AccountId: 011433970860
ContactId: 1d335ca8-e7fa-4ae3-b94b-3b22874f3011
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 334880 ms
Total Talk Time (AGENT): 149167 ms
Total Talk Time (CUSTOMER): 57701 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/1d335ca8-e7fa-4ae3-b94b-3b22874f3011_20250528T12:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for broader office to check on claim status. Please be informed that this call is being recorded and monitored for quality and training purpose. How are you doing today?
[AGENT][NEUTRAL] I'm good, [PII], and yourself?
[CUSTOMER][POSITIVE] Yeah, I'm also doing good. Thank you so much.
[AGENT][NEUTRAL] Good. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII] with the extension of [PII].
[AGENT][NEUTRAL] Thank you. And [PII], how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] Only one?
[AGENT][NEUTRAL] OK. I can help you with that. And what is your patient's policy number, please?
[CUSTOMER][NEUTRAL] 02455394.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the uh data service and total bill amount, please.
[CUSTOMER][NEUTRAL] Date of service is [PII]. Total charge amount is $292.05.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim has been received more than once, [PII]. The most recent claim was received that was received was denied as a duplicate of previously submitted expenses. Do you need the original claims information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the original claim was received on [PII].
[AGENT][NEUTRAL] And it was denied on [PII]?
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 1773.
[AGENT][NEUTRAL] And the reason for the denial for 99214 was denied as office visits are not covered by the policy.
[AGENT][NEUTRAL] This member supplemental plan [PII] does not cover office visits.
[AGENT][NEGATIVE] And the other codes were denied for the same reason of this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK. It's not covered under uh provider policy.
[AGENT][NEUTRAL] No, sir. The patients plan.
[AGENT][NEUTRAL] The member's plan.
[CUSTOMER][NEUTRAL] OK. It's not covered under the patient policy, right?
[AGENT][NEUTRAL] Yes, and I read you the specific remark. This service is not covered when performed in a doctor's office or clinic.
[AGENT][NEUTRAL] And the other reason was office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] The member's policy does not cover office visits.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits with those remarks, [PII], you can print that by going to our portal, which is located at [PII].
[CUSTOMER][NEUTRAL] OK. May I know the appeal mailing address?
[AGENT][NEUTRAL] The same as claims and sent to attention appeals department.
[AGENT][NEUTRAL] And an appeal must be filed within 180 days from the date of the decision.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Car reference number?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][NEUTRAL] Could you please spell your name once?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] Thank you so much. Have a great day.
[AGENT][POSITIVE] You're welcome. I hope you have a great day too, [PII], if that's all I can help you with. Thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Ah.