AccountId: 011433970860
ContactId: 29d4981b-9c57-44a4-a394-970ed3b1f39c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377769 ms
Total Talk Time (AGENT): 92074 ms
Total Talk Time (CUSTOMER): 127939 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/29d4981b-9c57-44a4-a394-970ed3b1f39c_20250402T18:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office and I'm having a question about the claim.
[AGENT][NEUTRAL] OK, I can help you, [PII]. What's the policy number and the claim number?
[CUSTOMER][NEUTRAL] Policy number is 01905621 and the claim number is, one moment.
[CUSTOMER][NEUTRAL] Mm, OK. 356-916-0.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please check with the date of service?
[AGENT][NEUTRAL] [PII] moment.
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And if you can verify the patient's name and date of birth for me?
[CUSTOMER][NEUTRAL] Patient name is um [PII] by [PII].
[AGENT][NEUTRAL] Thank you for that information. And what question did you have regarding claim 356-9160?
[CUSTOMER][NEUTRAL] Date of service is [PII]. OK, so you have the same number. I'm sorry. So, uh, this claim, uh, is denied as for the you be this provider does not have a provider participation network. Uh, benefits have, uh, not been reduced. So this is a denial reason is mentioned and it is also mentioned that this is non-covered service. So is it deliver to patient or not?
[AGENT][NEUTRAL] OK, so the only remark code on the explanation of benefits from APL is office visits are not covered by the above name policy. The other verbiage that you said is not our remark code.
[AGENT][NEUTRAL] And we do not determine patients responsibility.
[CUSTOMER][NEUTRAL] So this is not patient responsibility, right?
[AGENT][NEUTRAL] No, that's not what I said. I said we do not determine patients responsibility.
[CUSTOMER][NEUTRAL] OK. And could you please let me know that patient was active on this uh date of service or not? [PII].
[AGENT][NEUTRAL] I will.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the remark code that you said that's on our ELB that is incorrect if that's what's in your system.
[AGENT][NEUTRAL] I'm showing the policy effective date.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And I show the policy is active, and I'm sorry, the effective date for [PII] is [PII].
[AGENT][NEUTRAL] And I show that the policy is active.
[CUSTOMER][NEUTRAL] OK, so as you were saying that denial, um, reason is incorrect to mention, so what is the denial reason? Because as for the EOB as I have the, this is a paper EOB which we have received from the American Public Life Insurance Company. So it is mentioned, uh, as a, um, the reason that non-covered service. So what is the our reason as well.
[AGENT][NEUTRAL] That's not a remark code [PII].
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] You have a copy of the explanation in your hand?
[CUSTOMER][NEUTRAL] So what is the remark code?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Turn to the back.
[AGENT][NEUTRAL] Of that EO be in.
[CUSTOMER][NEUTRAL] That, OK.
[CUSTOMER][NEUTRAL] OK, so remark code is D2H001.
[AGENT][NEUTRAL] Yes. And what does that say?
[CUSTOMER][NEUTRAL] Office visits are not covered by the above-numbered policy. OK. OK. Um.
[AGENT][NEUTRAL] Yeah, that's our remark code that's our denial code, not the other information that you stated.
[CUSTOMER][NEUTRAL] That is also mentioned on the UB. Uh, I got your point, but that, uh, point is also mentioned on the UB. So, could you please spell your name for me?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] You'll use my name in today's date as reference for today's call. It's [PII]. Did you have any other questions I can help out with today?
[CUSTOMER][NEUTRAL] Uh, no, thank you.
[AGENT][POSITIVE] Alrighty thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too.