AccountId: 011433970860
ContactId: 9b25583a-d6f9-4670-8f1f-3c10b0b7d1c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347209 ms
Total Talk Time (AGENT): 134794 ms
Total Talk Time (CUSTOMER): 93762 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/9b25583a-d6f9-4670-8f1f-3c10b0b7d1c1_20250402T19:45_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] Yeah, my name is [PII] calling from broad checking on the claim status.
[AGENT][POSITIVE] OK, [PII]. Well, I'll be more than happy to help you with the claim status. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] One claim.
[AGENT][NEUTRAL] Alright, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02114030.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, date of birth, uh [PII].
[AGENT][NEUTRAL] Thank you, 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 and the total bills?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII] total charge amount 44043.
[AGENT][NEUTRAL] [PII] $443.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Internal Medicine of Saint Louis.
[AGENT][NEUTRAL] Thank you, and I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 35353.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 27
[CUSTOMER][NEUTRAL] One moment. No, it's, it's in [PII], right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Claim received, it's claim received date uh [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, sorry for that.
[AGENT][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Yeah, yeah, you and I mean the claim number.
[AGENT][NEUTRAL] 353-276-4.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] Code 99214 was denied because office visits are not covered by the policy.
[AGENT][NEUTRAL] Code 99396 was denied because the policy only provides benefits listed in the um policy.
[CUSTOMER][NEUTRAL] Both coats are non-covered under the.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I be the patient?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility. That would be up to um your policies with the remaining balances.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] May I know how much amount still uh it's uh pending?
[CUSTOMER][NEUTRAL] Like, uh,
[CUSTOMER][NEUTRAL] It's $25 right?
[AGENT][NEUTRAL] What do you mean by amount pending?
[CUSTOMER][NEUTRAL] Uh, like how much amount, uh, you get from primary, you need to pay from primary.
[CUSTOMER][NEUTRAL] It's $25 right?
[AGENT][NEUTRAL] I don't understand the um question. So you, we don't pay anything from primary, we pay after primary, but we couldn't pay because it's not covered by their policy with APL.
[CUSTOMER][NEUTRAL] OK, may I know your name?
[AGENT][NEUTRAL] Are you asking
[AGENT][NEUTRAL] Sure, my name is [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You, you said something. I'm, I, I interrupt you. Could you please continue further?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me think about what I was saying, um.
[AGENT][NEUTRAL] I don't remember. I think I was, we were talking about the amount. I was trying to see if you were asking about the allowed amount. I don't, I didn't understand the question.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, load on.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Actually loan amount.
[AGENT][NEUTRAL] It's not really a particular allowed amount. The office treatment rider would have pulled from the outpatient max, which is $1000 per calendar year.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] All right, [PII], was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No thank you. May I know the call reference number?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, and again, that's [PII] A, first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Yeah, thank you bye bye.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] OK