AccountId: 011433970860
ContactId: 5e30b6a3-f61e-4b9a-a3b8-c0d55d1b90a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 194389 ms
Total Talk Time (AGENT): 71859 ms
Total Talk Time (CUSTOMER): 64607 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/5e30b6a3-f61e-4b9a-a3b8-c0d55d1b90a0_20250218T19:49_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Um, hi [PII], um, I'm calling to, um, just confirm if you guys have received a, um.
[CUSTOMER][NEUTRAL] A claim that we sent in sorry.
[AGENT][POSITIVE] I'll be happy to assist with claim status. May I have your first name, please?
[CUSTOMER][NEUTRAL] And get claim status sorry.
[CUSTOMER][NEUTRAL] Yes, my first name is [PII].
[AGENT][NEUTRAL] And [PII], if I can get a good callback number for you?
[CUSTOMER][NEUTRAL] That would be [PII], no extension.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Um, the policy number is 02419737.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] Data service for the team?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And you're texting.
[CUSTOMER][NEUTRAL] Sorry, you said tax ID?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that information and I'm sure that the claim was denied because position charges are not covered under the policy.
[CUSTOMER][NEUTRAL] I'm so sorry, can you can you repeat that?
[AGENT][NEUTRAL] Claims denied because the physician's charges are not covered under the policy.
[CUSTOMER][NEUTRAL] Um, OK, so.
[CUSTOMER][NEUTRAL] Is dermatology not covered under her plan?
[AGENT][NEUTRAL] It's covered, but the physician's charges, the co-pay associated with the physician's charges is not covered, only treatment and procedures at the office visit is covered.
[CUSTOMER][NEUTRAL] Um, I'm so sorry. I'm not understanding, um, what does it mean that the co-pay is not in, um.
[CUSTOMER][NEUTRAL] And network or
[AGENT][NEUTRAL] What you billed us 99214, that's the code for physician's charges, what the physician charged her to see her.
[CUSTOMER][NEGATIVE] We're not covered.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that is generally associated with her co-pay with her insurance. We don't cover that. Had the doctor billed for some tests he did, some procedure he did, we would have covered it.
[AGENT][NEUTRAL] But the physician's charges associated with the copay is not covered.
[CUSTOMER][NEUTRAL] Oh, I see what you mean.
[CUSTOMER][NEUTRAL] Got it. OK, alright, um, OK, alright, may I please have a reference number for this call?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] Um, no, that is all, thank you so much.
[AGENT][POSITIVE] Thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too bye.