AccountId: 011433970860
ContactId: a24e5ad4-17dd-42b4-a2fb-cf9598c9e601
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264500 ms
Total Talk Time (AGENT): 86050 ms
Total Talk Time (CUSTOMER): 77791 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/a24e5ad4-17dd-42b4-a2fb-cf9598c9e601_20250611T18:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], hi. I'm checking on a claim. Um, this is [PII] calling from Day and Night Pediatrics and the date of service for um [PII].
[AGENT][NEUTRAL] OK, I'm happy to check on a claim. Do we have the patient's policy number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, 01634912 ML 7.
[AGENT][NEUTRAL] Name and date of birth, please?
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And then just to reconfirm date of service [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And then do we have a builded amount?
[CUSTOMER][NEUTRAL] Well, the original bill amount is 623, but what we're looking for is a line of 99212 if it paid for the co-pay.
[AGENT][NEUTRAL] OK, let me take a look here.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so we did get the claim, it looks like um the office visit is not covered by the members secondary plan, so that was denied.
[CUSTOMER][NEUTRAL] OK, and when did you receive it?
[AGENT][NEUTRAL] Uh, let me give you that date, one moment.
[AGENT][NEUTRAL] Claimants received [PII] and then processed on [PII].
[CUSTOMER][NEUTRAL] OK, that's why is it that you were able to cover it in February but not in March?
[AGENT][NEUTRAL] Let me go back to.
[AGENT][NEUTRAL] Do you have the date of service in February by chance or no?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And let me see.
[AGENT][NEUTRAL] Do you have a claim number for that one because I'm just not seeing the 99212 right off the bat.
[CUSTOMER][NEUTRAL] No, there it's 99214. It's for an office visit, the same as 99.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see here one second.
[CUSTOMER][NEUTRAL] I see um 99214.
[AGENT][NEUTRAL] Was it for vital?
[AGENT][NEUTRAL] Was that for vital Group Holdings?
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[CUSTOMER][POSITIVE] Mhm. Correct, yes.
[AGENT][NEGATIVE] So I showed that that actually denied for the same reason. The payment on that particular date of service was for a procedure code 87,880.
[CUSTOMER][NEUTRAL] Got it. I see what you're saying.
[AGENT][NEUTRAL] 99214 yeah, shown denied.
[CUSTOMER][NEUTRAL] So, OK, alright, perfect, um, your name was?
[AGENT][NEUTRAL] My name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] OK, [PII] and a reference number for this call, please?
[AGENT][NEUTRAL] Call reference would be my name with today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No initial for last name?
[AGENT][NEUTRAL] You can use my initial which is [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you very much. You have a wonderful day.
[AGENT][POSITIVE] You're welcome. You too, bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.