AccountId: 011433970860
ContactId: d516c8c1-430e-41b1-a7b5-3aaeff6fe244
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 222250 ms
Total Talk Time (AGENT): 91240 ms
Total Talk Time (CUSTOMER): 72670 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/d516c8c1-430e-41b1-a7b5-3aaeff6fe244_20250226T19:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I was calling on behalf of a facility, and I was calling to see if a claim was processed through a network.
[AGENT][NEUTRAL] Sure, I can check on that claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII] and that's right?
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It is 02517281.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, [PII], um, [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that and then what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, do you have that bill amount?
[CUSTOMER][NEUTRAL] Yes, it is $6,885.66.
[AGENT][POSITIVE] Got it thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] OK. Sure, I do believe I found this claim. Um, just to make sure, was this with, uh, is it Piedmont Henry Hospital?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, OK, so we did receive this claim and it has been processed, so it does state that the claim submission received has been noted as an accident or an injury uh their outpatients uh benefit only allows payment for sickness therefore no benefits are payable.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it did pay, uh, we received a small payment of 250, um, so I was gonna submit an appeal, but I wanted to see if it was processed through like a multi-plan or PHCS network.
[AGENT][NEUTRAL] Sure, so this particular one we did not pay a benefit on so if you did receive a benefit, it could have been through that multi plan as you said, um, these are typically part of a multi plan um it might have been through, uh, they're called 90 degrees or IMA if you'd like I can give you their information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, no, that's OK. I just wanted to see if um it was just processed through a through multi-plan, so I'll be able to send that, um, over to them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] That'll be all. And can I have your name and a reference number?
[AGENT][NEUTRAL] Yes, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] last initial is [PII] And was there anything else I could help you with today?
[CUSTOMER][POSITIVE] That'll be all. Thank you so much. I really do appreciate it.
[AGENT][POSITIVE] All right, thanks for calling APL. You too. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.