AccountId: 011433970860
ContactId: 18e231e3-d7c4-4261-a8ba-20003be29b73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 176330 ms
Total Talk Time (AGENT): 73150 ms
Total Talk Time (CUSTOMER): 57850 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/18e231e3-d7c4-4261-a8ba-20003be29b73_20250314T19:41_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL. my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider's office.
[CUSTOMER][NEGATIVE] I need your assistance for denied claim.
[AGENT][POSITIVE] OK, I'll be happy to assist. Um, I'm sorry, you said your name was [PII]?
[CUSTOMER][NEUTRAL] It's for her?
[CUSTOMER][NEUTRAL] For hand
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] And if I can get a good callback number for you?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] All right. So that would be 232-0069.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Uh it's for the office visit to outpatient.
[AGENT][NEUTRAL] OK. I do show the office visit is covered under the outpatient. Um, patient has a $100 deductible and a calendar year maximum of
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] $6000. Now, only the treatment and procedures at the visit will be covered. The co-pay that's associated with the uh physician's charges would not.
[CUSTOMER][NEUTRAL] OK, so we actually submit a claim after the primary.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And build amount 158949.
[CUSTOMER][NEUTRAL] And we are looking for 4619 after the primary.
[AGENT][NEUTRAL] Right, so you build.
[AGENT][NEGATIVE] For the physician's charges and that's not covered, so it was denied.
[CUSTOMER][NEGATIVE] Is not covered.
[AGENT][NEUTRAL] Right. Remember, only the treatment and procedures at the visit will be covered. The co-pay associated with the physician's charges is not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, is there any claim number?
[AGENT][NEUTRAL] Claim number is 35217887. Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Uh, that's all, um, if I can get a reference number please.
[AGENT][NEUTRAL] Reference is just my name [PII] last initial S as in Sam, and the date and time of the call.
[CUSTOMER][POSITIVE] Alright, thank you [PII] for cooperation.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] You too bye.