AccountId: 011433970860
ContactId: b180ca94-c4d9-4072-ab0e-068d78fa59ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287709 ms
Total Talk Time (AGENT): 69224 ms
Total Talk Time (CUSTOMER): 122949 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/b180ca94-c4d9-4072-ab0e-068d78fa59ff_20250402T21:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, this is [PII] calling from provider office. I'm calling regarding the claim status.
[AGENT][NEUTRAL] OK, [PII], I'm happy to check on claim status for you. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number I have is, it's D Delta 47305787.
[AGENT][NEGATIVE] Unfortunately, I can't pull the member with that number. Do you have a claim number or their name or social?
[CUSTOMER][NEUTRAL] Get we thought.
[CUSTOMER][NEUTRAL] Yes, uh, the member's name, uh, the member's first name is it's, uh, [PII], it's S Sierra, H Hotel.
[CUSTOMER][POSITIVE] E Echo Lima Bravo Yankee.
[CUSTOMER][NEUTRAL] And the last name is it's uh [PII].
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Me.
[AGENT][NEUTRAL] May I please have the insured's date of birth?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes, uh, the date of birth I have is it's, uh, [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Do you have a date of service, [PII]?
[CUSTOMER][NEUTRAL] Yes, uh, the first date of service I have is uh.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] In the build out?
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] Uh, for the amount of $400 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so it looks like we did receive a claim for the state of service. Claim was received [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was denied on [PII]. Policy does not provide benefits for inpatient visits.
[CUSTOMER][NEUTRAL] This.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEGATIVE] Policy and does not.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] And, and what should be the?
[CUSTOMER][NEUTRAL] Inpatient visit, OK, what should be the claim number?
[AGENT][NEUTRAL] Claim number is 356.
[AGENT][NEUTRAL] 9630.
[CUSTOMER][NEUTRAL] So, like, do you have any information like which type of benefits are covered under the member's plan?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] be.
[AGENT][NEUTRAL] So the member has a limited benefit hospital indemnity plan. This plan does cover any sort of intensive care, hospital admission. Um, it does also have a benefit for diagnostic testing, ambulance, and outpatient accident sickness treatment.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Actually this one is a inpatient discharge, so basically, OK, thank you for the information.
[CUSTOMER][NEUTRAL] OK, thank you for the information. I will contact the member regarding the eligibility and regarding the.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] That for that number. OK. Thank you for the information. That's all I need for today.
[AGENT][POSITIVE] You're welcome. Have a good day, [PII].
[CUSTOMER][NEUTRAL] OK, bye-bye.