AccountId: 011433970860
ContactId: 8969be03-b328-4509-9d57-e56462f81186
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285619 ms
Total Talk Time (AGENT): 107915 ms
Total Talk Time (CUSTOMER): 91666 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/8969be03-b328-4509-9d57-e56462f81186_20250204T19:26_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] It's [PII] calling from provider's office regarding claims.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claims. Did you say your name was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] All right and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And the member's policy number?
[CUSTOMER][NEUTRAL] 202556244.
[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][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII] for she and date of birth, [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] It's [PII].
[CUSTOMER][NEUTRAL] And build on $678.38.
[AGENT][NEUTRAL] $678.38.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I believe I just located the claim. I'm waiting for the total bill. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So shall we received it.
[CUSTOMER][NEUTRAL] OK, can I say the claim number?
[AGENT][NEUTRAL] Small received the claim on [PII].
[AGENT][NEUTRAL] Claim number is 353.
[AGENT][NEUTRAL] 963 6.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider.
[CUSTOMER][NEUTRAL] And then [PII] get out on the plane for the rider.
[AGENT][NEUTRAL] $132.29.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And did you need that checking information?
[CUSTOMER][NEUTRAL] Actually, I had a question. Uh, the claim was paid, uh, particularly, partially paid and denied the CPT code 99202.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Um, this claim only includes codes 1,711,017,000 and 99204. 99204 was denied. Let me see what the reason is. Hold on one moment. Looks like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK. So, special office visit not covered under the patient plan, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Could you double check one more time?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So, we can build the, so we can build the patient?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because we're not the major medical insurance company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you send me a copy of your withdrawal fax?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] will be
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, so I'll go ahead and fax this over to you now. And was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Hm, can I get the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name on today's date, and that's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for the information, [PII]. Have a good day and bye for now.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] OK.