AccountId: 011433970860
ContactId: 663d0642-b4d2-407a-8bd5-c8805345b7c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287089 ms
Total Talk Time (AGENT): 106414 ms
Total Talk Time (CUSTOMER): 114824 ms
Interruptions: 0
Overall Sentiment: AGENT=2.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/663d0642-b4d2-407a-8bd5-c8805345b7c8_20250321T15:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], good morning. This is [PII] calling from Memory Clinic regarding claim status.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with claim status. What is a good callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah. It is.
[CUSTOMER][NEUTRAL] 022164
[CUSTOMER][NEUTRAL] 87
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, and number 8.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please, sir?
[CUSTOMER][NEUTRAL] Yeah. Patient name, [PII], and the date of birth, [PII].
[AGENT][POSITIVE] All right, thank you, sir, and it would be my pleasure to assist you with that claim status for [PII], do you have a claim number or date of service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I do have the claim number with me and I will tell you when you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Yeah, it's 355.
[CUSTOMER][NEUTRAL] 669-0.
[AGENT][NEUTRAL] Thank you, [PII]. Can you verify that date of service I mean sorry, the provider name?
[CUSTOMER][NEUTRAL] Uh, yeah, you mean the individual provider?
[AGENT][NEUTRAL] That's correct, this facility name.
[CUSTOMER][NEUTRAL] Uh, yeah, it's the ER Clinic.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], I'm showing that we did receive that claim on [PII] and processed on [PII], and the claim was denied because officess are not covered and that is per the guidelines of the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so this one is in office, is it, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. So, is it not covered in the patient plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] And this one actually already processed by United Healthcare and
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And you guys applied to the, this amount to the patient responsibility, right?
[AGENT][NEUTRAL] We don't determine patient responsibility, that would be determined by the provider. We're not major medical.
[CUSTOMER][NEUTRAL] Uh-huh. OK.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] [PII], is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, no, I, sir. This is all I need. And can you, uh, elaborate on what is not covered under this patient plan? Can you?
[CUSTOMER][NEUTRAL] Elaborate this one a bit, please.
[AGENT][NEUTRAL] Yes, so this is a secondary policy to the major medical.
[AGENT][NEUTRAL] The only
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me, I apologize, and I'm getting those pol the benefits pulled up. The only service that is covered in a in a doctor's office is for procedures or treatments.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the consultation or the office visit is not covered.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. This is a consultation. OK, got it.
[CUSTOMER][NEGATIVE] Mm hm. OK, got it. Since this is the consultation code, it is not good.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, [PII]. OK. Thank you. Thank you for the help. Any call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date and spell my name [PII] first initial.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Last name is [PII].
[AGENT][POSITIVE] And it has been a pleasure to assist you with that claim information, [PII]. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Um, no, [PII]. Thank you, thank you. Have a nice day. Bye-bye. Happy weekend.
[AGENT][POSITIVE] I hope you have a wonderful day as well and thank you for calling APL. Take care.
[CUSTOMER][POSITIVE] Thank you. Take care. Bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye.