AccountId: 011433970860
ContactId: 1c161af8-61f4-473d-902f-989b9002cc2d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 152139 ms
Total Talk Time (AGENT): 67086 ms
Total Talk Time (CUSTOMER): 48837 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/1c161af8-61f4-473d-902f-989b9002cc2d_20250425T16:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, um, I have a claim that was, uh, there was one line denied on, um, the claim, and I was just wanting to double check on it because it was denied it's not covered.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, let's take a look. What is the policy number or the claim number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The policy number 002230085.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then can I get the name on the policy?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then lastly, [PII], I just need to verify please the address.
[CUSTOMER][NEUTRAL] Um, actually I'm calling from a provider's office.
[AGENT][NEUTRAL] Oh, I'm sorry, what, um, what is the date of service form or do you have the claim number?
[CUSTOMER][NEUTRAL] Um, yes, claim number 3589255.
[AGENT][NEUTRAL] OK, let's take a look here.
[AGENT][NEUTRAL] All right, so it looks like the claim was denied showing that office visits are not covered under the member's policy. So we're the secondary insurance, this does cover treatment in an office, but it's not going to cover the actual office visit fee.
[CUSTOMER][NEUTRAL] OK, because this one that was denied the 92083, that is a um visual field testing.
[AGENT][NEUTRAL] Oh, is it? OK, let me see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yeah it looks like 92083 was the procedure code.
[AGENT][NEGATIVE] It looks like it fell under, they tried to do it under treatment but it wasn't a covered, it looks like benefit on the plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's not covered under her plan.
[AGENT][NEUTRAL] Yeah, it looks like it's not covered under the secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty. Uh, thank you for the information.
[AGENT][NEUTRAL] Yeah. Did you need me to check anything else?
[CUSTOMER][POSITIVE] Um, no, I think that's it. Thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too.