AccountId: 011433970860
ContactId: 18547a7a-fd9d-4c5c-b029-09bb7797593a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 170360 ms
Total Talk Time (AGENT): 65053 ms
Total Talk Time (CUSTOMER): 80188 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/18547a7a-fd9d-4c5c-b029-09bb7797593a_20250429T17:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Fairview Health Services. I have a patient here with just one denied claim that I had a quick follow up question on if that's OK.
[AGENT][NEUTRAL] Yeah, absolutely. Um, do we have the claim number, policy number?
[CUSTOMER][NEUTRAL] Yeah, I could pull up that claim number here.
[CUSTOMER][NEUTRAL] And that's just loading now.
[CUSTOMER][NEUTRAL] OK. This was
[CUSTOMER][NEUTRAL] Claim number 356-8701.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if you could just verify with me the insured's first last name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, this was for [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Alright, thank you.
[CUSTOMER][POSITIVE] Absolutely.
[AGENT][NEUTRAL] So it looks like the claim.
[CUSTOMER][NEUTRAL] And I think the subscribers at Avery Legal oh sorry for cutting you off.
[AGENT][NEUTRAL] Yeah, no, you're you're totally fine. Um, it looks like the claim was denied stating office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, so it looks like that that process is primary and left to $80 co-pay. Do you know if, um, this denial you guys have, would that be patient responsibility?
[AGENT][NEUTRAL] Yeah, so we're not able to advise on the responsibility for the patient that's up to the facility or provider, um.
[CUSTOMER][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] It looks like, cause we're their secondary insurance, so this is only covering it looks like treatment in office. It's not covering any office visit fee.
[CUSTOMER][NEUTRAL] Oh, I see. OK.
[CUSTOMER][POSITIVE] All right, that sounds good.
[CUSTOMER][NEUTRAL] OK. So I think that was actually all that I had then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, would I lastly be able to grab a call reference number from you if you had one?
[AGENT][NEUTRAL] Yeah, absolutely. So call reference is my name with my last initial and today's date. My name again is [PII], that's [PII] Last [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Bye.