AccountId: 011433970860
ContactId: 12526956-7d1e-4599-bd93-63bae179bd0b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331799 ms
Total Talk Time (AGENT): 132304 ms
Total Talk Time (CUSTOMER): 88487 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/12526956-7d1e-4599-bd93-63bae179bd0b_20250625T15:24_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh, sorry, what is your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Yep, hi, this is [PII] calling from provider's office to shop on claims.
[AGENT][NEUTRAL] Sure, I can assist you with claims Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh yeah, it is [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] May I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] Uh yes, let me help you with that. Just for a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it is, uh, sorry, what did you ask me?
[AGENT][NEUTRAL] The name of the facility, Asher, OK.
[CUSTOMER][NEUTRAL] A clinic clinic, yes.
[AGENT][NEUTRAL] OK, thank you and may I have the patient's policy number?
[CUSTOMER][POSITIVE] Oh yeah, for sure. Let me help you with that. It is, uh,
[CUSTOMER][NEUTRAL] 02135063.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh yes. It is, um,
[CUSTOMER][NEUTRAL] [PII] with the total charge amount of $301 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you, and that was [PII], and for future, you can check claim status online through our website at [PII], and that's just optional.
[AGENT][NEUTRAL] And you said the total charge is $301?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] not.
[AGENT][NEUTRAL] OK, it looks like we received the claim on [PII], processed [PII].
[AGENT][NEUTRAL] And the claim was denied, the denial reason is office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the call license number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Um, should you move to the next one for the same patient?
[AGENT][NEUTRAL] The same patient, what is the date of service?
[CUSTOMER][NEUTRAL] A different patient.
[AGENT][NEUTRAL] Different patient or the same patient?
[CUSTOMER][NEUTRAL] Different, same patient but different, same patient.
[AGENT][NEUTRAL] OK, it's the same patient or a different patient?
[CUSTOMER][NEUTRAL] Same patient.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] Yeah, the data service is um
[CUSTOMER][NEUTRAL] 3:17 or 2. And may I know who is responsible for that is the the provider.
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Uh, you told that outpatient offices are not covered, right? May I know who is responsible for that?
[AGENT][NEUTRAL] OK, um, this is a secondary supplemental plan to the major medical office. This is not a covered service under the member's plan. So it's up to the provider's discretion.
[AGENT][NEUTRAL] Or you can go back to the primary EOB.
[CUSTOMER][NEUTRAL] Occasionally one of the next one.
[AGENT][NEUTRAL] Is it a different member or same member?
[CUSTOMER][NEUTRAL] Same number for 3 317 2025 with the total charge amount of $552 even.
[AGENT][NEUTRAL] 562.
[AGENT][NEUTRAL] Is that what you said?
[CUSTOMER][NEUTRAL] 52.
[AGENT][NEUTRAL] 52 552. OK. The same date of service, um [PII].
[CUSTOMER][NEUTRAL] 52, yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] OK, and this denial is the same denial. Of visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mo
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Uh, have a nice day.
[AGENT][NEUTRAL] You as well, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you for calling APM. Have a good afternoon.