AccountId: 011433970860
ContactId: e75448e8-f955-41e3-b46c-6716ecd1d0cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220970 ms
Total Talk Time (AGENT): 97002 ms
Total Talk Time (CUSTOMER): 40816 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/e75448e8-f955-41e3-b46c-6716ecd1d0cd_20250110T16:41_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII] and I was calling to get claim status on a member.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] 02479410.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the date of service and the amount of the claims?
[CUSTOMER][NEUTRAL] [PII] for $376.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] And let me see if I can find this claim for you. And for future, you can check the status online through our website at [PII] and that's just optional. You can always call. And what is the procedure code?
[CUSTOMER][NEUTRAL] 99284.
[AGENT][NEUTRAL] Let me pull it.
[AGENT][NEUTRAL] I'm waiting on the system.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. So it looks like we processed the claim on [PII] and the claim was denied. Um, the reason for this denial is that the policy does not provide any benefits for treatment of
[AGENT][NEUTRAL] Alcohol or drug abuse?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And does that leave this full balance as patient liability?
[AGENT][NEUTRAL] Correct, um, this is a, um, policy, this policy is a limited hospital indemnity plan, um, so it's gonna be up to the provider's discretion.
[AGENT][NEUTRAL] We don't have any contraction in the remaining.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I have the um claim number?
[AGENT][NEUTRAL] Sure, the claim number is 351-68660.
[CUSTOMER][POSITIVE] Great, thank you for your help.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] No, that's everything.
[AGENT][POSITIVE] Yeah, alright, well thank you for calling APO. Have a good day, Miss.
[CUSTOMER][POSITIVE] Thank you too bye.
[AGENT][POSITIVE] Thank you.