AccountId: 011433970860
ContactId: a1d98644-62b6-40ed-9488-b8169769780f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226380 ms
Total Talk Time (AGENT): 88918 ms
Total Talk Time (CUSTOMER): 61257 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/a1d98644-62b6-40ed-9488-b8169769780f_20250317T17:44_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] Uh, hey, [PII], very good afternoon. This is, uh, [PII] calling from provider's office.
[AGENT][POSITIVE] Hi [PII], how are you doing today?
[CUSTOMER][POSITIVE] I'm doing great, thanks for asking. What about you?
[AGENT][POSITIVE] I'm doing well, and how may I assist you today?
[CUSTOMER][NEUTRAL] I'm checking for a claim.
[CUSTOMER][NEUTRAL] Your dad
[AGENT][NEUTRAL] The phone went in and out. You said you're checking on a claim.
[CUSTOMER][NEUTRAL] Denial, yes.
[AGENT][NEUTRAL] Denial. OK. Well, I'll be more than happy to help you with the denial, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It will be [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it is 02556241.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] All right, I have the policy here. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that 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] It's uh [PII] uh with the bill amount $270.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] All right, so I'm showing the claim was received on [PII], on [PII]. We um processed the claim, it was denied because office visits are not covered on the claim. Did you need the claim number?
[CUSTOMER][NEUTRAL] Yeah, please go for the claim number.
[AGENT][NEUTRAL] Claim number is 357-076-6.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So office visits are not covered under his patient's plan, that's what he said.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] So we can build this to patients.
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we're not the major medical insurance.
[CUSTOMER][NEUTRAL] I gave that um and we have to do this to someone, right?
[AGENT][NEUTRAL] So I'm not saying that you don't. I'm just saying because we're a secondary insurance, we do not determine patient responsibility. So whatever your process is for outstanding or remaining balances that will be applied here, but we don't determine that for you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So patients plan.
[CUSTOMER][NEUTRAL] OK. And uh what will be the, what will be your last name initial?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And what's the card reference number for today's card?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] Thank you so much for that and uh have a great day ahead. Bye-bye. Stay safe.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can help with?
[CUSTOMER][POSITIVE] Oh, that's all. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling APO bye bye.
[CUSTOMER][NEUTRAL] OK.