AccountId: 011433970860
ContactId: 292b0ffa-4c70-4b26-adf8-2ea40ee1b256
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330279 ms
Total Talk Time (AGENT): 107785 ms
Total Talk Time (CUSTOMER): 88777 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/292b0ffa-4c70-4b26-adf8-2ea40ee1b256_20250217T19:44_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII] is [PII] calling for [PII] E check a claim status. How are you today?
[AGENT][POSITIVE] I'm doing well how are you?
[CUSTOMER][POSITIVE] Yes, I'm good. Thank you.
[AGENT][NEUTRAL] Of course and yeah I can check on a claim for you. I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, look, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. The callback number is [PII].
[AGENT][NEUTRAL] All right, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes. Do you remember ID?
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 06734
[AGENT][NEUTRAL] OK, thank you and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] The patient's name is [PII]. The date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] All right. The data services [PII]. The total charges are $1,485 even.
[AGENT][NEUTRAL] OK, and that was [PII]?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we did receive this claim, [PII], uh, we were unable to pay a benefit as this is not a covered diagnostic under this patient's policy.
[CUSTOMER][NEUTRAL] All right. Thank you. So, could you please provide me the claim receipt date?
[AGENT][NEUTRAL] Yes, one moment, let me get that.
[AGENT][NEUTRAL] OK, so this claim was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh [PII]. Could you please repeat the reason again?
[AGENT][NEUTRAL] Yes, so it's not a covered diagnostic test for this patient's policy.
[CUSTOMER][NEUTRAL] Not covered the diagnosis, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] If you'd like [PII], I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] Uh, all right. So before that, I would like to know which diagnosis is not covered.
[AGENT][NEUTRAL] But it's just not a covered diagnostic test, um, so it is very particular on what kinds of diagnostic tests are covered under this policy, so that would be MRIs, CT scans, uh, things like that. This one is not a covered benefit.
[CUSTOMER][NEUTRAL] Um, sorry, I'm a little confused here. So you're stating that the denial reason is not covered the diagnosis for the patient's policy, right?
[AGENT][NEUTRAL] The diagnostic test is not covered under this patient's policy. Yes.
[CUSTOMER][NEUTRAL] Diagnostic cast.
[AGENT][NEUTRAL] The diagnostic test is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So you don't have the, the specific diagnosis. So you mean the diagnosis or MRI or CTC is not covered, right?
[AGENT][NEUTRAL] Right. This, this particular medical test is not covered for this patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, a quick moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. Thank you for your patience. So, could you please provide me the claim number?
[AGENT][NEUTRAL] Yes, that is 34.
[AGENT][NEUTRAL] 96,060.
[CUSTOMER][NEUTRAL] 349-6060. Thank you. Can I get the call office number for the call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII], was there anything else I could help you with again?
[CUSTOMER][POSITIVE] Mm, no. I done for the day. Thank you for your office and you have a wonderful day today.
[AGENT][POSITIVE] OK. All right. Yeah, thanks for calling APL. You too. Bye-bye.
[CUSTOMER][NEUTRAL] But for now.