AccountId: 011433970860
ContactId: cc86ba89-a873-4d6c-bde3-d7dbc7807643
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 120879 ms
Total Talk Time (AGENT): 57093 ms
Total Talk Time (CUSTOMER): 46949 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/cc86ba89-a873-4d6c-bde3-d7dbc7807643_20250213T13:52_UTC.wav
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[AGENT][NEUTRAL] For contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from Ortho Lone Star. I have a question in regards to a denial for a better understanding on the member, please.
[AGENT][NEUTRAL] Yes, I can certainly help with um with that denial code. What's the policy number, please?
[CUSTOMER][NEUTRAL] It's 02546623.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] The patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] I do appreciate that. Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you very much. And what is the data service that we have for the [PII]?
[CUSTOMER][NEUTRAL] It's for [PII]. Total amount billed on the claim was for $140.
[AGENT][POSITIVE] I see. Thank you.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] Policy doesn't cover anything within a physician's office.
[AGENT][NEUTRAL] Um, what it does is that, now, there is a, there is an office visit co-pay. Uh, they usually have 4 of those. Let me just check about the calendar. Oh, well, this doesn't even have that. So, um, I take that back, so, so nothing at all within a physician's office is, is going to be covered on this policy. It's, it's strictly in and out of hospital only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hospital only stuff. OK, alright, that explains it. OK, and if I can just get an initial to your last name or reference number so I can document the account, I'd appreciate it.
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as a reference. Is there anything else at all that I may help with?
[CUSTOMER][POSITIVE] Nope, that's gonna be it. Thank you.
[AGENT][POSITIVE] OK, well thank you for contacting APL have a good morning.