AccountId: 011433970860
ContactId: 919d4799-8603-4129-add5-175453564783
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 674580 ms
Total Talk Time (AGENT): 144152 ms
Total Talk Time (CUSTOMER): 163553 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/919d4799-8603-4129-add5-175453564783_20250402T18:01_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, uh, good afternoon.
[CUSTOMER][NEUTRAL] Uh, my name is [PII], uh, from provider's office.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, regarding the claims.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah. Uh [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy number starts with number 024.
[CUSTOMER][NEUTRAL] 5 sorry, 02451543 M for Mike, L for Lima, number 8.
[AGENT][NEUTRAL] And may I have the name of the facility you're calling from, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, from Serena Sara Chiropractic.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, and may I have the name and date of birth?
[CUSTOMER][NEUTRAL] And uh you want your name, please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Wonderful. OK. The patient name is um
[CUSTOMER][NEUTRAL] [PII]. And date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, uh, [PII].
[CUSTOMER][NEUTRAL] And the total charge with the before primary, 335.
[AGENT][NEUTRAL] OK. All right, let me see if I can find this claim for you and that was [PII], correct?
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] OK, and for future, you can check claim status online through our website at [PII] and that's just optional. And let me pull this ELV.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, it's gonna be one minute it's pulling up.
[CUSTOMER][NEGATIVE] I think this claim is denied, I believe.
[AGENT][NEGATIVE] Mhm. Yes, it is denied. Um, it was processed [PII] and the denial reason is that office visits are not covered and service rendered in office is not covered.
[CUSTOMER][NEUTRAL] Yeah, but you know what, we just see the remittance, but since this is chiropractic, right? Usually, chiropractics of reed in only office, right? So, how come, uh, they denied this is not covered. Can you double-check, please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because we do not cover anything in office, any specialists, including a chiropractic, is not covered. So specialist visits or PCP visits are not covered.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm. You mean, uh, chiropractic?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, we don't, uh, cover the chiropractic.
[AGENT][NEUTRAL] Correct, it's not covered under this plan, under the member's plan.
[CUSTOMER][NEUTRAL] OK, OK. We just confused with the, you know, uh, the denial description, uh, so that's why, OK, just give me one second, uh.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Even all courts were denied, right? Uh.
[AGENT][NEGATIVE] Anything done in the chiropractic. Correct, yes. Everything is going to be denied because it's just not covered. It's not a covered service under the policy.
[CUSTOMER][NEUTRAL] All quotes for the same reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because uh primary, uh, primary allowed actually. So that's why. Um, so, uh, American Public Life usually uh doesn't cover the chiropractics.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It depends on the policy. There's some policy that does um that do, there's some that don't, so this one doesn't.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] For this member.
[CUSTOMER][NEUTRAL] Based on this patient policy. So we can build the patient, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't, we cannot tell you what to do with the claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. I think, um, just, just bear with me. uh I have another data service to look but I hope it's the 79. Uh, can you check for [PII]?
[AGENT][NEUTRAL] [PII], sure.
[CUSTOMER][NEUTRAL] Uh, for the documentation, I know it's the same denial, uh, I just want to.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] OK. Yeah, it is the same denial.
[CUSTOMER][NEUTRAL] Uh, for the 1127, it's a 20.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 79, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] So it's not covered.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Actor, can you uh send this copy of the EOB uh through fax for this 1127 loan.
[AGENT][NEUTRAL] OK. What is the fax number?
[CUSTOMER][NEUTRAL] 954.
[CUSTOMER][NEUTRAL] 680.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 6055.
[AGENT][NEUTRAL] OK, that's 9546806055.
[CUSTOMER][POSITIVE] Uh, yes, you got it right.
[AGENT][NEUTRAL] Is it to your attention?
[CUSTOMER][NEUTRAL] Uh, yeah, you can use my name.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][POSITIVE] Uh, yeah, you're fine. Take your time.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Well thank you for holding and being patient for Mr. [PII]. I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Uh, I think we are done. Yeah, thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good afternoon.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Mm.