AccountId: 011433970860
ContactId: 834ac10b-b22b-45e5-956b-4a9ecaa3778e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368260 ms
Total Talk Time (AGENT): 131459 ms
Total Talk Time (CUSTOMER): 89906 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/834ac10b-b22b-45e5-956b-4a9ecaa3778e_20250508T15:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi there, my name is [PII] from provider's office looking for claim status.
[AGENT][NEUTRAL] OK, well, I can definitely 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] Yep, um, my direct line is [PII] and the policy ID number is 02536181.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] I don't know if I'm saying it right, but uh date of birth is [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, yes, I have two, the first data service is [PII]. The amount is.
[CUSTOMER][NEUTRAL] 362.
[AGENT][NEUTRAL] OK, and the second one?
[CUSTOMER][NEUTRAL] 12 to 24 Beaumont 405.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold while I pull the claims?
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] Alright, thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] First one is this one.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you so much for holding. So for the first day of service [PII], um we received that claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 1801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because office visits are not covered on this policy?
[CUSTOMER][NEUTRAL] Oh, OK, because both services are um office visits.
[AGENT][NEUTRAL] Right, that's why the claim was denied.
[CUSTOMER][NEUTRAL] OK, um, and that's for [PII].
[CUSTOMER][NEUTRAL] Second
[AGENT][NEUTRAL] No, this is for [PII], the first data service you gave me.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, I thought, I thought you meant, I thought you meant [PII]. OK, so office visit is not covered, OK.
[AGENT][NEUTRAL] And then let me get the 2nd 1 for you. Hold on 1 2nd.
[AGENT][NEUTRAL] And for the 2nd, 0, let me know when you're ready for the 2nd 1.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] OK, um, for the second one, we also received that on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 1810.
[AGENT][NEUTRAL] And um we process the claim on [PII].
[AGENT][NEUTRAL] Code 99213 was denied because office visits are not covered on this policy.
[AGENT][NEUTRAL] But code 69,210 was paid $112.39.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Um,
[CUSTOMER][NEUTRAL] Let me see uh.
[CUSTOMER][POSITIVE] Alright, that should be good. Alright, um, thank you so much and um so.
[CUSTOMER][NEUTRAL] The member's benefit, what does it cover?
[AGENT][NEUTRAL] So, um, for the secondary policy, we cover inpatient and outpatient um facilities. So they in or sorry, their outpatient covers treatment done in the office, but for like 99213 or like the place of service charge, the facility, that's not covered, only the treatment in the office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right perfect thank you so much um and do you provide a reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, I'm sorry, what was your first name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, not by myself or nothing.
[AGENT][POSITIVE] Alright, thanks for calling APO. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.