AccountId: 011433970860
ContactId: cb3a7f7a-5856-464b-b30e-d130239e0480
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302500 ms
Total Talk Time (AGENT): 86888 ms
Total Talk Time (CUSTOMER): 97830 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/cb3a7f7a-5856-464b-b30e-d130239e0480_20250102T21:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling you from provider's office, and I am looking for claim information.
[AGENT][NEUTRAL] OK [PII], I can help you with the claim. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Uh, patient's name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and her policy number, please?
[CUSTOMER][NEUTRAL] 2549961
[AGENT][NEUTRAL] 2549961
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me look her policy up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, can you, um, give me the date of service, please?
[CUSTOMER][NEUTRAL] Sure. It's [PII] and the claim amount was 3,976 even.
[AGENT][NEUTRAL] OK, and that was [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] OK and the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm sorry, this claim was sent to anesthesia management.
[AGENT][NEUTRAL] C
[CUSTOMER][NEUTRAL] Yes, entry anesthesia management.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a brief hold, [PII], while I look this claim up for you, and I will be right back.
[CUSTOMER][NEUTRAL] Sure, take your time. You are on hold.
[AGENT][NEUTRAL] OK, thank you so much for holding for me, um, [PII]. I've got the claim pulled up. The claim number is 354.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's 3541409.
[AGENT][NEUTRAL] And the claim was denied because the policy does not provide benefits for anesthesia services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, uh, like this policy does not have anesthesia benefits. Uh, can you tell me, uh, uh, does this policy have medical benefits or only anesthesia, like, uh,
[AGENT][NEUTRAL] Does it have benefits for what, sir?
[CUSTOMER][NEUTRAL] Like, uh, you said that the policy does not have anesthesia benefits for the, does that mean that only anesthesia benefits are not there or, uh, all the benefits are not there, like medical benefits are also not there. Is it, uh, can you check that?
[AGENT][NEUTRAL] Uh, right, it just, um, for this claim it just states that the anesthesia is not covered under the policy it's a non-covered service.
[CUSTOMER][NEUTRAL] Mhm. OK. And uh one more thing, I just want to ask that, do you have any other insurance details for the patient?
[AGENT][NEUTRAL] Uh, let me look and see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, the patient does not have any other health benefits.
[CUSTOMER][POSITIVE] All right. Thank you so much. Can you give me the reference number for this call?
[AGENT][NEUTRAL] Yes, sir. You can use my name. It's [PII] and today's date.
[CUSTOMER][POSITIVE] Mhm. All right then. Thank you so much, sorry, for your help. Bye-bye. Have a great rest of the day.
[AGENT][POSITIVE] You're, you're welcome, [PII]. You too. Thank you, sir. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.