AccountId: 011433970860
ContactId: 887f65ea-96f9-40ff-9c62-d20639e7aa56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289709 ms
Total Talk Time (AGENT): 82921 ms
Total Talk Time (CUSTOMER): 116810 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/887f65ea-96f9-40ff-9c62-d20639e7aa56_20250404T18:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, I'm [PII] calling for provider to check on the plan status.
[AGENT][POSITIVE] All right, I'm happy to check on a claim for you today. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, I do have.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] That is 01897877.
[CUSTOMER][NEUTRAL] Well I
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] And what's your first name and a callback number, please?
[CUSTOMER][NEUTRAL] Sure. My name is [PII] and the callback number is [PII].
[AGENT][NEUTRAL] All right. And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure, uh, the date of service which is [PII] for $145 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Oh really.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so it looks like we did receive a claim for this state of service. It looks like claim was denied, office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Not covered. So could you please help me with the MRI, sorry, the claim number?
[AGENT][NEUTRAL] The claim number is going to be 352.
[AGENT][NEUTRAL] 9386.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, not cover under mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] CPT code which is 99213. Is there any specific reason why the office visit is not covered under the patient uh plan?
[AGENT][NEUTRAL] It's just not covered under the member's policy. We're the secondary insurance.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so we can change the CPT code and we can rebuild it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can't advise on billing. I'm just letting you know that office visits are not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Could you please help me with the correct uh mailing address?
[AGENT][NEUTRAL] Mailing address is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. And uh what is the time referring limit?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] Oh time frame. OK, can I get the call reference number for this call?
[AGENT][NEUTRAL] Call reference would be my name with my last initial, then today's date. My name again is [PII], which is [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much. Have a great day, bye.
[AGENT][NEUTRAL] You too, bye bye.
[CUSTOMER][NEUTRAL] Bye.