AccountId: 011433970860
ContactId: 7e111021-a060-43c8-8f20-f8b247d17215
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376559 ms
Total Talk Time (AGENT): 119911 ms
Total Talk Time (CUSTOMER): 172821 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/7e111021-a060-43c8-8f20-f8b247d17215_20250326T20:36_UTC.wav
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[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII] how.
[CUSTOMER][NEUTRAL] Hello. Hi. This is [PII].
[AGENT][NEUTRAL] Can I help you?
[CUSTOMER][NEUTRAL] Yes, hi. This is [PII] calling for orthopedic Solution Management. Uh, to check on additional information about the claim that has been denied. Please note call will be monitored, recorded for the quality and training purposes, OK? And uh you said that your name is [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] How are you doing, [PII]?
[AGENT][NEUTRAL] And Ava, you're, you're stating you need and.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Yes, ma'am. Thank you. And what is your callback number, Ava?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And you said that you were needing additional information on a claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And what is the member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Member policy number is 60801.
[AGENT][NEUTRAL] That's um our electronic payer ID.
[CUSTOMER][NEUTRAL] Um, one moment, let me just have a look.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Member ID.
[CUSTOMER][NEUTRAL] Policy number 02574927.
[AGENT][NEUTRAL] OK, can you give me that again, please?
[CUSTOMER][NEUTRAL] 02574927
[CUSTOMER][NEUTRAL] 57228
[AGENT][NEUTRAL] One moment while I get the member's information pulled please.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And any information that I do provide for you Ava will be a verification of benefits and not a guaranteed payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the birth date is [PII].
[CUSTOMER][NEGATIVE] With a pay back.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] I.
[AGENT][POSITIVE] I said thank you.
[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] [PII]. Total charge amount $123.95.
[AGENT][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] What's.
[AGENT][NEUTRAL] You said the date of service [PII].
[AGENT][NEUTRAL] 5, is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And what is, uh-huh.
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Uh, give me a second. Let me just verify. $640 even.
[AGENT][NEUTRAL] OK, because you had given me a different amount. So it's 640.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] $640.
[AGENT][NEUTRAL] OK, and do you already have the claim number? Yes, ma'am, do you have the claim number?
[CUSTOMER][NEUTRAL] Yes, 40.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] 357-414-2.
[AGENT][POSITIVE] That is correct. So how can I help you with that claim today?
[CUSTOMER][NEUTRAL] A general claim status.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] The reason for the denial state office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go.
[AGENT][NEUTRAL] And the other remark?
[AGENT][NEUTRAL] states this policy does not provide a benefit in which no charges were incurred.
[CUSTOMER][NEUTRAL] One moment. What about procedure code 99214?
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] Office visits are not covered under this policy.
[CUSTOMER][POSITIVE] Good job.
[CUSTOMER][NEUTRAL] Uh, non-covered has like patients policy providers contract.
[AGENT][NEUTRAL] Patient.
[CUSTOMER][NEUTRAL] One cover as the patient's policy. And which policy, OK. Member's plan. And uh what is the member's plan name?
[AGENT][NEUTRAL] Members's plan
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] Med link.
[AGENT][NEUTRAL] The supplement policy.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] Really thank you call reference.
[AGENT][NEUTRAL] And if you need it
[AGENT][NEUTRAL] Yes ma'am, and if you need a copy of this explanation of Benefit saver, we do have a portal that you can print that from by going to secured.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And the reference number, my name and today's date.
[CUSTOMER][NEUTRAL] And call reference?
[CUSTOMER][POSITIVE] OK, [PII]. Ready, thank you for your help and have a great day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, yes, ma'am, you too. If that is all then that I can help you with, thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] I