AccountId: 011433970860
ContactId: 46c1d83c-6b14-42a1-b05f-60152dff677f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 176139 ms
Total Talk Time (AGENT): 80920 ms
Total Talk Time (CUSTOMER): 64911 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/46c1d83c-6b14-42a1-b05f-60152dff677f_20250210T20:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name's [PII], and I'm calling from a provider's office. I have a question regarding one of our patients' claims processing.
[AGENT][NEUTRAL] OK, [PII], I'm happy to take a look. Do we have a claim number, policy number?
[CUSTOMER][NEUTRAL] I do have a claim number of 3557168.
[AGENT][POSITIVE] Alright, thank you for that. Let me pull this up here.
[AGENT][NEUTRAL] Right. And then if you could just verify with me the patient's name and date of birth, please, [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you so much. So, let's see here.
[AGENT][NEUTRAL] Um, so that claim, it looks like it was denied. It does show office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then it looks like on some of the other line items, um, the insured's primary paid full benefits so there was nothing additional for us to pay it's showing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, so that office visit, my question was because there isn't showing anything for a patient responsibility and I know it says it's not covered under the benefits, but I just wanted to call to make sure is that officer the charge being set to the member's responsibility?
[AGENT][NEUTRAL] Oh, yeah, I mean, if it wasn't paid, then yeah, it would be because their plan doesn't cover the fee for the office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] I just wanted to make sure cause you didn't have it on there. I didn't want to be like, OK, it's not coming out of their plan, it's not gonna pay, it's their responsibility. And then something comes back saying, no, my insurance said it's not my responsibility, you know, that's not a situation I wanna be in.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For sure, yeah, no, it looks like, um, yeah, their plan just doesn't cover the fee.
[CUSTOMER][NEUTRAL] OK, OK, um, I thank you for the clarification, uh, do you guys use call reference numbers or just OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Absolutely. So the call reference is my name with my last initial and then today's date. My name again is [PII], that's [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Awesome thank you so much for your help today. I hope you have a great rest of your day.
[AGENT][POSITIVE] You, you too, [PII]. Take care.
[CUSTOMER][NEUTRAL] Bye.