AccountId: 011433970860
ContactId: 05fae8b1-b010-4e14-b632-c322a968e439
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249360 ms
Total Talk Time (AGENT): 106416 ms
Total Talk Time (CUSTOMER): 78584 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/05fae8b1-b010-4e14-b632-c322a968e439_20250107T20:46_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of [PII]. Would like to verify regarding on the denial that the patient has, does, does not have coverage for office visit.
[AGENT][NEUTRAL] OK, so you're looking into a claim denial?
[CUSTOMER][NEUTRAL] Yes, I have a claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hey, um, let me have a callback number just in case we get disconnected there, you know.
[CUSTOMER][NEUTRAL] [PII]. Can you spell me your name, please?
[AGENT][NEUTRAL] Sure. My name is [PII] that's [PII]. Last initial is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment
[CUSTOMER][NEUTRAL] Uh, make systems loading. I don't know what happened.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Anyway, here's the policy ID.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02187730.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name is
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and may I have the claim number?
[CUSTOMER][NEUTRAL] Uh, the claim number that I have is 3493716.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, this was for a date of service [PII].
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Yes, and it was denied stating the office visits are not covered by the policy. How may I assist you with this claim?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, can you, can I verify the policy regarding on this one?
[CUSTOMER][NEUTRAL] Uh, may I know the coverage for the patient?
[AGENT][NEUTRAL] Uh, general coverage or you're trying to look for office benefit coverage?
[CUSTOMER][NEUTRAL] For the office visit, is that uh
[CUSTOMER][NEUTRAL] Just to verify that the, the patient has no coverage for office visit.
[AGENT][NEUTRAL] And that's correct, and there's no office visit benefit for this member under this policy.
[CUSTOMER][NEUTRAL] Uh, basically, what are the basic coverage for the patient?
[AGENT][NEUTRAL] OK. So this one covers outpatient facilities, which is um hospital, ER visit, urgent care, diagnostic centers, surgical centers, um, see, it will cover procedures done in office like uh ultrasounds, injections, um.
[AGENT][NEUTRAL] X-rays or anything like that in the office, but it will not cover the co-payment for the visit. So it will not cover the visit itself.
[CUSTOMER][NEGATIVE] OK, basically, there's no coverage for this.
[AGENT][NEUTRAL] And then it will cover.
[AGENT][NEUTRAL] For for the visit, correct. Mhm.
[CUSTOMER][NEUTRAL] But she has uh outpatient inpatient hospital services even in uh.
[CUSTOMER][NEUTRAL] Procedure made by office, but not the office visit. Coffee.
[AGENT][POSITIVE] Correct. That is correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any reference number for this call, sir?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][POSITIVE] Uh, no, that, that's all, that's all I have. Thank you so much, so.
[AGENT][POSITIVE] Thank you. You're welcome and thank you for calling ATL. Have a good day, Mr.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK