AccountId: 011433970860
ContactId: cc44d3ce-8b7e-474e-92a0-5d95af9cd742
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 233470 ms
Total Talk Time (AGENT): 54208 ms
Total Talk Time (CUSTOMER): 74948 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/cc44d3ce-8b7e-474e-92a0-5d95af9cd742_20250508T20:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII], this is [PII] calling for provider to check on additional information about a claim that has been denied. Please know this call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] All right, [PII]. I'm happy to check a claim. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 11 sorry I just missed that.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK it's coming up now.
[CUSTOMER][NEUTRAL] OK, the policy number is?
[CUSTOMER][NEUTRAL] 25,964,440
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Angel of birth. Date of birth is [PII].
[AGENT][NEUTRAL] Date of service.
[CUSTOMER][NEUTRAL] There's a [PII].
[AGENT][NEUTRAL] And the build them out?
[CUSTOMER][NEUTRAL] $200.01.
[AGENT][NEUTRAL] OK, so it looks like the claim was denied. Um, the outpatient benefit on the member plan only allows for payment of outpatient surgery in an outpatient hospital or physician office. So, therefore, there were no benefits payable.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, outpatient.
[CUSTOMER][NEUTRAL] Be on the plan on what.
[CUSTOMER][NEUTRAL] Only alone.
[CUSTOMER][NEUTRAL] Payments outpatient.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] In our patient
[CUSTOMER][NEUTRAL] Hospital or physician or?
[CUSTOMER][NEUTRAL] OK, so this is not covered as for the patient plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And may I know the patient plan type, PPO or HMO?
[AGENT][NEUTRAL] Uh, this is a limited benefit hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK, let me take the benefit.
[CUSTOMER][POSITIVE] Hospital indemnity plan. OK, thank you so much. Just give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh the claim number for this one?
[CUSTOMER][NEUTRAL] Uh, 04173590739.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. And the claim process date of the [PII].
[AGENT][NEUTRAL] Let me double check that one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Claim is received [PII], processed [PII].
[CUSTOMER][POSITIVE] Thank you so much. I think all reference for this one?
[AGENT][NEUTRAL] It's going to be my name with my last initial in today's date. My name is [PII], that's [PII] Last initial [PII] like [PII].
[CUSTOMER][POSITIVE] Thank you so much for listening, [PII], and have a wonderful day. Take care, bye.
[AGENT][NEUTRAL] You too, [PII]. Bye.