AccountId: 011433970860
ContactId: 5229b4a7-1a7d-478f-994c-1449c43bce35
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223990 ms
Total Talk Time (AGENT): 76219 ms
Total Talk Time (CUSTOMER): 98622 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/5229b4a7-1a7d-478f-994c-1449c43bce35_20250508T19:51_UTC.wav
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[AGENT][NEUTRAL] APL. My name is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good afternoon.
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII] and I'm calling from provider office. I have a question related to the claim denial.
[AGENT][NEUTRAL] OK. May I have your name again, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Your callback number?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number?
[CUSTOMER][NEUTRAL] 02569347.
[AGENT][NEUTRAL] OK, I have that as 02569347. Thank you. Verify the patient's name and date of birth.
[CUSTOMER][MIXED] It's funny but you don't have it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, patient name is uh [PII] Fix. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you very much for that verification process. You're calling in regards to a denied claim. What is that claim number, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, that is 357-046-6.
[AGENT][POSITIVE] Thank you so much. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then.
[CUSTOMER][NEUTRAL] I was just gonna call it.
[CUSTOMER][NEUTRAL] Man.
[AGENT][NEUTRAL] May I please place you on hold, please?
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you so much. Hello, huh? Thank, OK. Thank you so much for your patience. Uh, it's denied as a non-covered benefit. Uh, wellness is not covered on this policy. A wellness test is not covered on this policy.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Wellness, uh, no, this is not for the wellness. Uh, actually this, uh, CPT code is for the preventive services, the call guard testing.
[AGENT][NEUTRAL] Correct. Preventative wellness, preventative wellness is not a covered benefit on this policy.
[AGENT][NEUTRAL] My
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Could you spell your name?
[AGENT][NEUTRAL] Of course, [PII], the last digits [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] All right. And uh what is the uh effective uh coverage date and the term date?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, please. The effective date shows [PII] and this policy currently shows active for this member.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And is there any any call reference?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, but you can use my name, please. [PII], last initials [PII], and today's date. And I anything else I can assist you with, please?
[CUSTOMER][POSITIVE] Uh, no [PII], um, that's enough, and, uh, have a good day. Bye for now.
[AGENT][POSITIVE] Thank you for calling APL. Take care. Bye.