AccountId: 011433970860
ContactId: ad8f95f3-ff53-4a99-b4dc-e99a6199b8db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345880 ms
Total Talk Time (AGENT): 151356 ms
Total Talk Time (CUSTOMER): 112370 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/ad8f95f3-ff53-4a99-b4dc-e99a6199b8db_20250501T21:13_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I need to check on 22 claims please.
[AGENT][NEUTRAL] Sure, I can assist you with claims and may I have your name?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]
[AGENT][NEUTRAL] Thank you, Miss [PII]. And you're calling from a provider's office or this is your personal policy?
[CUSTOMER][NEUTRAL] It's I'm calling from a provider's office.
[AGENT][NEUTRAL] Provider, OK. And may I have a callback number just in case we get disconnected, Miss [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] West Tennessee Healthcare Hospitalist.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Mhm it will be 02407342.
[AGENT][NEUTRAL] OK. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you and may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Mhm, the first one is [PII] of 23 $275.
[AGENT][NEUTRAL] OK, let me see if I can find that one and that was in [PII]. All right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, for the future you can check claim status online through our website at [PII] and that's just optional and bear with me, let me pull this ELB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] All right. OK, looks like he was denied. Um, I'm waiting on the denial reason.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so we processed the claim on [PII] and the policy, or sorry, not the policy, but the claim was denied stating that the policy provides no benefits for charges made by a doctor for inpatient visit.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, so it's an inpatient visit.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So those, those are not, are not covered.
[AGENT][NEUTRAL] Correct. This is a limited policy, mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Got you. OK. So it will probably be the same for this other one on [PII] or [PII] because it was a hospital visit, so that would be denied as well.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] What about for any type of testing like an EKG or something? Are those covered?
[AGENT][NEUTRAL] EKG is not covered. Um, usually, this one only covers like CT scan, MRIs or stuff like that. Uh, and that's just once per year. Um, I can check and see if we receive any claims, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that dance service is 100 of 23.
[AGENT][NEUTRAL] What is
[AGENT][NEUTRAL] Yes, OK, so I just see one here. Let me pull the COV one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that one is for $26.
[AGENT][NEUTRAL] 26.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And that was 1010 of 23.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] What is the procedure code? Do you have a procedure code for me?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, uh 93,010.
[AGENT][NEGATIVE] OK, 4 $26 here it is. So that one was denied. Let me see what's the denial refund for this one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] Probably not covered also.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Maybe that the maximum benefit was exhausted, but let me double check.
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] So, well, it does say non-cover procedure. So it's no it's a non-cover procedure.
[CUSTOMER][NEUTRAL] OK, and that that that date of the uh denial was was when?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] OK, [PII]. Alright, well it's too old to be a pay. OK, well I think that's all I need and we'll cover this and your name again.
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Alright, and have you got a call number for you, sir?
[AGENT][NEUTRAL] We don't have reference numbers, Miss [PII]. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright wonderful we thank you so much so you have a good evening.
[AGENT][POSITIVE] You as well thank you for calling APL. No problem, Miss [PII].
[CUSTOMER][NEUTRAL] Bye bye, bye bye.
[AGENT][NEUTRAL] Bye.