AccountId: 011433970860
ContactId: d0289a2a-a39f-43cb-8876-475e57940749
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 222740 ms
Total Talk Time (AGENT): 77738 ms
Total Talk Time (CUSTOMER): 68862 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/d0289a2a-a39f-43cb-8876-475e57940749_20250213T17:17_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good, good morning. My name is [PII] and I'm calling to claim status.
[AGENT][NEUTRAL] Uh, sure, Ms. [PII], I can assist you with claim status, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, and this is your personal policy or you're calling from a provider's office?
[CUSTOMER][NEUTRAL] Calling from a facility.
[AGENT][NEUTRAL] What's the name of the facility?
[CUSTOMER][NEUTRAL] Name of the facility is Inova Fairfax Hospital.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, policy number is 01612256.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. All right. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It of service is [PII] and the bill amount was $5,088.35.
[AGENT][POSITIVE] All right, thank you. Let's see.
[AGENT][NEUTRAL] OK, so it looks like um.
[AGENT][NEUTRAL] We received the claim [PII], processed [PII].
[AGENT][NEGATIVE] And the claim was denied. The reason for this denial is that the service was rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK, um, when was this coverage terminated?
[AGENT][NEUTRAL] OK, let me get that for you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so he did not have coverage on [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII], um, do you have a claim number at least?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK, can I go ahead and get that?
[AGENT][NEUTRAL] Um, yes, yeah, it's 354-6049.
[CUSTOMER][NEUTRAL] OK, so that was received on [PII] and then denied on [PII] as um coverage terminated on [PII], correct?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][POSITIVE] Got it, yeah, [PII] thank you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, and if I could just get a reference number for today please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Um, do you need the spelling of my name or any other information, Miss [PII]?
[CUSTOMER][POSITIVE] Uh, no, I'm good, thank you so much. I appreciate your help.
[AGENT][POSITIVE] All right. You're welcome and thank you for calling APO. Have a good day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Mm.