AccountId: 011433970860
ContactId: 087cab2d-7d0a-4eb0-a40f-39b780fdfd1e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285279 ms
Total Talk Time (AGENT): 85012 ms
Total Talk Time (CUSTOMER): 91580 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/087cab2d-7d0a-4eb0-a40f-39b780fdfd1e_20250306T18:37_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, hi, my name is [PII], and I'm calling from provider office and this call may be recorded for quality and training purposes. Uh, I'm checking for claim status. Could you please help me with that?
[AGENT][NEUTRAL] I can help you, [PII] with the claim status. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah it is uh 02319319 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is uh [PII].
[CUSTOMER][NEUTRAL] C
[CUSTOMER][NEUTRAL] What date of birth is [PII].
[AGENT][NEUTRAL] Alright, thanks for verifying that information, [PII], and you said that you're checking a claim status for what date of service?
[CUSTOMER][NEUTRAL] It is [PII]. The amount is $5160 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type service was that for [PII]?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] I know it, but was it for a sickness or is that a wellness claim?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, means what are you asking like a wellness or uh sickness like this is an MRI services.
[AGENT][NEUTRAL] What's the procedure code on the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It is 77049.
[CUSTOMER][NEUTRAL] And um 9575.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] The diagnosis code on the claim, not the procedure code.
[CUSTOMER][NEUTRAL] It is oh yeah Z80.3.
[AGENT][NEUTRAL] Yeah, so it was denied as a wellness or a screening. Family history.
[AGENT][NEUTRAL] Based on the Z code on the claim, the diagnosis code, this policy covers, uh, sickness only, sickness and not wellness.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Services means you're saying that uh 880.3 is an uh is a wellness related services and uh as for the patients plan that only cover sickness services.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Correct, sickness or injury.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sickness or injury, let me note down this one.
[CUSTOMER][NEUTRAL] Sickness or.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] OK, uh, so for that reason this one is getting denial?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, when did you receive this claim and when, when it got denied?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so let me give you the received date, the process date, and the claim number.
[AGENT][NEUTRAL] The received date is [PII]-24. Pro 12-3124.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number
[AGENT][NEUTRAL] It's 354.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 669-0.
[AGENT][NEUTRAL] And you can also check status online um at secured.
[AGENT][NEUTRAL] Uh [PII]. [PII], and did you have any other questions?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No, only this concern, just help me with the call reference number and could you please spell your name?
[AGENT][NEUTRAL] You'll use my name in today's date as reference for today's call [PII].
[AGENT][NEUTRAL] Oh NYA
[AGENT][NEUTRAL] First initial last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much. Have a great day. Stay safe bye for now.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.