AccountId: 011433970860
ContactId: 3ec5e45f-a7d4-4c9c-814f-a78d4c8c040c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 233580 ms
Total Talk Time (AGENT): 64601 ms
Total Talk Time (CUSTOMER): 99657 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/3ec5e45f-a7d4-4c9c-814f-a78d4c8c040c_20250603T19:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. My name is [PII] and I'm calling from provider's office to check on medical claim status. Can you please help me with claims?
[AGENT][POSITIVE] Yeah, I'm happy to check on a claim. What's the policy number?
[CUSTOMER][NEUTRAL] The policy ID is 02556914.
[AGENT][POSITIVE] Thank you. And do you have a good callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you. What's the patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient's last name is [PII], the first name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] The date of service is [PII] for a total of $320 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, so it looks like we did receive this claim on [PII].
[AGENT][NEUTRAL] [PII], claim was denied, [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Diagnostic tests performed were not a covered benefit under the member's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a diagnostic, OK.
[CUSTOMER][NEUTRAL] Uh, diagnostic what is performed?
[AGENT][NEUTRAL] The diag diagnostic testing is not covered under this member's policy.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Covered under.
[CUSTOMER][NEUTRAL] Patient's policy. Just give me a moment. So do we need to build this claim to patient?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility. That's up to the uh facility or the provider.
[CUSTOMER][NEUTRAL] So, if you're telling that it is not covered as for patient's policy and the diagnostic, whatever it is, is not covered as for patient's policy, so that means we need to build this claim to patient only, right?
[AGENT][NEUTRAL] I can't, we can't advise on what to bill the patient. I'm just letting you know that it's not covered under the member's plan.
[CUSTOMER][NEUTRAL] Just give me a moment. I.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, just a sec, uh, techniques to identify the return. OK, the cause of medical condition.
[CUSTOMER][NEUTRAL] And this uh diagnosis, uh, the, uh, the thing which we have built on the claim is not related to, uh, sorry, what do we say? Uh, it is actually not, uh, this is actually what do we say, CT scan done on the claim.
[CUSTOMER][NEUTRAL] OK, diagnostic, yes.
[AGENT][NEUTRAL] Yes, it was not, it's not a covered benefit on the member's plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. What is the claim number?
[AGENT][NEUTRAL] 354-475-5
[CUSTOMER][NEUTRAL] OK, thank you. So what is the call reference number?
[AGENT][NEUTRAL] That is my name with today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much for all your assistance and you have a wonderful day.