AccountId: 011433970860
ContactId: 2c24aff5-b985-4010-bcc1-2fca023fbca1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 196119 ms
Total Talk Time (AGENT): 82007 ms
Total Talk Time (CUSTOMER): 77136 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/2c24aff5-b985-4010-bcc1-2fca023fbca1_20250411T15:18_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hey, [PII], my name is [PII]. I'm calling from provider's office for an things to our reason. How are you doing today?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][NEUTRAL] Uh, pretty well, uh, like last Friday.
[AGENT][NEUTRAL] It is Friday. I, I'll be more than happy to assist you with the denial clarity. And um for my notes, can you spell your first name for me please and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII], callback number [PII], direct line?
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Mhm. It's gonna be.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Right. It's 02491250 Mary Lima number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] His name is
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills?
[AGENT][NEUTRAL] Or the claim number if you have it.
[CUSTOMER][NEUTRAL] Uh, data service.
[CUSTOMER][NEUTRAL] I do have a claim number. So it's gonna be 3581379.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] OK, and the claim was denied because office visits are not covered on the policy and what questions did you have about it?
[CUSTOMER][NEUTRAL] All right, so, right, it's denied as, uh, how, however, uh, is why exactly it's been denied it's an office visit.
[AGENT][NEUTRAL] Office visits are not covered on this policy. So this is their secondary insurance.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] The secondary insurance has its own benefits as primary does as well. So on this policy, it does not cover office visits. It's broken into in hospitals and
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] As per patient's plan, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] Mm, we can build this patient, right?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility, so that would be up to, uh, whatever your procedures are for a remaining balance.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, no problem. Thank you very much. Please send me the call reference number on the call.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you very much, [PII]. I hope you enjoy your day.
[AGENT][POSITIVE] You also managed. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Oh, no, done. Mhm. Thank you very much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Likewise, thank you.
[AGENT][NEUTRAL] Bye bye.