AccountId: 011433970860
ContactId: cff785c6-8f96-410b-a786-5ad167d14ff0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 447399 ms
Total Talk Time (AGENT): 114697 ms
Total Talk Time (CUSTOMER): 124367 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/cff785c6-8f96-410b-a786-5ad167d14ff0_20250602T20:33_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 from Va Valley Hospital to check on our claim status.
[AGENT][NEUTRAL] OK, I'm happy to check on a claim. Do you have the policy number?
[CUSTOMER][NEUTRAL] Member policy number I do have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's gonna be 02377560.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] It is uh [PII].
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It is $35,293.63. I repeat 35293.63.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so it looks like we did receive a claim for the state of service. Uh, the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Claim was denied [PII]. The patient plan does not provide. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Patient plan uh does not have any outpatient services covered under the policy.
[AGENT][NEUTRAL] And the diagnostic testing was not covered under the member's policy.
[CUSTOMER][NEUTRAL] Outpatient services.
[CUSTOMER][NEUTRAL] And
[AGENT][NEGATIVE] Diagnostic testing was not covered.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] OK, claim number?
[AGENT][NEUTRAL] 348.
[AGENT][NEUTRAL] 5610.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, just a moment.
[CUSTOMER][NEUTRAL] Uh, but [PII], this is an emergency. Is there any possible to reconsider this and send the claim back for review?
[AGENT][NEUTRAL] The patient's plan doesn't have coverage for outpatient services, unfortunately, so this is not a covered benefit.
[CUSTOMER][NEGATIVE] Outpatient services unfortunately.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] What's the patient plan?
[AGENT][NEUTRAL] This is a limited benefit hospital indemnity plan.
[CUSTOMER][NEUTRAL] Limited benefit Hospital.
[AGENT][NEUTRAL] Indemnity.
[CUSTOMER][NEUTRAL] Could you please spell that for me?
[CUSTOMER][NEGATIVE] Damnity.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] I as in India, N as in November, D as in Delta, E as in Edward.
[AGENT][NEUTRAL] M as in Mary, N as in November, I as in India, T as in Tango, Y as in Yankee.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] And what are the services covered under this plan?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Patient plan has a hospital admission benefit, a hospital confinement benefit, also intensive care, and a rehab benefit.
[CUSTOMER][NEUTRAL] And also intensive care for and rehab.
[CUSTOMER][NEUTRAL] rehab benefit and hospital benefit, rehab benefit and?
[AGENT][NEUTRAL] Intensive care.
[CUSTOMER][NEUTRAL] Intensive care.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Only 3. Hospital, rehab, and intensive.
[AGENT][NEUTRAL] The patient was not admitted to the hospital. It's showing it was under outpatient. They need to be in the hospital admitted for at least 18 consecutive hours.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Who
[CUSTOMER][NEUTRAL] 18 consecutive hours, just a second.
[AGENT][NEUTRAL] If they were not admitted to the hospital, the patient plan will not pay.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Does member have any other active coverage for this data service?
[AGENT][NEUTRAL] Not that I see with us.
[CUSTOMER][NEUTRAL] I see
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do not have uh EOB. If you could please fax to the fax number which I give, that would be very helpful.
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Should we mark attention to anybody on that?
[CUSTOMER][NEUTRAL] Attention to [PII].
[AGENT][POSITIVE] OK. Give it about 5 minutes and you should have that. [PII], is there anything else I can help with?
[CUSTOMER][POSITIVE] That's it thank you so much.
[AGENT][POSITIVE] You're welcome thanks for calling APL bye bye.