AccountId: 011433970860
ContactId: 7716f622-4fa0-46c8-bc05-f0349b31c615
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 188500 ms
Total Talk Time (AGENT): 68743 ms
Total Talk Time (CUSTOMER): 67478 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/7716f622-4fa0-46c8-bc05-f0349b31c615_20250128T19:20_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office looking for claim nails.
[AGENT][NEUTRAL] You were looking, you're looking for a claim denial?
[CUSTOMER][POSITIVE] Uh, yes, you're right.
[AGENT][NEUTRAL] So have you received a response and the claim was denied?
[CUSTOMER][NEUTRAL] Uh, yes, it is, uh, we got the correspondence that it's page 0.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me get the policy number and the claim number that you have, [PII].
[CUSTOMER][NEUTRAL] Uh-huh, yes. Uh, the policy number is D as in Delta 47,600,140.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] 354-448-6.
[AGENT][NEUTRAL] And a phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Extension of [PII].
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the patient's uh name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is uh [PII] and the date of birth of
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thanks for that, [PII]. And you're wanting to clarify the denial reason or?
[CUSTOMER][NEUTRAL] Oh yeah, just to clarify it, it is still is non-covered charges. So can I know why it is non-covered?
[AGENT][NEUTRAL] So on the back of the explanation of benefits that you have should be a remark code.
[AGENT][NEUTRAL] And that remark code sites, one moment. Do you have the ELB in front of you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh, yes.
[AGENT][NEUTRAL] OK. Do you see a remark code of DHO 28?
[AGENT][NEUTRAL] On there.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] Says the above reference policy does not provide a benefit for anesthesia services.
[CUSTOMER][NEUTRAL] Uh, no, actually.
[CUSTOMER][NEUTRAL] Uh, just a minute.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yes, it is the reference policy does not provide the benefits for anesthesia services.
[AGENT][NEUTRAL] Yeah, that's the reason for the denial of the claim.
[CUSTOMER][NEUTRAL] So, can we be a number for it?
[AGENT][NEUTRAL] We do not determine patients responsibility.
[CUSTOMER][NEUTRAL] But as for the member's plan, nonhe services are not covered, right?
[AGENT][NEUTRAL] This is the patient's policy, correct.
[CUSTOMER][POSITIVE] Got it. Thank you. And uh what is your name?
[AGENT][NEUTRAL] You'll use my name in today's date as reference for today's call. It's [PII].
[AGENT][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] And first initial of my last name is [PII], are you calling from the anesthesiologist's office or are you a third party?
[CUSTOMER][NEUTRAL] I'm calling from the office.
[AGENT][NEUTRAL] OK. Anything else I can help out with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you. Have a nice day. Take care. Bye-bye.
[AGENT][POSITIVE] You, you're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye.