AccountId: 011433970860
ContactId: 3b9138b3-6121-466a-ba51-e79bb9698f92
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292899 ms
Total Talk Time (AGENT): 107623 ms
Total Talk Time (CUSTOMER): 57386 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/3b9138b3-6121-466a-ba51-e79bb9698f92_20250325T16:27_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting APO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for the provider to check on additional information on a claim that has been denied. Please note, this call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] Thank you. I can help with the claim. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Yes. The policy number is 018.
[CUSTOMER][NEUTRAL] 934
[CUSTOMER][NEUTRAL] 70
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] With the date of birth, [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I can have in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes. The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's a direct line.
[AGENT][POSITIVE] Great, thank you. [PII], what is that uh that data service that we're looking for for [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] For the total charges of $781.30.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm just checking.
[AGENT][NEUTRAL] Well, I'm trying to find something for that data service. It was $781 so just so just checking.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like uh there is a claim number um.
[AGENT][NEUTRAL] 35.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 69875.
[AGENT][NEUTRAL] Uh, that is, uh, we have that, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, the, the uh policy doesn't cover anything within a physician's office. Uh, so it doesn't cover the, the office visit co-pays.
[AGENT][NEUTRAL] Uh, it doesn't cover, um,
[AGENT][NEUTRAL] Any treatment within the physician's office, uh, no matter what the CPT code.
[AGENT][NEGATIVE] Uh, so it looks like we, I've got several of these that were, uh, denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and it looks like they were, uh, returned, so, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's, that's what has happened here is that it was, yeah, that's, it's, it's uncovered. It's, I mean, it's not covered for the pat the patient's uh plan. Yeah.
[CUSTOMER][NEUTRAL] They are non-code.
[CUSTOMER][NEUTRAL] Thank you. And the patient's plan name, please?
[AGENT][NEUTRAL] It's American Public Life.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And the outstanding amount, is it the patient's responsibility or the provider's write off?
[AGENT][NEUTRAL] Well, it's, I really don't know what to tell you about that. I mean, this, I can only tell you that it's not covered on this policy, so I don't know whether he has another one. you know, this is, this is just a secondary insurance. He may have another insurance, but as far as we're concerned, he, he doesn't, uh, it's not covered through us, so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's really the only thing I could tell you.
[CUSTOMER][POSITIVE] Mhm. No problem.
[CUSTOMER][NEUTRAL] Thank you. And a car reference number, please?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII], and we'll use that in today's date as a reference. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Nothing else that's it.
[AGENT][POSITIVE] OK, well thank you for contacting if you have a good.