AccountId: 011433970860
ContactId: befb0e5c-a93c-4b5d-a9d0-72b9b090657b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 643500 ms
Total Talk Time (AGENT): 206839 ms
Total Talk Time (CUSTOMER): 176741 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/befb0e5c-a93c-4b5d-a9d0-72b9b090657b_20250402T21:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Hi [PII], I have a question on a claim that was, is, it's been a while now and I'm getting billed by anesthesiologist.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they sent me a copy of the explanation of benefit.
[CUSTOMER][NEUTRAL] And on there it says that the.
[CUSTOMER][NEUTRAL] Um, the, their claim was denied because of inpatient benefits for this calendar year has been met.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I, I'm OK, but it was an outpatient.
[CUSTOMER][NEUTRAL] Procedure, so I'm just wondering if that was if there was an error or something.
[AGENT][NEUTRAL] OK, can I get your policy number, please?
[CUSTOMER][NEUTRAL] OK, the, would that be the group number or that outpatient benefit number?
[AGENT][NEUTRAL] Uh, outpatient benefit number.
[CUSTOMER][NEUTRAL] OK, it's 01568608 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] OK, [PII], I just need to verify a few pieces of information. Could you please provide your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. And what is a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Couple more pieces of information, your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In the city?
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you. And lastly your email address.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, and what date of service was that?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let's see what's going on.
[AGENT][NEUTRAL] Uh, do you know what the total charges were for that?
[CUSTOMER][NEUTRAL] Uh, let's see if it says, well, uh, oh, total bill charges 3,416.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Give me just a moment pulling up the information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And you did say [PII], is that correct?
[CUSTOMER][POSITIVE] Yes, that's what I see on here. I think that's right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see
[CUSTOMER][NEUTRAL] Because I remember having the surgery right around [PII], so that sounds.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me see what we've got.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] That
[CUSTOMER][NEUTRAL] I think that.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEGATIVE] Sorry, system's running just a bit slow.
[AGENT][NEUTRAL] I'm trying to pull up the original claim of what we received. Let's see, I think I've located it.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because they coded everything is inpatient um.
[AGENT][NEUTRAL] But you're saying
[CUSTOMER][NEUTRAL] Well I was wondering about that they're saying that.
[CUSTOMER][NEUTRAL] Well they, well, I, I did ask that you hold it properly and they're saying that they did and.
[CUSTOMER][NEGATIVE] And you issued the denial based on it being impatient.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Yeah, um, let me find.
[AGENT][NEUTRAL] OK, let's see
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, let me place you on a brief hold if you don't mind.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What is the deal here? Let's see.
[AGENT][NEUTRAL] And so it's not that one.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What is that
[AGENT][POSITIVE] OK, thanks for holding.
[AGENT][NEUTRAL] Yeah, I, I don't think this is is in line with I don't know if this is accurate, so because I don't show an inpatient claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And, and you were, I mean, you would know if you had out you, you had outpatient surgery, correct? You had it on the same day and was discharged.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Right, that's correct.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] What I'm gonna do, I'm gonna send this to our claims department for research, um because like I said I don't see an inpatient claim anywhere um the.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] The claim that I have on file for the facility is for outpatient.
[AGENT][NEUTRAL] Which we um so I I don't know and I can't see the claim for this one so I'm gonna send it to our claims department for some research um let me see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm gonna put your contact is it the [PII]?
[CUSTOMER][NEUTRAL] Yes, that's that's my number.
[AGENT][NEUTRAL] OK, all right, so let me send this to them. They should get this tomorrow and they can start researching this, and then they'll either reach back out to us and we'll contact you back, um, or they will contact you and and explain what's going on. So because I'm, it's not making sense either so.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then the other thing that the, the lady.
[CUSTOMER][NEUTRAL] Said was that they have notes in the system that they were told that I didn't have coverage for that period.
[AGENT][NEUTRAL] No, we've got you, we've got you in here covered and active, so I don't know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Not sure where that information would have come from, because I've got your policy.
[AGENT][NEUTRAL] Yeah, your policy effective date [PII], so.
[CUSTOMER][NEUTRAL] Yes, I've had it for quite a while, um, and uh the other thing she said that there should be a reference number from.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, that
[CUSTOMER][NEUTRAL] You know, when I call and I should call and give her that, is there a reference number?
[AGENT][NEUTRAL] Uh, reference number is just my name, um, and my name's [PII], and then my first initial, my last name is [PII] and then it's today's date. We actually don't have numerical numbers so what I'm gonna do, I'm gonna make specific notes in our system, OK, so any, so they could see that.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That I'm gonna refer this to our claims department so like I said turnaround time on that shouldn't be too long, just a day or two, and then we can figure out and go from there see what what's going on so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. OK. Thank you so much for your help, [PII].
[AGENT][NEUTRAL] OK, is there anything else I can help with, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][NEUTRAL] OK, well thank you for calling APL and we'll get this sent through for review.
[CUSTOMER][POSITIVE] OK thank you have a good evening.
[AGENT][POSITIVE] Thank you you too.