AccountId: 011433970860
ContactId: 791e3b0e-4d6c-40c7-92b9-1185892101af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 256119 ms
Total Talk Time (AGENT): 96964 ms
Total Talk Time (CUSTOMER): 75820 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/791e3b0e-4d6c-40c7-92b9-1185892101af_20250506T13:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Good morning. My name is [PII]. I'm calling from a provider's office, and I'm calling on a status on a claim for one of my patients.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][POSITIVE] Thank you. And the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] And member ID number is gonna be.
[CUSTOMER][NEUTRAL] I have 02329702 M as in Mary, L as in Larry.
[CUSTOMER][NEUTRAL] And I'm gonna say 8.
[AGENT][NEUTRAL] Thank you. Hold on one moment. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] Her date of birth I'm it's, I'm sorry. [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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] Um, sorry.
[CUSTOMER][NEUTRAL] It's actually 2 claims.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you pick up the co-payment for the pri from her primary insurance?
[AGENT][NEUTRAL] Um, yes, we're the secondary. We pay towards the copay, deductible and co-insurance after primary.
[CUSTOMER][NEUTRAL] OK, perfect. So the total claim amount was, um, the first claim is going to be
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] 982 $982. date of service, [PII].
[AGENT][NEUTRAL] OK, what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Doctor [PII] or living uh Vital MG Group Holdings.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so for that one, I'm trying to receive the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3593033.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII].
[CUSTOMER][NEUTRAL] 359-3033. OK.
[AGENT][NEUTRAL] And on [PII], we denied the claim. Um, code 99213 was denied because office visits are not covered on this policy.
[AGENT][NEGATIVE] Um, the other two calls were denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] So you don't cover an ultrasound done in the doctor's office? You don't cover co-payments for ultrasound done in office?
[AGENT][NEUTRAL] Um, let me pull up the benefits. Hold on one moment.
[AGENT][NEUTRAL] So no, the member doesn't have the office treatment rider, so the policy is broken down into inpatient and outpatient. So under outpatient, we would pay up to $3500 per calendar year, but they don't have any coverage for the office setting.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So, no office setting. OK, perfect. Um,
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And can I get your name and a reference number?
[AGENT][NEUTRAL] Sure, my name is [PII] like [PII], and there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. Have a great day.
[AGENT][NEUTRAL] You also [PII], was there anything else I can help with?
[CUSTOMER][NEUTRAL] Oh no, that'll be it.
[AGENT][POSITIVE] Alright, thanks for calling APL have a great day bye bye.
[CUSTOMER][NEUTRAL] You too bye bye.