AccountId: 011433970860
ContactId: a04eeeaf-e390-4f6e-b3cf-6b9f3b281eb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285649 ms
Total Talk Time (AGENT): 136522 ms
Total Talk Time (CUSTOMER): 49718 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/a04eeeaf-e390-4f6e-b3cf-6b9f3b281eb9_20250404T18:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from my provider's office on a medical field.
[AGENT][NEUTRAL] Sure, I can, uh, we're just needing, uh, uh, regarding a claim. I'm sorry.
[CUSTOMER][NEUTRAL] Yes, medical. Yeah, medical.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you are with the provider's office you said?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, 2550107.
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] And then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and do you have that bill amount?
[CUSTOMER][NEUTRAL] 456.
[AGENT][NEUTRAL] 456 even? OK, thank you. One moment please.
[AGENT][POSITIVE] OK, I do believe I've found it. Give me just a moment.
[AGENT][NEUTRAL] OK, so yes, we did receive this claim. We were unable to pay a benefit as um.
[AGENT][NEUTRAL] Let's see. What was that? Treatment in an outpatient hospital is not covered under this policy. So the covered facilities would be emergency room, urgent care, physician's office, or a physical speech or occupational therapy facility.
[CUSTOMER][NEUTRAL] OK. Um, how can I obtain the EOB?
[AGENT][NEUTRAL] Uh, I can send that to you. Do you have a fax number?
[CUSTOMER][NEUTRAL] Yes, 336.
[AGENT][NEUTRAL] OK. Uh-huh.
[CUSTOMER][NEUTRAL] 2777809
[AGENT][NEUTRAL] OK, I'm going to read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and I would just put it to your attention, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, I'll go ahead and get that sent now. Should get it here in about within 10 minutes or so. Was there anything else I could help you with?
[CUSTOMER][POSITIVE] Uh, yes, I do have one more for her.
[AGENT][NEUTRAL] Uh, was it for a different date of service?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] 117 25 for 6:16.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, so we did receive this one as well, and that denial reason is the same. Treatment in outpatient hospital is not covered under this policy. Did you want me to send you that EOP as well?
[CUSTOMER][POSITIVE] Yes, that would be great.
[AGENT][NEUTRAL] OK, I will get both of those sent to you. Did you need those claim numbers?
[CUSTOMER][POSITIVE] Um, yeah, you can give me that, yeah, that would be good.
[AGENT][NEUTRAL] Of course. OK, so the first one, for [PII], that was 3571.
[AGENT][NEGATIVE] Oh goodness, sorry, bear with me, my system just froze up.
[AGENT][NEUTRAL] Sorry, there we go, 357-175-5.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the other one for [PII] that was 3571759.
[CUSTOMER][NEUTRAL] OK, what can I use as a reference?
[AGENT][NEUTRAL] Uh it would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's all. Thank you so much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thanks, you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.