AccountId: 011433970860
ContactId: b4b858c2-d08b-4493-b05e-49a59268ce62
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318670 ms
Total Talk Time (AGENT): 152554 ms
Total Talk Time (CUSTOMER): 62950 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/b4b858c2-d08b-4493-b05e-49a59268ce62_20250124T19:23_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], my name is [PII] and I need some information on a claim, please.
[AGENT][NEUTRAL] OK, [PII], or do you already have a claim number or are you needing to check claim status?
[CUSTOMER][NEUTRAL] I need to check status please.
[AGENT][POSITIVE] Yes ma'am, I can help you and [PII], what is your callback number please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] So yeah.
[AGENT][NEGATIVE] [PII], you, [PII], your voice went completely out. I didn't hear any of their phone number.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Can you hear me now?
[AGENT][NEUTRAL] I can hear you at the moment. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] That is 02288797.
[AGENT][NEUTRAL] OK, thank you. One moment while I get um the information pulled up, please.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] birthday is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for for her?
[CUSTOMER][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] And the total charge is $2,603.85.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, so the most recently received claim was denied as a duplicate of previously submitted expenses. Do you need the original information?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, that claim was received and processed on [PII].
[AGENT][NEUTRAL] And what the, what is the, I want to make sure that I have this correct. What is the facility name again?
[CUSTOMER][NEUTRAL] It's Baptist Deaconess Madisonville Hospital.
[AGENT][NEUTRAL] OK, thank you. So the claim number is 341.
[AGENT][NEUTRAL] 273 5.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] And the reason for the denial states.
[AGENT][NEUTRAL] The outpatient treatment benefit provides an indemnity amount when a covered person receives treatment in an emergency room, urgent care facility, physic physician's office, or physical, speech or occupational therapy facility. Treatment in an outpatient hospital less than 18 hours is not covered by this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient hospital treatment is not covered by policy.
[AGENT][NEUTRAL] Uh-huh. Treatment in an outpatient hospital less than 18 hours is not covered by this policy.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits [PII], you can go to our portal.
[AGENT][NEUTRAL] At [PII] and you should be able to print that out.
[CUSTOMER][NEUTRAL] OK, [PII]
[AGENT][POSITIVE] Uh-huh. That is correct.
[CUSTOMER][NEUTRAL] And what was the rest of it?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do I have to register for that?
[AGENT][NEUTRAL] You would mhm you would create your own username and with password.
[AGENT][NEUTRAL] It's a self-registering. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can you provide a call reference number please?
[AGENT][POSITIVE] Sure, you would actually use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, thank you for your help.
[AGENT][POSITIVE] All right. Absolutely, Ms. [PII]. You're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Not at this time, thank you.
[AGENT][POSITIVE] OK. Well, yes, ma'am, you're welcome and thank you again for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] You as well. Thank you. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.