AccountId: 011433970860
ContactId: 34b02a43-55c3-4461-945c-139b6ff76b19
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 291739 ms
Total Talk Time (AGENT): 83388 ms
Total Talk Time (CUSTOMER): 127829 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/34b02a43-55c3-4461-945c-139b6ff76b19_20250218T16:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. My name is [PII] and I need a claim so remember. Could you please help me with that?
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] I get.
[CUSTOMER][NEUTRAL] Yeah, I'm calling from the provider's office. I need a clean sheet, so I remember. Could you please help me with that?
[AGENT][NEUTRAL] Yes, I can check on a claim for you. What was your name?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and my last name first initial, it's [PII].
[AGENT][NEUTRAL] OK, um, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 02433267.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Oh yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] with the charge amount of $364.87.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what was the name of the provider's office this was with?
[CUSTOMER][NEUTRAL] Yeah, it's North Atlanta Primary Care, also known as Southeast Medical PC.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so we did receive this claim, just a moment. So for the procedure code 99214.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] I said that's an office visit. Office visits are not covered under this policy. As for the remaining items, we are missing the primary EOB.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so you need the primary before the primary before the process for the CBDs.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And could you please also tell me the denial reason for that why does this policy doesn't cover the office visit?
[AGENT][NEUTRAL] Right offices if they're not covered under this policy.
[CUSTOMER][NEUTRAL] Yeah, but it's there any specific reason for that?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is there any specific reason for that?
[AGENT][NEGATIVE] Office visits are simply not covered under this policy.
[CUSTOMER][NEUTRAL] Mhm. OK. And could you please check also the
[CUSTOMER][NEUTRAL] Earlier this claim was sent for reprocessing. Could you also check the status on that?
[AGENT][NEUTRAL] Oh, this is the only record of a claim that I have for this state of service.
[CUSTOMER][NEUTRAL] This is the only record offer
[CUSTOMER][NEUTRAL] Mm, OK. Just give me a moment, please.
[CUSTOMER][NEUTRAL] Uh, so the patient's policy doesn't cover the officers, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But uh these are just normal office visits, so why does the patient plan doesn't cover that.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I was just saying that these are the normal offices, so why this patient plan doesn't cover this.
[AGENT][NEGATIVE] It's just simply not covered under this policy.
[CUSTOMER][NEUTRAL] And they did that.
[CUSTOMER][NEUTRAL] OK, there's no any specific reason. It's just the patient policy doesn't cover this.
[AGENT][NEUTRAL] It does not cover office visits.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][POSITIVE] OK, thank you for that and.
[CUSTOMER][NEUTRAL] Could you please provide me the call reference number for this call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh my name is spelled [PII], and can I get the spelling of your first name one more time? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and my last name first initial, it's [PII].
[AGENT][POSITIVE] OK, thank you for that and was there anything else I could help you with?
[CUSTOMER][POSITIVE] No, thank you for assisting. Have a great day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] But