AccountId: 011433970860
ContactId: 184cc6f2-498e-4a0c-b2c5-66adc9cf06fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261920 ms
Total Talk Time (AGENT): 103386 ms
Total Talk Time (CUSTOMER): 87502 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/184cc6f2-498e-4a0c-b2c5-66adc9cf06fa_20250305T18:07_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] Hi, this is [PII], and I'm calling for a provider to check on additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. Good afternoon. How are you today, [PII]?
[AGENT][NEUTRAL] I'm good, [PII] and yourself?
[CUSTOMER][POSITIVE] I'm doing fine, thanks for asking.
[AGENT][NEUTRAL] Good. So you have, you're wanting to get some additional information on a claim that was denied, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that and what is your callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] It is 02403932.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] And any information that I provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII] and date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what is the date of service and the total bill amount for him, please, [PII]?
[CUSTOMER][NEUTRAL] And data service was on [PII] and it is for $465 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] And do you have the claim number for this data service, [PII]?
[CUSTOMER][NEUTRAL] Yes. The claim number is 356-0446.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] And the provider group name?
[CUSTOMER][NEUTRAL] Group name is Arizona.
[CUSTOMER][NEUTRAL] Colorectal Experts LLC.
[AGENT][POSITIVE] OK, thank you. So how can I help you with this claim today?
[CUSTOMER][NEUTRAL] On this claim, I'm calling for the procedure code 99203.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEGATIVE] Which was denied as non-covered. Yes. Uh, may I know why it is not covered?
[AGENT][NEUTRAL] That is correct. Office visits are not covered by this policy. The members supplemental policy, Allen does not cover office visits.
[CUSTOMER][POSITIVE] Got it. Thank you very much for that information. And may I know the plan type for this patient, please?
[AGENT][NEUTRAL] This is a supplemental policy.
[CUSTOMER][POSITIVE] Got it. Thank you very much for that.
[AGENT][NEUTRAL] And then it's called meddling. Yes, sir. Mhm.
[CUSTOMER][NEUTRAL] I'm sorry. Uh, what was the last part?
[AGENT][NEUTRAL] The specific name for the type of supplemental policy it is is a Medlink, M E D L I N K.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Got it. Thank you very much for that. And may I have a reference number for our call, please?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes sir you will use my name that I gave you, [PII] along with today's date and if you do need a copy of this explanation of benefits with those remarks on it, you may print that from by going to our portal and our website for our portal is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, got it. Then that would be all to see. Thank you so much for your assistance. Have a great day and take.
[AGENT][POSITIVE] Oh, you're certainly welcome. Yes, sir. Well, you too. That is all I can help you with. Thank you again for calling [PII], and I hope you have a great afternoon also.
[CUSTOMER][POSITIVE] Thank you, bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.