AccountId: 011433970860
ContactId: dad8a587-ccc9-4e3c-bd6a-13e51f115f52
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266269 ms
Total Talk Time (AGENT): 57156 ms
Total Talk Time (CUSTOMER): 65382 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/dad8a587-ccc9-4e3c-bd6a-13e51f115f52_20250408T14:44_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], my name is [PII]. I'm calling from AdventHealth in [PII], and I'm trying to get some clarification on a claim denial.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, [PII], I can help you with claim denial. Um, do you have a good callback number?
[CUSTOMER][NEUTRAL] Um, yes, it's [PII], that's my direct line.
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Um, yes, it's D as in David, 48600005.
[AGENT][NEUTRAL] Uh, do you have the social of the patient?
[CUSTOMER][NEUTRAL] Um, one second.
[CUSTOMER][NEUTRAL] I do not because he's a minor.
[AGENT][NEUTRAL] OK, uh, what's the last name?
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][NEUTRAL] OK, what was the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, um let's see.
[AGENT][NEUTRAL] Do you have the claim number?
[CUSTOMER][NEUTRAL] I have 202-5031.
[CUSTOMER][NEUTRAL] 30016.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's got a few policies. Let me figure out which one this is.
[AGENT][NEUTRAL] What was the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what was the bills amount?
[CUSTOMER][NEUTRAL] $5,281.46.
[AGENT][NEUTRAL] And who was the provider?
[CUSTOMER][NEUTRAL] It's AdventHealth Tampa.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you said 5,28146, is that right?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So it looks like this is a hospital indemnity plan and on this policy, the outpatient services are only payable for outpatient surgery in an outpatient hospital or physician's office.
[AGENT][NEGATIVE] So it won't pay for an ER visit.
[CUSTOMER][NEUTRAL] OK, so ER is in the covered service. OK, that's what I needed to know.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'll just confirming before the patient, um, OK, and can I get a reference number for the call please?
[AGENT][NEUTRAL] A reference number is just my name, [PII], first initial of my last name, [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much. I appreciate it.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thanks have a good one bye bye.