AccountId: 011433970860
ContactId: e0f1de2c-81c1-4be0-ace3-3f512484e0ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 336450 ms
Total Talk Time (AGENT): 93430 ms
Total Talk Time (CUSTOMER): 57461 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/e0f1de2c-81c1-4be0-ace3-3f512484e0ef_20250129T16:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi there, it's [PII]. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] I'm doing great, sir. I, I have a patient. I need to confirm claim status.
[AGENT][POSITIVE] OK, I'm happy to check on a claim for you. What's the patient's policy number?
[CUSTOMER][NEUTRAL] It's 02505495.
[AGENT][POSITIVE] Alright thank you one moment.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] Thank you. Data service?
[CUSTOMER][NEUTRAL] Uh, the data service is [PII]. Billmo is $300.
[AGENT][NEUTRAL] All right, thank you. Let me take a look here, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] All right, thank you for your patience on that. So it looks like we did receive the claim.
[AGENT][NEUTRAL] Uh, the received date on the claim was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was denied. The policy provides no benefits for inpatient visit charges.
[CUSTOMER][NEUTRAL] OK. Could you provide me the claim number?
[AGENT][NEUTRAL] 349.
[AGENT][NEUTRAL] 8781.
[CUSTOMER][NEUTRAL] OK. And it's denied on?
[AGENT][NEUTRAL] Claim was denied [PII].
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, the thing is that we have, uh, sent this claim back for view on [PII]. Could you confirm [PII] sent this claim back for you.
[AGENT][NEUTRAL] Um, yeah, we've received it multiple times. Let me check the other claims. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, the claim was received a second time on [PII], and then a third time on [PII].
[CUSTOMER][NEUTRAL] OK, could you confirm the status of [PII]?
[AGENT][NEUTRAL] Uh, yes, one moment.
[AGENT][NEUTRAL] Uh, this claim was denied, states that the outpatient treatment benefit provides only in a covered facility, so the claim was denied.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] You said uh outpatient treatment is only covered?
[AGENT][NEUTRAL] Treatment in an outpatient hospital is not covered under this policy when it's less than 18 hours.
[CUSTOMER][NEUTRAL] OK. Could you confirm the patient's name?
[AGENT][NEUTRAL] Uh, patient has a limited benefit hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK. Could you confirm which kind of benefit patient?
[CUSTOMER][NEUTRAL] Uh, having this plan?
[AGENT][NEUTRAL] Uh, this plan pays for hospital admission, which would need to be 18 hours or longer.
[CUSTOMER][POSITIVE] OK. Thank you for that information. Have a good day.
[AGENT][NEUTRAL] You too. Bye bye.