AccountId: 011433970860
ContactId: 4521992c-cdb5-4367-bda7-bb726f740cd8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313579 ms
Total Talk Time (AGENT): 66274 ms
Total Talk Time (CUSTOMER): 121269 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/4521992c-cdb5-4367-bda7-bb726f740cd8_20250611T20:37_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, hi, [PII]. This is [PII] calling from products office regarding claims. I mentioned the last name is [PII].
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][POSITIVE] And my callback number would be whenever you're ready.
[AGENT][NEUTRAL] OK, that's that.
[CUSTOMER][NEUTRAL] Um, that would be
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] you have the policy number for the patient? Are you needing claim status?
[CUSTOMER][NEUTRAL] OK. And the policy number would be 024.
[CUSTOMER][NEUTRAL] 58526.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name would be [PII] and the date of birth is [PII], sorry.
[AGENT][NEUTRAL] OK, and uh what was the date of service and bill charges?
[CUSTOMER][NEUTRAL] That would be [PII] with the bill amount of $221.92.
[AGENT][NEUTRAL] And [PII] was the patient?
[CUSTOMER][NEUTRAL] Name would be [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I'm sorry, what was that date of service again? Sorry about that.
[CUSTOMER][NEUTRAL] It's, no worries. Uh, it's [PII].
[AGENT][NEUTRAL] Bill charges?
[CUSTOMER][NEUTRAL] It's $221.92.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh, was your seat [PII]. Process [PII].
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, just a moment. It's [PII] and process done, [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And what would be the status?
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] Office visits are not covered under the policy, claim was denied.
[CUSTOMER][NEUTRAL] OK. Of.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] are not covered as as per patient plan, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] As the patient and the claim number ending with 106, correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh, if it is non-core as per the patient plan, then can I go ahead and bill it to the patient?
[AGENT][NEUTRAL] We're a secondary policy, so we can't instruct on patient responsibility.
[CUSTOMER][NEUTRAL] Uh, uh, I'm sorry, I didn't get you.
[AGENT][NEUTRAL] We are a secondary policy, so we cannot instruct on patient responsibility.
[AGENT][NEUTRAL] We can't determine patient responsibility.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Actually, um, primary is, uh, Aetna, and they have processed and uh they have applied $100 towards the patient responsibility which is deductible.
[CUSTOMER][NEUTRAL] Oh, as this is your office visit and it is not covered as for the patient plan. So, don't you think we can bill to the patient if it is not covered as for the patient plan?
[AGENT][NEUTRAL] I, I mean, I cannot instruct you on patient responsibility. All I can tell you is how the claim processed.
[CUSTOMER][NEUTRAL] OK. Mm, then what would be the resolution? Is it going to be the providers right of then?
[AGENT][NEUTRAL] According to this policy, we don't cover office visits, so I, I, I don't know what else to, what other information to give you.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] It's not a Medicaid plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If it's not a Medicare plan, then it's fine. Uh, so just.
[CUSTOMER][NEUTRAL] OK. Can I have the call reference number for this claim?
[AGENT][NEUTRAL] It's my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] [PII], today's date.
[CUSTOMER][POSITIVE] 61. OK. Thank you for the information, [PII]. Have a wonderful day.
[AGENT][POSITIVE] Thanks for calling APL. You as well. Bye bye.