AccountId: 011433970860
ContactId: a7b64beb-36b4-4ff9-b2e9-71b41c353952
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 298679 ms
Total Talk Time (AGENT): 108620 ms
Total Talk Time (CUSTOMER): 84771 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/a7b64beb-36b4-4ff9-b2e9-71b41c353952_20250604T18:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. This is [PII], last initial [PII], and I'm calling for the provider's office to check claim status.
[AGENT][NEUTRAL] I can help you with claim status, [PII].
[CUSTOMER][NEUTRAL] I can.
[AGENT][NEUTRAL] Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] 02545774.
[AGENT][NEUTRAL] One moment while I look that up.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, sorry?
[AGENT][NEUTRAL] Can you please verify the patient's name and date of birth for me?
[CUSTOMER][NEUTRAL] Patient's first name is [PII].
[CUSTOMER][NEUTRAL] Last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Data service, [PII].
[AGENT][NEUTRAL] OK give me just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said [PII], correct? [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII], yes.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the provider's name or the hospital name?
[CUSTOMER][NEUTRAL] Yeah, the provider's name is [PII].
[AGENT][NEUTRAL] OK. And um what is the hospital name?
[CUSTOMER][NEUTRAL] Savanna Multi Specialty Associate.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like we received this claim on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 35.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 91
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 123.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] It looks like that claim was denied because the outpatient rider only allows payment for outpatient surgery.
[AGENT][NEUTRAL] In an outpatient hospital or physician office, therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] Oh, OK. The provider will allow for the outpatient services, right?
[AGENT][NEUTRAL] Right. It's for an outpatient surgery and it needs to be in a surgery center or an outpatient hospital, I'm sorry, or a physician office. And so this is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so, basically, uh, it is non-covered, uh, the outpatient services are not covered, right?
[AGENT][NEUTRAL] Um, it only allows for the surgery to be in an outpatient hospital or a physician office.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so yes, this one wasn't covered because it wasn't, um, performed in either of those two places.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And uh it was denied on [PII], correct?
[AGENT][NEUTRAL] Yes, ma'am. Yes, sir.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, thank you. Uh, I just want your name and reference number.
[AGENT][NEUTRAL] OK, so we don't have call reference numbers, but you can use my name.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] In today's date, so [PII] in today's date.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much for your assistance. Have a great day.
[AGENT][POSITIVE] OK. Thank you for calling APL. If there's nothing else, I hope you have a great day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Mm bye.