AccountId: 011433970860
ContactId: 82666392-f617-430d-82dc-416bd880c85e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327549 ms
Total Talk Time (AGENT): 91845 ms
Total Talk Time (CUSTOMER): 98472 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/82666392-f617-430d-82dc-416bd880c85e_20250516T21:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good evening. My name is [PII] and I'm calling from provider office. I have some denied claims to discuss.
[AGENT][NEUTRAL] OK, I can get clarification on those claims for you. um, I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] My name is [PII]. It is A alpha, Bravo, H Hotel, I India. Can you please spell your name?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And I mean, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]. Last name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Direct line it is.
[AGENT][NEUTRAL] And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I do. Give me a second, please.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Policy number is
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 01986419.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] My name is [PII]. Date of birth.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. um, do you have the claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim number is
[CUSTOMER][NEUTRAL] 359 8
[CUSTOMER][NEUTRAL] 683.
[AGENT][NEUTRAL] OK that was 359-868-3?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so on this claim, uh, we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Office visits are not covered under this policy.
[AGENT][NEUTRAL] Right, office visits are not covered. Correct.
[CUSTOMER][NEUTRAL] So that's why this claim is denied is not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the balance is member responsibility?
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] So according to your denial, this balance will be moved to the
[CUSTOMER][NEUTRAL] Patient or do, or the, or to the other insurance.
[AGENT][NEUTRAL] We were unable to pay a benefit, however, we do not say what is patient responsibility that is up to the provider.
[CUSTOMER][NEUTRAL] OK. Can I please get your last name initial?
[AGENT][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And call reference number?
[AGENT][NEUTRAL] That would be my first name, last initial and today's date. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] I have one more claim.
[AGENT][NEUTRAL] Is this for the same member?
[CUSTOMER][NEUTRAL] Member is different.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Do you need claim number or?
[AGENT][NEUTRAL] Uh, one moment please. I'm just finishing up some notes. I'll let you know when I'm ready for that.
[CUSTOMER][NEUTRAL] Member ID.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, you can go ahead and just give me that next claim number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 359-865-3.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what was the name and date of birth for this number please?
[CUSTOMER][NEUTRAL] Member name is?
[CUSTOMER][NEUTRAL] 2 E. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. uh, so this claim denial was for the same reason office visits are not covered under this policy.
[CUSTOMER][POSITIVE] Thank you. Thank you, [PII]. Thank you for the information.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So both the claims are denied because the office visits are not covered under the member policy.
[AGENT][NEUTRAL] Was there anything else I can help you with?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. No, I have only 22 claims for today. Thank you.
[AGENT][POSITIVE] Alright, of course, thanks for calling APL have a great rest of your day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.