AccountId: 011433970860
ContactId: 0e426834-2578-411c-b850-6705ba3d15dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 474920 ms
Total Talk Time (AGENT): 193685 ms
Total Talk Time (CUSTOMER): 102311 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/0e426834-2578-411c-b850-6705ba3d15dc_20250529T18:13_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh thank you for response. I'm calling from provider office looking for claim denial status.
[AGENT][NEUTRAL] OK, you're calling to get the reason for a denial on a claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that and who am I speaking with, please?
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] What is your name?
[CUSTOMER][NEUTRAL] My name is [PII] Initial of my last name, [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy numbers are that you're calling on behalf of today?
[CUSTOMER][NEUTRAL] Yes, just allow me a moment please.
[CUSTOMER][POSITIVE] Pretty good thank you
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Member policy is, yes, it is 021068.
[CUSTOMER][NEUTRAL] 97
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] OK, sir. Thank you. One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, and sir, any information that is provided today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what is the data service store that you're calling about?
[CUSTOMER][NEUTRAL] [PII] charge amount 260.
[AGENT][NEUTRAL] I'm so
[AGENT][NEUTRAL] What's the date again?
[CUSTOMER][NEUTRAL] [PII] and charge amount is
[CUSTOMER][NEUTRAL] $268 even.
[AGENT][NEUTRAL] OK, thank you. So first off, on the policy that you gave to me, that is an old policy that was not even active for your data service. The policy number you gave me terminated [PII].
[AGENT][NEUTRAL] So let me see what the other policy number would be for your data service.
[CUSTOMER][NEUTRAL] Can you repeat the can you repeat the termination date of the policy number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The correct policy number that you should have for the particular date of service that you are calling about is 241-9330.
[AGENT][NEUTRAL] And that policy was active from [PII].
[AGENT][NEUTRAL] So give me a moment to get that information pulled up to see if the claim was processed under that policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so this claim was processed under this policy number that I just gave you that was active for the data service. The claim was received on [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 1333.
[AGENT][NEUTRAL] And the reason for the denial on this claim for 99214 is state office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] And the other code was denied because insured's primary insurance provided full benefits, there are no benefits payable.
[CUSTOMER][NEUTRAL] 99214 denied because?
[AGENT][NEUTRAL] Office visits are not covered?
[AGENT][NEUTRAL] Under the supplemental policy.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Just allow me a moment.
[CUSTOMER][NEUTRAL] And the other one?
[CUSTOMER][NEUTRAL] 921-34.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That just states that it was.
[CUSTOMER][NEGATIVE] It is denied because
[AGENT][NEUTRAL] The insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] Primary insurance provided benefits?
[AGENT][NEUTRAL] Insured's primary insurance.
[AGENT][POSITIVE] Provided full benefits.
[AGENT][NEGATIVE] There are no benefits payable.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefitsar with those remarks on it, you can print that by using that claim number from our portal and our website for the portal is located at [PII].
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. And is there anything else I can help you with?
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] May I have call reference for this?
[AGENT][NEUTRAL] Yes, sir, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] How do you spell your name?
[AGENT][NEUTRAL] [PII], first initial to last name is [PII].
[CUSTOMER][POSITIVE] So, thank you for assisting me today.
[AGENT][POSITIVE] Well, you're very welcome. And if that's all I can help you with, thank you again for calling APL Star.