AccountId: 011433970860
ContactId: 42e6caa5-31f9-4d66-845a-750b955272b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 294980 ms
Total Talk Time (AGENT): 106757 ms
Total Talk Time (CUSTOMER): 70539 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/42e6caa5-31f9-4d66-845a-750b955272b5_20250514T20:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling UPL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I have a question on a claim for one of our patients.
[AGENT][NEUTRAL] OK, I can help you with a claims question. May I, um, get your name and your callback number?
[CUSTOMER][NEUTRAL] My name is [PII] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII] [PII] and the ID number is 01780660 M like Mike L like Larry 8.
[AGENT][NEUTRAL] OK, let me pull up [PII]'s policy.
[AGENT][NEUTRAL] And you said her name was [PII]?
[CUSTOMER][NEUTRAL] Uh, it's [PII], uh huh.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, OK, got you. Alright, and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] [PII] for $231.
[AGENT][NEUTRAL] OK, and then what were the charges after the primary paid their part?
[CUSTOMER][NEUTRAL] Uh, looks like there's a $50 balance I do a co-pay from Amed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then what's the name of the facility you're calling from please?
[CUSTOMER][NEUTRAL] For Institute for Cardiovascular disease.
[AGENT][NEUTRAL] OK, let me um put you on a quick hold. I'm gonna pull up this claim for us, [PII] and I'll be right back.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Thank you alright.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 2:31.
[AGENT][NEUTRAL] 50.
[AGENT][NEUTRAL] 35
[AGENT][NEUTRAL] 846.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], I've got the claim pulled up now. Um, I do show that the claim was denied.
[AGENT][NEUTRAL] And the remark on the claim was because office visits are not covered by the insured's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, even if you guys are the secondary plan, they're just, they don't cover office visits?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright, um.
[CUSTOMER][NEUTRAL] That's strange if it's a secondary.
[CUSTOMER][NEUTRAL] I did you guys process it as a secondary?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, and so what does this plan cover really?
[CUSTOMER][NEUTRAL] Like inpatient or something.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Right, so the way that this policy works is it, it is a supplemental insurance and this is to verify benefits. It's not a guarantee of payment. They do have an outpatient calendar year benefit of $2500 that goes towards deductible, co-pay or co-insurance, but under the patient's policy, the plan type that they chose does not cover office visits.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect, I appreciate that. Alright, just a reference and then it should be good to go.
[AGENT][NEUTRAL] Yes sir, um you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Alright, thanks for the help, take care.
[AGENT][POSITIVE] You're very welcome, and thank you for calling APL Mike. I appreciate it.
[CUSTOMER][NEUTRAL] OK OK bye bye now.
[AGENT][NEUTRAL] Bye-bye.