AccountId: 011433970860
ContactId: a5e3a1c2-a1fc-4659-bcfe-ede3d58be90e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 164559 ms
Total Talk Time (AGENT): 73478 ms
Total Talk Time (CUSTOMER): 53797 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/a5e3a1c2-a1fc-4659-bcfe-ede3d58be90e_20250304T15:55_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII], my name is [PII] from Einstein Medical Center, and I was calling to check on claim status for a member.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Policy number is 02454488.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII], and it's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yes, state of service is 9-18-2024. Bill amount is $5,991.45.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I'm trying to received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3531859.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the policy does not provide any benefits for the treatment of alcohol and or drug use.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, charges, OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, alright, thank you. Could you also tell me what type of plan this is?
[AGENT][NEUTRAL] Sure, hold on one moment let me see.
[AGENT][NEUTRAL] So this is a hospital indemnity policy, so it's a limited um medical benefit policy. Um, it has a list of coverages and then the amount that would be paid for it and if it's not on that list, it wouldn't be covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much. And can I get a reference number for this call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. You have a great day.
[AGENT][POSITIVE] You also, [PII], thanks for calling APL and I hope you have a great day as well. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.