AccountId: 011433970860
ContactId: db8179fd-906c-49e7-a211-9c3d721eafb2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321760 ms
Total Talk Time (AGENT): 90846 ms
Total Talk Time (CUSTOMER): 78315 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/db8179fd-906c-49e7-a211-9c3d721eafb2_20250508T19:58_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Conifer CHI Hospital checking on the claim status.
[AGENT][NEUTRAL] OK, and I missed your name. What was that?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] And then what provider were you with?
[CUSTOMER][NEUTRAL] Oh yeah, I'm with, uh, one minute.
[CUSTOMER][NEUTRAL] Bagan Mesi Health System.
[AGENT][NEUTRAL] OK. Do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] 02344794
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] Date of birth is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII] with the bill amount of 273.07.
[AGENT][NEUTRAL] OK, looks like we received that on.
[AGENT][NEUTRAL] It was received 12-9-2024. Pro 12-11, 2024.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Can you please spell out your name?
[AGENT][NEUTRAL] [PII], it's [PII]
[AGENT][NEUTRAL] Um, for this policy, it does not provide a wellness expense benefit.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It is a claim status. Uh, can you please provide me the claim status, not with the benefits?
[AGENT][NEGATIVE] It's denied, so it's denied for the policy does not provide a wellness expense benefit.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Uh, the other denial is outpatient treatment benefit provides an amount when covered person receives treatment in an ER, urgent care, physician's office, or physical or occupational therapy facility.
[AGENT][NEUTRAL] Treatment in an outpatient hospital.
[CUSTOMER][NEUTRAL] OK. Can I have
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Oh, OK. Can I have the claim number once?
[AGENT][NEUTRAL] 353-9654
[CUSTOMER][NEUTRAL] OK. Uh, once again, can you please repeat the denial is playing or denied us?
[AGENT][NEUTRAL] It looks like there's 2 reasons that it denied, and that is
[AGENT][NEGATIVE] Policy does not provide a wellness expense benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Treatment in an outpatient hospital less than 18 hours is not covered by policy.
[CUSTOMER][NEUTRAL] One minute.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Can I have, can you please fax us the UB?
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] [PII], it's a direct line, no, sorry, it's a fax number?
[AGENT][NEUTRAL] OK, you like gave that as your callback number, so the fax number is [PII].
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] No, one minute.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'll get that faxed over. It just takes about 5 minutes.
[AGENT][NEUTRAL] Anything else I can help with today?
[CUSTOMER][NEUTRAL] Uh, can you please provide me with the call reference number?
[AGENT][NEUTRAL] Uh it's my name is [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you. Have a nice day.
[AGENT][POSITIVE] Thanks for calling APL. You as well. Bye bye.