AccountId: 011433970860
ContactId: 83afecb0-c170-4854-a21e-fbd6005cb3ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 234970 ms
Total Talk Time (AGENT): 86532 ms
Total Talk Time (CUSTOMER): 62712 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/83afecb0-c170-4854-a21e-fbd6005cb3ed_20250224T16:55_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from provider's office. I need regarding claim denial.
[AGENT][NEUTRAL] OK, I can help you with your claim denial, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] 02549555
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][POSITIVE] Huge more
[CUSTOMER][NEUTRAL] [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 for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yes, [PII] $370 370.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure, yeah.
[AGENT][NEUTRAL] Hold on one moment. And you said it was denied?
[CUSTOMER][NEUTRAL] Yes, CBD 99204 Golden Height.
[CUSTOMER][NEUTRAL] As benefit name not found.
[AGENT][NEUTRAL] Oh, a particular code, OK.
[AGENT][NEUTRAL] Hold on one moment, let me see what this is denied for.
[CUSTOMER][POSITIVE] For sure.
[AGENT][NEGATIVE] Oh, this was denied because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, office visits are not covered by the policy, member's policy.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What's the member's plan name?
[AGENT][NEUTRAL] So this is a Medlik 9. It's a supplemental gap insurance policy.
[CUSTOMER][NEUTRAL] OK, what type of uh plan name? Uh, could you please, uh, it's F 4G.
[AGENT][NEUTRAL] This is not in relation to Medicare or Medicaid.
[CUSTOMER][NEUTRAL] No, I just want to confirm. It is uh Medicare plan type F4 GON.
[AGENT][NEUTRAL] This policy is not in relation to Medicare or Medicaid, it's neither.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me one moment.
[AGENT][NEUTRAL] This policy is 2nd to their Florida Blue policy.
[CUSTOMER][NEUTRAL] OK. So what type of services are covered in members plan?
[AGENT][NEUTRAL] Outpatient um services and inpatient and after admission, outpatient, um, meaning hospital emergency room, urgent care, um, surgery in outpatient facility, there's no in-office setting for this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But no, could it be that but no office visit setting.
[AGENT][NEGATIVE] There's no in-office setting coverage on this policy. Office visits aren't covered by the policy.
[CUSTOMER][NEUTRAL] OK, car reference number.
[AGENT][NEUTRAL] Um, there's no call reference number. You can use my name in today's date, and that's [PII] First initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much for the help. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome, [PII], and thanks for calling APL. Bye-bye.