AccountId: 011433970860
ContactId: 997dc28b-ccf4-4e39-999b-dfd3aead671d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400510 ms
Total Talk Time (AGENT): 129307 ms
Total Talk Time (CUSTOMER): 146081 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/997dc28b-ccf4-4e39-999b-dfd3aead671d_20250529T17:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] Uh, could you please help me with the claim?
[AGENT][NEUTRAL] I can help you with the claim. Um, can you give me your name one more time?
[CUSTOMER][NEUTRAL] Sure. It's [PII], and my last initial is [PII].
[AGENT][NEUTRAL] OK, and a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] And what's the policy number for the claim?
[CUSTOMER][NEUTRAL] And the policy number. You want the ID number or NPI or the member policy number?
[AGENT][NEUTRAL] Uh, the policy number or it might say policy certificate number.
[CUSTOMER][NEUTRAL] Mm, uh, I don't understand. Like, if you can just say specifically?
[AGENT][NEUTRAL] Do you have the policy number or what is it, what numbers do does it show on there?
[CUSTOMER][NEUTRAL] The member policy number is 02509857.
[AGENT][NEUTRAL] OK, I'm sorry one more time 02.
[CUSTOMER][NEUTRAL] 509857.
[AGENT][NEUTRAL] Alright, one moment while I look that up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. It's
[CUSTOMER][NEUTRAL] [PII], then [PII], [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] I do have the date of service and as well as claim number. Which one do you want?
[AGENT][NEUTRAL] Um, what's the claim number?
[CUSTOMER][NEUTRAL] It's 3602485.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm showing that we received that claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK. So my question is that,
[AGENT][NEUTRAL] It looks like we paid 72 0 go ahead.
[CUSTOMER][NEUTRAL] Yeah, so sorry for interrupting. So, you, we got a denial for 99213 as a non-cover. May I know, is it like uh why is it non-covered?
[AGENT][NEUTRAL] Um, so it covered partially, uh, it looks like we paid $72.68.
[AGENT][NEUTRAL] Let me see why the other parts were denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it looks like this policy does not cover office visits, um, so the office visit portion of this claim was denied.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. So basically, you don't cover the office visit. OK, no worries. Um, I have one more question. Would you be able to help me with that as well?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Is it for the same patient or a different patient?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I think it's a different patient. It's a different patient.
[AGENT][NEUTRAL] OK, uh, give me just a moment to close this one out and then I will help you with that next one, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] One more moment please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is the next policy number?
[CUSTOMER][NEUTRAL] And the policy number is 02509855.
[AGENT][NEUTRAL] OK, give me just a moment to look that up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][POSITIVE] Uh that'll be the right.
[CUSTOMER][NEUTRAL] It's [PII], and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Yes, I do have the claim number and it is
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3602454
[AGENT][NEUTRAL] OK. I'm showing that we received that claim on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] We paid an amount of $121.57.
[CUSTOMER][NEUTRAL] Yes. Uh, may I know the denial one?
[AGENT][NEGATIVE] Um, it's the same denial as the last one. This policy also does not cover office visits.
[CUSTOMER][NEUTRAL] OK. May I have the call reference?
[AGENT][NEUTRAL] So we don't have call reference numbers, but you can use my name and last initials in today's date. So [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thanks so much for your help. Really appreciate it. OK. Have a lovely day ahead. Bye-bye.
[AGENT][POSITIVE] Have a great day. Thank you for calling ATL.