AccountId: 011433970860
ContactId: 6097ecf6-4bb9-4c8c-97ab-aedf7f5b6545
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384410 ms
Total Talk Time (AGENT): 133756 ms
Total Talk Time (CUSTOMER): 150727 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/6097ecf6-4bb9-4c8c-97ab-aedf7f5b6545_20250620T14:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling from the provider's office to additional information about the claim. Can you please assist me with that?
[AGENT][NEUTRAL] Yes, I can get clarification regarding that claim. I'm sorry, you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Oh yes, I do have the policy number. It is 593557505.
[AGENT][NEUTRAL] OK, that's gonna be a bit too long to be one of our policy numbers, [PII], uh, do you maybe have their social or is that their social?
[CUSTOMER][NEUTRAL] OK, let me check on that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, should I provide you the social number? Uh, it is [PII].
[AGENT][NEUTRAL] OK, got it one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then uh what was the name for the member?
[CUSTOMER][NEUTRAL] Uh, name of the member is the first name is [PII] is the first name and the last name is spelled as [PII]. And the date of birth is gonna be on [PII].
[AGENT][POSITIVE] Perfect thank you so much for verifying that I was able to find this member's policy uh let me know when you're ready and I can give you that correct policy number.
[CUSTOMER][NEUTRAL] So, go ahead.
[AGENT][NEUTRAL] That is 0233.
[AGENT][NEUTRAL] 7284.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Of course and then did you have that claim number?
[CUSTOMER][NEUTRAL] Uh, no, we do not have a claim number as we have built a primary and it was crossed over to the secondary insurance which is uh like you know.
[CUSTOMER][NEUTRAL] Yeah, United, uh, American Public Life Insurance Company.
[AGENT][NEUTRAL] Right, OK, um, what was the date of service?
[CUSTOMER][NEUTRAL] Uh, the data service is gonna be on [PII] and with the total charge amount of $1,066 even.
[AGENT][NEUTRAL] OK, that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, thank you, um, and then do you have the uh tax ID for this provider?
[CUSTOMER][NEUTRAL] Uh, sure, I do have the tax ID number. It is [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so I was able to locate this claim we were unable to pay a benefit as office visits are not covered under this policy, nor is treatment received in a physician's office.
[AGENT][NEGATIVE] So none of the items were are covered.
[AGENT][NEUTRAL] If you'd like I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK the claim is uh not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, it is not covered under the patient's plan or provider's contract.
[AGENT][NEUTRAL] Uh, the the patient's policy, it doesn't cover office visits or treatment received in office.
[CUSTOMER][NEUTRAL] OK, what, uh, what is that, uh, not, is that a diagnosis code or a CPT code?
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] Uh, could I know what is not covered? It is as a CPT code or a diagnosis code?
[AGENT][NEUTRAL] So the office visits are not covered, so that would be the 99214 office visits are not covered and then the 31575 and 3123 as those were treatments received in office, those are not covered either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, cause this uh code or not covered. Thank you. Just give me a moment over here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, can you help me with, uh, what is the receipt date and the process of this claim?
[AGENT][NEUTRAL] Uh, yes, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So this claim was received on [PII], and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. And can I know what is the claim number?
[AGENT][NEUTRAL] That is 36.
[AGENT][NEUTRAL] 09.
[AGENT][NEUTRAL] 789.
[CUSTOMER][POSITIVE] Thank you. Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just give me a hold on, almost done.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] let me check.
[CUSTOMER][NEUTRAL] Can you check whether this patient has any kind of payments in previous for this kind of services?
[AGENT][NEUTRAL] They do not as this policy does not cover office visits or treatment received in office.
[CUSTOMER][NEUTRAL] OK, thank you. You can do it with the call reference number.
[AGENT][NEUTRAL] Reference number would be my first name, last initial, and today's date and so my name is spelled [PII] Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] No, thank you so much for assisting with this one. Have a nice day.
[AGENT][POSITIVE] Of course thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.