AccountId: 011433970860
ContactId: ceb1fd49-6772-4ec8-bdc3-c4d620570637
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471880 ms
Total Talk Time (AGENT): 189982 ms
Total Talk Time (CUSTOMER): 95448 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/ceb1fd49-6772-4ec8-bdc3-c4d620570637_20250527T14:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from provider office to check our client status.
[AGENT][NEUTRAL] OK, you said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes. Yeah.
[AGENT][NEUTRAL] OK, [PII], and you have one claim to check status on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Yes, our callback number is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Yes, the policy number is 02588076.
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] And any information that I do provide for you today like it will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yeah, the member's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yes, so the date of services.
[CUSTOMER][NEUTRAL] [PII] for the amount of $531.67.
[AGENT][NEUTRAL] OK, give me the bail them out one more.
[AGENT][NEUTRAL] You said, I'm so sorry. Hold on. Give me 1 2nd. Yeah, give me 1 2nd, [PII]. Just one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] The amount of
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, take it.
[AGENT][NEUTRAL] OK. So again, the data surface is 2-11-2025, and what is the bill amount?
[CUSTOMER][NEUTRAL] That is 531.67.
[AGENT][NEUTRAL] 67.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received. The received date was [PII]. It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is going to be 357-8603.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this claim again was denied. The reason for the denial, [PII]?
[AGENT][NEUTRAL] States.
[AGENT][NEUTRAL] The outpatient treatment benefit provides an indemnity amount. When a covered person receives treatment in an emergency room, urgent care facility, 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] Uh, it was not covered under the patient policy, right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And if you need a copy.
[CUSTOMER][NEUTRAL] OK, then who's responsible for the entire charges?
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Yes, I just ask who's responsible for the bill charges, the patient or the provider?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider to determine that.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, [PII], you can print that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah, OK. And may I know whether this claim is processed as in-network or out of network?
[AGENT][NEUTRAL] There is no network affiliate um actually for this plan this participates with the multi-plan network.
[CUSTOMER][NEUTRAL] So open access.
[AGENT][NEGATIVE] I'm sorry, there is an echo on our call, [PII], that's making it extremely difficult for me to understand you.
[CUSTOMER][NEUTRAL] Oh sorry, I'm just asking whether this claim is processed as in-network or out of network or it was an open access network.
[AGENT][NEUTRAL] You were
[AGENT][NEUTRAL] OK, you would have to contact multi plan.
[AGENT][NEUTRAL] Regarding any network questions.
[AGENT][NEUTRAL] And I can provide you the, yes, ma'am, and I'm, yes, ma'am, I'm explaining that.
[CUSTOMER][NEUTRAL] Uh, no, I'm just asking whether it is, it was processed as in network or open.
[AGENT][NEUTRAL] Yes, you would need to contact them and I can give you their phone number if you would like.
[CUSTOMER][NEUTRAL] Oh no, we don't need that. Uh, may I know the patient plan type?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is a limited benefit hospital indemnity plan. It is not major medical insurance.
[CUSTOMER][NEUTRAL] Uh, can I get the phone number, please?
[AGENT][NEUTRAL] I'm sorry, what did you ask?
[CUSTOMER][NEUTRAL] Uh, could you please provide me the multi-plan phone number? Uh, we need to check whether it is in-network or out of network, so.
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] And I'll be happy to connect you if you would like.
[CUSTOMER][NEUTRAL] You have the option to transfer the.
[AGENT][NEUTRAL] I do. And is there anything else that I have my name that I gave you at the beginning of the call along with today's date?
[CUSTOMER][NEUTRAL] Yeah, before that, can I get the call reference?
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome. And again, if that is all I can help you with, thank you for calling ATO. I hope you have a very nice day and I'll be happy to connect you.
[CUSTOMER][NEUTRAL] For questions