AccountId: 011433970860
ContactId: 4c377dce-c3e0-4425-8b45-de17c98c0d5b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 219460 ms
Total Talk Time (AGENT): 46640 ms
Total Talk Time (CUSTOMER): 77330 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/4c377dce-c3e0-4425-8b45-de17c98c0d5b_20250415T20:54_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can 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] OK, [PII], I can help you look at a claim. Do you have a good callback number?
[CUSTOMER][NEUTRAL] That would be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's a direct line.
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, and that would be.
[CUSTOMER][NEUTRAL] 0016.
[CUSTOMER][NEUTRAL] 319
[CUSTOMER][NEUTRAL] 18
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is?
[CUSTOMER][NEUTRAL] [PII] with the date of birth, [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] Data services.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the bill charges?
[CUSTOMER][NEUTRAL] $275 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and you had a question about the denial, is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. How can I help?
[CUSTOMER][NEUTRAL] Yes, it's with the denial on the CPT code.
[CUSTOMER][NEUTRAL] 97,110 and 97,140 bill on the claim.
[CUSTOMER][NEGATIVE] They have been denied stating
[CUSTOMER][NEUTRAL] That occupational therapy are not covered benefits under this policy. I just need a confirmation on that one, please.
[AGENT][NEUTRAL] Uh, yes, it looks like kinesiology, speech or occupational therapy is not covered under the plan.
[CUSTOMER][NEUTRAL] And the patient's plan name, please?
[AGENT][NEUTRAL] Uh my name is.
[AGENT][NEUTRAL] [PII] 4 F as [PII] 3.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And outstanding amount is it the patient's responsibility?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility. We just process according to the plan since this is secondary.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And for the same member, I have one more data service.
[AGENT][NEUTRAL] OK, the date.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Uh, it looks like it was denied for the same reason.
[CUSTOMER][POSITIVE] Thank you for confirming.
[CUSTOMER][NEUTRAL] And the card reference number for this number, please?
[AGENT][NEUTRAL] Um, it's just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you. And that's it from my end.
[CUSTOMER][POSITIVE] Thank you for your assistance, [PII]. Have a great day.
[AGENT][POSITIVE] Thanks for calling APL. You have a good day too.
[CUSTOMER][NEUTRAL] Bye.