AccountId: 011433970860
ContactId: a239ecd6-e7da-4df9-8599-d8e8438870a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 188509 ms
Total Talk Time (AGENT): 77577 ms
Total Talk Time (CUSTOMER): 51427 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/a239ecd6-e7da-4df9-8599-d8e8438870a8_20250613T15:34_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] And uh, uh, my name is [PII]. I'm calling from Integrity Medical Group, and I was calling to check status on a claim that I have.
[AGENT][POSITIVE] OK, well, I can definitely help you with the claim status. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 01792105
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Last name is [PII]'s, first name is [PII]. Date of birth [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 and total bill for your claim?
[CUSTOMER][NEUTRAL] Data service I have is uh [PII] and my bill amount is $358.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 350.
[AGENT][NEUTRAL] 8893.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Um, code 99204 was denied because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And code 92567 was denied um because it showed the explanation of benefits showed that primary provided full benefits for that code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. I'll just get a reference number.
[AGENT][NEUTRAL] You're very welcome. Well, there's no call reference number, but you can use my name and today's date. Again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, I just have a general question. So, um, you said office visit is not are not covered. Is it just for this member's policy or American Public life just do not cover medical office visits?
[AGENT][NEUTRAL] Oh, no, this particular member's policy.
[CUSTOMER][POSITIVE] Oh it's for his policy. OK, that's what I was. Thank you. Have a great day.
[AGENT][POSITIVE] Very welcome. Well, thanks for calling APL and I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too, [PII] bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.