AccountId: 011433970860
ContactId: 6e2bb6da-9048-4ed0-be81-1a2f245d674e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 178130 ms
Total Talk Time (AGENT): 71444 ms
Total Talk Time (CUSTOMER): 55287 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/6e2bb6da-9048-4ed0-be81-1a2f245d674e_20250318T15:47_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] Uh, this is [PII] calling for the provider to check on additional information about a claim that has been denied. Please know this call will be monitored and recorded for quality and training purposes, [PII].
[AGENT][NEUTRAL] OK. Well, I'll be more than happy to assist you with the claim denial clarity, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, the callback number is [PII] direct line. Policy number is 01950971.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] member's name was [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service or the claim number for the claim?
[CUSTOMER][NEUTRAL] That service is January, uh, so the, the claim number is 356-8582.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] 582.
[AGENT][NEUTRAL] I'm waiting for it to come up. Hold on one moment.
[AGENT][NEUTRAL] OK, so I see it here, code 99214 was denied because office visits are not covered on the policy, and code J like juice 3301 was denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK. What's the member's plan name?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, this is the members Medlink. It's a supplemental, um, gap insurance policy.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Is that uh submit link.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much and uh may I have the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII], first name is [PII] Was there anything else I can help you with today, [PII]? You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] But also from my end. Thank you now. Have a great day.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye bye.