AccountId: 011433970860
ContactId: d1f84824-9364-4c72-988c-d94162d4bbad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 237880 ms
Total Talk Time (AGENT): 88742 ms
Total Talk Time (CUSTOMER): 87859 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/d1f84824-9364-4c72-988c-d94162d4bbad_20250320T15:13_UTC.wav
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[AGENT][NEUTRAL] Calling APL. my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hello [PII]. I'm calling from a provider's office to check claim status for a medical claim.
[AGENT][POSITIVE] I'd be happy to assist with claim status today. Uh, may I have your first name please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII], if I can get a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] That policy number is 02551202.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that information. What's the date of service?
[CUSTOMER][NEUTRAL] service is [PII].
[AGENT][NEUTRAL] And the tax ID.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. Uh, OK, looks like the claim was denied. One moment, let me see what the deny was.
[AGENT][NEUTRAL] OK, it looks like the claim denied because.
[AGENT][NEUTRAL] Office patient hospital or physician hospital only?
[AGENT][NEUTRAL] The outpatient rider only allows payment for outpatient surgery in an outpatient hospital or physician office. Therefore, no benefits were payable.
[CUSTOMER][NEUTRAL] So with the urgent care not be considered a physician office?
[AGENT][NEGATIVE] No, they, they would not have uh benefits for treatment in the urgent care.
[CUSTOMER][NEGATIVE] So basically they don't have urgent care coverage.
[AGENT][NEUTRAL] That's correct. No, they don't.
[CUSTOMER][NEUTRAL] OK, and can you confirm a claim number and also if an EOB has been mailed with the the decision?
[AGENT][NEUTRAL] Yes, uh, one moment.
[AGENT][NEUTRAL] OK, looks like that claim number is uh excuse me, 3575069.
[AGENT][NEUTRAL] And that claim was processed on [PII].
[AGENT][NEUTRAL] And the EOB was sent to, yeah, [PII]. EOB was sent to PH Urgent Care of South Carolina [PII] in [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, yeah, that's the correct address and while you're already on that patient, are you able to check?
[CUSTOMER][NEUTRAL] Another date of service as well, which I'm sure it's gonna deny for the same reason, but just to confirm that a claim was received too um so I have another date of service and it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, same thing, processed and denied on [PII] and that claim number is 3575074.
[CUSTOMER][NEUTRAL] 5074.
[CUSTOMER][NEUTRAL] OK, and how about a 2925 data service? I'm not sure if that would have had time to make it to you yet.
[AGENT][NEUTRAL] We don't have that one.
[CUSTOMER][NEUTRAL] OK, so that's on call.
[CUSTOMER][NEUTRAL] That one.
[CUSTOMER][NEUTRAL] OK, and that process the same date that [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Data service process also on OK.
[CUSTOMER][NEUTRAL] EOP was mailed, so we're just waiting on that EOB. OK, may I get your name and a call reference number?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII] [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] No, that will be all thank you so much I appreciate your time today.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.