AccountId: 011433970860
ContactId: 3447d816-9103-40ba-9400-dfa4698fea9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330059 ms
Total Talk Time (AGENT): 114647 ms
Total Talk Time (CUSTOMER): 96869 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/3447d816-9103-40ba-9400-dfa4698fea9d_20250502T14:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. This is [PII]. I'm here to find the status of a claim.
[AGENT][NEUTRAL] OK, I could check on a client for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] I'm sorry, that was [PII].
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, uh, and then can I get that policy number, please?
[CUSTOMER][NEUTRAL] Yeah. Policy ID is 0246.
[CUSTOMER][NEUTRAL] 7128.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Member's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. And what was the date of service for this claim?
[CUSTOMER][NEUTRAL] D of service will be [PII].
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, and then uh do you have that bill amount?
[CUSTOMER][NEUTRAL] Total bill amount will be
[CUSTOMER][NEUTRAL] $226 even.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] How do you spell your name, by the way?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], do you have the tax ID for this provider?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] The shop
[AGENT][NEUTRAL] So I don't have a claim for the state of service for that amount, [PII]. I do have one from this provider for $196.
[CUSTOMER][NEUTRAL] What's the date of service of that claim?
[AGENT][NEUTRAL] It is that same data service. It's uh [PII].
[CUSTOMER][NEUTRAL] OK. Uh wait.
[AGENT][NEUTRAL] Um, I could give you those procedure code. Were there two procedure codes?
[CUSTOMER][NEUTRAL] Uh, no, there are 3 procedure codes.
[AGENT][NEUTRAL] OK, so then it doesn't look like we.
[CUSTOMER][NEUTRAL] 99402.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] No, so this one does have the 99402 and 96127, but those are the only two procedure codes on this claim.
[CUSTOMER][NEUTRAL] Yeah, we have uh built this claim on.
[CUSTOMER][NEGATIVE] Oh yes, actually, uh, yes, uh, the procedure code 81025 is not correct. It has zero balance left, so.
[AGENT][NEUTRAL] I see. OK, so then this is the correct claim. OK. So yes, we did receive this and we were unable to pay a benefit as the services are not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Uh, so it is denied, correct?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEGATIVE] Not covered uh when it is serviced on office.
[AGENT][NEUTRAL] Yes, the services are not covered in a when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK. Uh, could you please wait?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. Uh, what is the denial date?
[AGENT][NEUTRAL] Uh, let's see this process that was [PII].
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Oh, wait.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me verify it once.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It will be patience responsibility.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] But will be patient for your responsibility, correct?
[AGENT][NEUTRAL] Oh, we don't say what is patient responsibility, uh, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, can I have the claim number and the card reference number?
[AGENT][NEUTRAL] Sure, that claim number is 3594014.
[CUSTOMER][NEUTRAL] And what about the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. And so my name is spelled [PII] And was there anything else I could help you with?
[CUSTOMER][POSITIVE] No, thank you so much for your help. Have a nice day.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.