AccountId: 011433970860
ContactId: 7b40d2fa-5ed7-4c47-acd9-1ee8df11f776
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 177000 ms
Total Talk Time (AGENT): 89307 ms
Total Talk Time (CUSTOMER): 55687 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/7b40d2fa-5ed7-4c47-acd9-1ee8df11f776_20250623T14:20_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from Centera Medical Group provider billing, and I just wanted to get some clarification on a medical claim denial.
[AGENT][NEUTRAL] OK, and [PII], what is your callback number if we are disconnected please?
[CUSTOMER][NEUTRAL] Direct number is [PII].
[AGENT][POSITIVE] Thank you very much, and I'm ready for the policy number, please.
[CUSTOMER][NEUTRAL] OK, it is 02440115.
[AGENT][NEUTRAL] OK, let me just repeat that to you, [PII]. I have that as 02440115.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you, verify the patient's name and date of birth please.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you very much, and you're calling for a clarification on your denial. I can certainly help you with that.
[AGENT][NEUTRAL] Do you have that claim number? You're welcome or that date of service until the charge amount. OK, great.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] Yep, um, claim number is 357-076-2.
[AGENT][NEUTRAL] OK, let me get that pulled
[CUSTOMER][NEUTRAL] Data service is [PII] of this year.
[AGENT][POSITIVE] OK, thank you so much. One moment please, and let me get that pulled up and thank you for having that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and it shows that the claim denied office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you give me any more clarification about what the policy does cover?
[AGENT][POSITIVE] Of course I can go over the benefits with you. One moment please, and get that pulled up for you as well.
[AGENT][NEUTRAL] OK, please note verification of benefits provided does not guarantee payment. Um, it covers, excuse me, services inside the office or clinic, but not the office visit fee. It serves, I'm sorry, covers lab fees, uh, DME.
[AGENT][NEUTRAL] Um, it also covers places of service such as a hospital outpatient facility, urgent care, emergency room, a diagnostic testing facility.
[AGENT][NEUTRAL] Covers um physical therapy.
[CUSTOMER][NEUTRAL] OK, and is it like a gap plan for the primary?
[AGENT][POSITIVE] This is this is a secondary that's correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right well I really appreciate that clarification. um, do you have a call reference number?
[AGENT][NEUTRAL] No, but you can use my name in today's date. Um, again, my name is [PII], last initial [PII], and you're very welcome. And anything else I can assist you with, please?
[CUSTOMER][POSITIVE] No, that'll be it. I hope you have a wonderful rest of your week, [PII], and I really appreciate your help.
[AGENT][POSITIVE] Thank you so much for calling. You have a great day as well, [PII]. Thank you. Thank you so much.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm