AccountId: 011433970860
ContactId: 968c83fa-14f2-4914-9c91-6134c7323ff4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 221740 ms
Total Talk Time (AGENT): 120463 ms
Total Talk Time (CUSTOMER): 65876 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/968c83fa-14f2-4914-9c91-6134c7323ff4_20250404T12:41_UTC.wav
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[AGENT][NEUTRAL] Contacting HTM. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh hey [PII], my name is [PII] I'm calling from the parts office for the claims for the medical claims.
[AGENT][NEUTRAL] OK, and do we have more than one claim that we're looking for?
[CUSTOMER][NEUTRAL] No, I have only one claim.
[AGENT][NEUTRAL] OK, and what is that policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 01826086. M as in Mike, L as in Lima, 8.
[AGENT][POSITIVE] Thank you. I can certainly help with the claim and the insured's name and date of birth, please.
[CUSTOMER][NEUTRAL] Uh, it's [PII] and the date of birth is [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][POSITIVE] I appreciate that. What is the service we're looking for this individual?
[CUSTOMER][NEUTRAL] Data service is [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $1,441 even.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not sure that I've got your claim. Um, let me just look at this. I've got one claim for that data service. I'm not sure that that's the date that's the bill amount that we have. So just let me check here. Is this for an office visit?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, can you check with the bill amount $55?
[AGENT][NEUTRAL] OK, um, I do have an office visit for that date, uh, but it's not, um, it's not for that billed amount. I, I will go ahead and tell you though that office visits are, yes, uh-huh.
[CUSTOMER][NEUTRAL] Is it for the uh billed amount $55 or?
[CUSTOMER][NEUTRAL] Uh, can you check with the bill amount $829?
[AGENT][NEUTRAL] OK, yes, thank you. Um, that claim number, uh, [PII], that's, that's the one. that claim number is 3576878. I didn't want to give you the wrong information. So the claim was was received by us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we received your claim on the [PII]. We processed it on the [PII], but this policy doesn't cover um office visits. It covers treatment within the physician's office, but not the office visit co-pay itself.
[AGENT][NEUTRAL] So, um, we were unable to pay that, and that's the, the, your claim 3576878 with a denial.
[CUSTOMER][NEUTRAL] So you're saying that this claim is denied because this is not an office visit, right?
[AGENT][NEGATIVE] It it's, it's denied because it is an office visit. The, the, uh, policy will um pay for treatment.
[AGENT][NEUTRAL] Within the physician's office, but not the office visit co-pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on. So is that going to be a patient's responsibility?
[AGENT][NEUTRAL] Uh, well, you'd have to, I, I can't really tell you that. I can just tell you that, that we aren't obligated to, to pay the, the claim. That's the only thing really that I can tell you.
[CUSTOMER][NEUTRAL] So you do not pay you guys, uh, do not pay for the office visit copays, right?
[AGENT][POSITIVE] That, that is correct, right.
[CUSTOMER][NEUTRAL] OK, what's the conference number?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII], and we'll use that in today's date as a reference. Is there anything else I can help with?
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] OK, thanks for contacting you have a
[CUSTOMER][NEUTRAL] No, thank you