AccountId: 011433970860
ContactId: 71210e89-d9c7-4c69-aee7-c15e3a8a2103
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 357220 ms
Total Talk Time (AGENT): 94465 ms
Total Talk Time (CUSTOMER): 94632 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/71210e89-d9c7-4c69-aee7-c15e3a8a2103_20250528T19:29_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] calling from provider's office and I'm checking for the claim denial reason.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] That's [PII]. And this is a direct line?
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 02337756. M as in Mike, I as in igloo, 8.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then you were needing claim status?
[CUSTOMER][NEUTRAL] Yes. Can I give you the date of service?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can help you with that. What is the data service?
[CUSTOMER][NEUTRAL] It's up to.
[CUSTOMER][NEUTRAL] It's [PII] and the charge amount is $1300 even.
[AGENT][NEUTRAL] OK, hold on one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the procedure code for that claim?
[CUSTOMER][NEUTRAL] Yeah, it's um
[AGENT][NEUTRAL] You can just give me one of them.
[CUSTOMER][NEUTRAL] 99214.
[AGENT][NEUTRAL] You can just give me one of them.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we did get that claim in. It was denied office visits or anything done in a doctor's office is not covered.
[CUSTOMER][NEUTRAL] And the patient plan name is?
[AGENT][NEUTRAL] Midlink
[CUSTOMER][NEUTRAL] And there's a gap insurance?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And uh it does not cover office visit?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK. And this claim was denied as a duplicate on uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] Right, because we already processed it one time and we got it a second time and it was denied as a duplicate. But the first time we denied it, it was denied as office visits and uh services done in the doctor's office not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you tell me the version of my day?
[AGENT][NEUTRAL] So it
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was denied [PII].
[CUSTOMER][NEUTRAL] And your name is? Can you please spell me out?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] If the primary claim process is copay, then it will be the patient responsibility, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can, can you tell me the reference number for this call?
[AGENT][NEUTRAL] We do not have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for the same patient, I have one more date of service.
[AGENT][NEUTRAL] And what's that date of service?
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] What's the data service?
[CUSTOMER][NEUTRAL] Yeah, and the date of service is [PII] and the charge amount is the same. It's $1300 even.
[AGENT][NEGATIVE] It was denied for the same reason office visits are not covered.
[AGENT][NEUTRAL] And services done in the doctor's office is not covered.
[CUSTOMER][NEUTRAL] And can you tell me the date for this one?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Bye-bye. Have a nice day.
[AGENT][POSITIVE] Thank you, [PII] for calling APL. You as well. Bye-bye.