AccountId: 011433970860
ContactId: a8f6ec40-10ea-4ba5-be76-d774ca80bf56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 512210 ms
Total Talk Time (AGENT): 120370 ms
Total Talk Time (CUSTOMER): 233376 ms
Interruptions: 8
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/a8f6ec40-10ea-4ba5-be76-d774ca80bf56_20250107T15:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] on
[CUSTOMER][NEUTRAL] Yeah, hi, it's [PII] here calling from provider office to check on the payment status.
[AGENT][NEUTRAL] OK, I didn't understand your first name. Can you spell it, please?
[CUSTOMER][NEUTRAL] Oh yeah, it's [PII], last initial it's [PII]. Yup.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] What's the first initial of the last name?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Are you saying [PII]?
[CUSTOMER][NEUTRAL] At
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, and you said you're checking claim status?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, if I can get the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is D as in Delta 43,509,860.
[AGENT][NEUTRAL] OK, do you have a copy of the medical ID card? Uh, the APL policy number will start with a 0.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, just to give me a second.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] 02353767 thank you and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yeah. It's [PII].
[AGENT][POSITIVE] Thank you, give me a moment to pull up the file, OK?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I the.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I promise
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have.
[AGENT][NEUTRAL] And what is the patient's name and date of birth, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you and we're checking claim status.
[CUSTOMER][POSITIVE] Oh yeah, that's correct.
[AGENT][NEUTRAL] And I can help with that. What's the date of service in charge?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII]. Charge amount is $528 and even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] I like.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We were.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so I show that the claim was received um [PII], um, processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 2024.
[AGENT][NEUTRAL] Uh, under claim number 353.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 1411.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] And there was no payable benefit because the service is not covered under this patient's policy.
[CUSTOMER][NEUTRAL] the.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] So does it apply like a patient responsibility or something?
[AGENT][NEUTRAL] We do not determine patients responsibility. We can just state that claim is not covered for the patient's policy.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And [PII], you can also check your claim status on the online service center at secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] ultra low.
[CUSTOMER][NEUTRAL] Uh, uh, I just want to know like, uh, does it follow like any guideline on something for this one for a pricing?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Uh, like, I just want to know, does it follow any guideline or something?
[AGENT][POSITIVE] Just what follow any guideline.
[CUSTOMER][NEGATIVE] It does not follow any guideline like Medicare guideline or like any other insurance guidelines.
[AGENT][NEUTRAL] Yeah, the denial of the claim is based on the policy that the patient has with American public life.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so, like, um, I just want to know, does it like apply to the patient responsibility or not because we have to like take a.
[AGENT][NEUTRAL] OK, we do not determine patients responsibility, [PII], because it's not covered under the policy, that's pretty much it. We can't tell you what they owe, it's just not covered.
[CUSTOMER][POSITIVE] But it was uh it's good.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Per their policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, can you just provide me like does it a Medicaid policy or like a Medicare policy?
[AGENT][NEUTRAL] This is a hospital indemnity medical policy.
[CUSTOMER][NEUTRAL] OK, sure. Or if we have to submit any like any a bill or something where we can submit that one.
[AGENT][NEUTRAL] You can appeal the claim, but it, it will be denied because the service is not covered by the patient's policy.
[AGENT][NEUTRAL] But you're more than welcome to submit an appeal.
[CUSTOMER][NEUTRAL] OK, sure. Just give me a moment.
[CUSTOMER][NEUTRAL] I, I, I do.
[CUSTOMER][NEUTRAL] Uh, can you just, can you just provide me, does the member is eligible for this state of service?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The date of service was denied [PII].
[CUSTOMER][NEUTRAL] Oh yeah, just I
[AGENT][NEUTRAL] I mean they they were effective during the date of service, but the service is not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Could you provide me the call reference number for this one?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][NEUTRAL] OK. Could you, uh, I'm jus[PII] forgot your, I just miss out your name. Could you provide me that?
[AGENT][NEUTRAL] [PII], first initial of my last name is [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. Thank you so much for your assistance. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You're welcome [PII] thank you for calling APL. Have a good day.