AccountId: 011433970860
ContactId: 14f16de2-04eb-4f7a-b61d-705335541cde
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321670 ms
Total Talk Time (AGENT): 56950 ms
Total Talk Time (CUSTOMER): 161597 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/14f16de2-04eb-4f7a-b61d-705335541cde_20250505T15:12_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for provider to check on additional information about a claim that has been denied. Please know this call will be monitored and recorded for quality and training purposes.
[AGENT][POSITIVE] I'd be happy to assist with claim status today, [PII], if I can get a good callback number for you.
[CUSTOMER][NEUTRAL] Sure, it's [PII]. It's a direct line, no extension.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Sure. The patient's member ID is 025657554.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure, the patient's name is [PII], and the date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the date of service for the claim?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Sure. The date of service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And tax ID.
[CUSTOMER][NEUTRAL] Sure. The tax ID is [PII].
[AGENT][NEUTRAL] Thank you for that information. I'm showing the claim was denied because the uh physician's charges are not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it under the patient's policy, correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Can I get the patient's policy name?
[CUSTOMER][NEUTRAL] 5368.
[AGENT][NEUTRAL] Metlink Gap.
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] And uh just to verify the amount of it, it's a patient responsibility, correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Thank you for that. Can you please verify whether the claim number is 358-87771. Is it correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you for that. For the same patient, I have one more date of service.
[AGENT][NEUTRAL] OK, what's the date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, it looks as though um.
[AGENT][NEUTRAL] A payment was made on this one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, for the code 99,210, uh, we got a denial last not code with the patient's policy. Can you verify it?
[AGENT][POSITIVE] Yeah, that's correct.
[CUSTOMER][NEUTRAL] It's also not covered as per the patient's policy?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] And uh is it a physician's charge?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Thank you for that. And uh the patient's policy name is Metlink Gap, correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And for this page, I have one more patient to be verify whether the call reference will be same or will it be different?
[AGENT][NEUTRAL] It's the same, it's my name and today's date and time.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][POSITIVE] Thank you for that. And uh just, it's also patient responsibility, the amount, correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Thank you for that. For the, can you provide the next member ID?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Sure. The member ID is 02473025 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what's the day of service?
[CUSTOMER][NEUTRAL] Date of services, [PII].
[AGENT][NEUTRAL] Showing claim denied because office visits, the physician's charges are not covered under the policy.
[CUSTOMER][NEUTRAL] OK. And it's also the same policy name?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Thank you for that. Can you please verify uh whether the, whether the account is the patient responsibility?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Thank you for that. And the claim number is 35887773, correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Thank you for that. You said uh call reference will be your name, the date and time. May I know the time, exact time, please?
[AGENT][NEUTRAL] Um, it is [PII]
[CUSTOMER][POSITIVE] Thank you for that, [PII]. Thank you for patiently assisting me today. I hope you have a great day.
[AGENT][POSITIVE] Thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] Yeah, you too.
[AGENT][NEUTRAL] All right.