial?
[AGENT][NEUTRAL] My name is [PII]. That's [PII], last initial [PII]. And may I have a callback number just in case we get disconnected? You're welcome.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] [PII], direct line.
[AGENT][NEUTRAL] OK. And may I have the name of the facility you're calling from from my notation?
[CUSTOMER][NEUTRAL] Broad River Physicians Group LLC.
[AGENT][NEUTRAL] Can you repeat or spell the first word that you said?
[CUSTOMER][NEUTRAL] B Bravo, R Romeo, O Oscar, A Alpha, D Delta.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 025958883
[AGENT][NEUTRAL] Thank you one moment let me pull that information.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the member's name is [PII]. Date of birth, number [PII].
[AGENT][POSITIVE] Perfect, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, date of service, [PII], charge amount $1280 even.
[AGENT][NEUTRAL] OK, [PII]. OK, let me see if I can find this claim for you. For future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] And let's see. OK, let me pull this ELB one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEGATIVE] Oh I'm gonna put up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] It looks like the claim was processed on [PII] and it was denied. Let me give you the denial reason.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so the, the reason is the outpatient rider only allows payment for outpatient surgery.
[AGENT][NEUTRAL] So this was a non-covered service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, what was that, outpatient?
[AGENT][NEUTRAL] Outpatient um benefits or outpatient rider are only allowing payments for surgery. So it will only cover surgery under that benefit.
[CUSTOMER][NEUTRAL] OK. Under the patient plan, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] May I know the patient, uh, mhm.
[CUSTOMER][NEUTRAL] Yeah, and the patient plan. May I know the patient's plan type?
[AGENT][NEUTRAL] This is a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] Limited hospital indemnity plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Do you have any other insurance policy for the state of service?
[AGENT][NEUTRAL] No, I don't have any other policies with us.
[CUSTOMER][NEUTRAL] Uh-huh, uh-huh.
[CUSTOMER][NEUTRAL] OK. So, uh, yep, so it's an uncovered service. Uh, may I know the caller reference number, Ella? Yeah, sorry, so, so.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] It's OK. We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much. A wonderful rest of your day. Bye-bye.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You as well. Thank you for calling ATL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.