AccountId: 011433970860
ContactId: 97d42bd7-9625-4d18-98a6-e8fc0d277da7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 195539 ms
Total Talk Time (AGENT): 82812 ms
Total Talk Time (CUSTOMER): 85603 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/97d42bd7-9625-4d18-98a6-e8fc0d277da7_20250417T12:38_UTC.wav
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[AGENT][NEUTRAL] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII], my name is [PII].
[AGENT][NEUTRAL] Hey [PII].
[CUSTOMER][NEUTRAL] How are you this morning?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] I'm good, thank you for asking.
[AGENT][POSITIVE] Awesome.
[AGENT][NEUTRAL] How can I assist you today, [PII]?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] How can I assist you this morning?
[CUSTOMER][NEUTRAL] Um, I'm calling about a claim that we received an explanation of benefits back about, and I'm not understanding the denial reason on the explanation of benefits, and I couldn't find the claim in your claim portal. So can you help me understand the denial, please?
[AGENT][NEUTRAL] Sure. Can I have a callback number for you, [PII] and that policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's 234.
[CUSTOMER][NEUTRAL] 571-3521
[CUSTOMER][NEUTRAL] And I show the policy number is 01888537.
[AGENT][NEUTRAL] And what is this member's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], uh [PII].
[AGENT][NEUTRAL] And what is the claim number that you have?
[CUSTOMER][NEUTRAL] It's 637-379-1.
[AGENT][NEUTRAL] What is the date of service because that's not our claim number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is your procedure called?
[CUSTOMER][NEUTRAL] 99213.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] That was the only procedure code?
[CUSTOMER][NEUTRAL] That's the only one, yes.
[AGENT][NEUTRAL] OK. It looks like office visits are not covered.
[CUSTOMER][NEUTRAL] Office visits just are excluded from the plan? OK, OK.
[AGENT][NEUTRAL] Yes let me give you the correct policy number because the policy number that you provided, that's not ours, so I don't know if that's the primary policy claim number but our claim number is 356-466-8. It's 356-466-8.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that is on the explanation of benefits also, so I apologize, I gave you the wrong number.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] So is this the member responsibility then or is this just um just denied by the plan and we determine that?
[AGENT][NEUTRAL] Um, so this is not a primary insurance company, so I can't tell you if it's the patient responsibility or not, [PII]. All I could just all I could do is verify that we didn't make a payment on this with the balance that was due from the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that means that you still have a, the patient still have a balance, so, but we just didn't make a payment.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, do you have, do you provide reference numbers for the calls?
[AGENT][NEUTRAL] We don't. However, you can use my name in today's date of reference. My name is spelled [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Today's day.
[CUSTOMER][POSITIVE] OK. OK. Well, thank you. You have a good morning.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well, [PII]. Goodbye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.