AccountId: 011433970860
ContactId: 586ce086-c629-434f-b7e1-04bb1593ffd3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 309059 ms
Total Talk Time (AGENT): 74199 ms
Total Talk Time (CUSTOMER): 131947 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/586ce086-c629-434f-b7e1-04bb1593ffd3_20250305T22:09_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, sure, this is [PII] calling from Broader office to check on our client status. How was your day?
[AGENT][POSITIVE] I'm good, thank you. How about you, Mr. [PII]?
[CUSTOMER][POSITIVE] Um, yeah, I'm doing great, great. Thank you for asking.
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] I'm sorry, can you repeat that one more time?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, it's 02512377.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Sure, sir. The patient name would be [PII], and date of birth would be
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh-huh. Yes, so the date of service would be [PII] for the bill amount of 1500, I mean, uh, 17, 1057.
[AGENT][NEUTRAL] 1057.
[CUSTOMER][NEUTRAL] Hold on
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And you said it's [PII]?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, let me pull this one moment.
[CUSTOMER][POSITIVE] Mhm. Sure, please take your time.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Bear with me, I'm still waiting on the system.
[CUSTOMER][POSITIVE] Sure, please take your time.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Do you know that's not.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, this is it.
[AGENT][NEGATIVE] All right, so it looks like we processed the claim [PII] and the claim was denied. The reason for this denial.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that
[AGENT][NEUTRAL] Benefit maximum for the date of service has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know why uh the CPT code 9041 I mean 90471 and 90739 were got denied.
[AGENT][NEUTRAL] OK. The policy does not provide benefits for vaccines or immunization administration.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So this particular city code 90471 and 90739 is a vaccine. Uh, it's a, immunization uh vaccine, so it is not covered under the patient plan.
[AGENT][POSITIVE] Mhm. Correct. Correct.
[CUSTOMER][NEUTRAL] Am I right?
[CUSTOMER][NEUTRAL] Uh-huh. So the member is, uh, is responsible for this bill amount, is that right?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement in the remaining of the claim.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, yeah, thank you so much for the information. And, uh, and I just need to confirm that this vaccine codes are not covered under the patient plan, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Uh-huh, thank you so much for the information and thank you so much for assisting me today. And may I have the go of us for today?
[AGENT][NEUTRAL] We don't have a reference numbers you can use my name in today's state.
[CUSTOMER][POSITIVE] Yeah, thank you so much for that one and thank you so much for assisting me today. Have a great day.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.