AccountId: 011433970860
ContactId: 9cfa3601-6e1e-40e2-96eb-8ee87f247357
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261279 ms
Total Talk Time (AGENT): 54060 ms
Total Talk Time (CUSTOMER): 121406 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/9cfa3601-6e1e-40e2-96eb-8ee87f247357_20250411T17:33_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yes, [PII]. This is [PII] calling for providers to check on additional information about a claim that's been denied. Please note this call will be monitored and recorded for quality and training purposes.
[AGENT][POSITIVE] I'd be happy to assist with a deny a claim today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Uh, is the policy number is?
[CUSTOMER][NEUTRAL] 02455926
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And what's the date of service for the claim?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[AGENT][NEUTRAL] And your tax ID.
[CUSTOMER][NEUTRAL] Uh, just one tax ID is [PII].
[AGENT][POSITIVE] Thank you for that information. One moment.
[AGENT][NEUTRAL] OK, I'm showing the claim was denied because it was not a covered place of service, um, the outpatient rider only allows payment for outpatient surgery and then hospital or physician's office.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK. Thank you so much. Outpatient that is only allow payment for outpatient surgery in the hospitals in office.
[CUSTOMER][POSITIVE] OK. Thank you so much. One moment.
[CUSTOMER][NEUTRAL] And uh this one is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but this one place of services office.
[AGENT][NEUTRAL] But it only covers for surgery. They didn't have surgery.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Opa surgery in hospital of shops. OK. Thank you so much. So is that not uh covered as for the plan or uh provide a contract?
[AGENT][NEUTRAL] The plan.
[CUSTOMER][NEUTRAL] OK. And may I know the patient plan type?
[AGENT][NEUTRAL] It's a um limited benefit hospital indemnity plan.
[CUSTOMER][NEGATIVE] Limited benefit.
[CUSTOMER][POSITIVE] Hospital in the plan. OK, thank you so much. Just give me one moment. And the claim number for this.
[CUSTOMER][NEUTRAL] Uh, is that 378-922?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 378922
[CUSTOMER][NEUTRAL] 5955
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I don't know one moment.
[CUSTOMER][NEUTRAL] 357-889-3, right?
[AGENT][NEUTRAL] Yes, that's the one I have.
[CUSTOMER][POSITIVE] OK, thank you so much. And uh the claim process date?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Thank you. One moment.
[CUSTOMER][NEUTRAL] OK, no payroll. OK, and the call reference for this?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Oh no but it's so and uh.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] You said [PII] and the time?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII] Eastern Standard Time?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], and have a wonderful day. Take care, bye.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Mhm.