AccountId: 011433970860
ContactId: 05ba73a8-f586-44bb-9dd9-f14169a40a28
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229149 ms
Total Talk Time (AGENT): 58434 ms
Total Talk Time (CUSTOMER): 82055 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/05ba73a8-f586-44bb-9dd9-f14169a40a28_20250331T17:49_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling from the provider's office to check on a claim status. Could you please help?
[AGENT][POSITIVE] I'd be happy to assist with claim status today, [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Yes, and that one is going to be 978555.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Patient name is [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] And what is the date of service for the claim?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And your tax ID.
[CUSTOMER][NEUTRAL] Yes, ma'am. And that one is going to be.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. I'm showing the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because this policy does not have coverage for outpatient services.
[CUSTOMER][NEUTRAL] So the member does not have coverage for outpatient, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, thank you. And yes, ma'am, yes ma'am. Can I know what is the received date and the process date of this claim?
[AGENT][NEUTRAL] Claim was received on [PII]. Claim denied on [PII].
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] And just want to know, ma'am, so actually we have only um billed with the emergency service.
[AGENT][NEUTRAL] I'm sorry, I don't, I don't quite understand what you're saying.
[CUSTOMER][NEUTRAL] No, so, as you said that the member does not have an outpatient policy, right? So actually, we have billed the client with the emergency service which is not an outpatient service.
[AGENT][NEUTRAL] I'm showing that the procedure code is 99285, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that's an ER department visit, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's considered an outpatient service. They weren't hospitalized overnight.
[AGENT][NEUTRAL] They weren't admitted. That's just an ER visit. That's considered outpatient.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] That's fine, ma'am. Thank you for that information. So can I know if there is any other uh insurance for the member, active insurance for the member?
[AGENT][NEUTRAL] Um, you have to ask the insured. We don't divulge that information.
[CUSTOMER][NEUTRAL] Thank you for that information. And can I get a reference number for the call, please?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] Well, thank you for that information and thank you for assisting on today's call and have a great day. Bye for now.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.