AccountId: 011433970860
ContactId: a456aba1-42bc-4701-9e7a-059a00fee45b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 463679 ms
Total Talk Time (AGENT): 183617 ms
Total Talk Time (CUSTOMER): 104445 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/a456aba1-42bc-4701-9e7a-059a00fee45b_20250106T13:55_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from provider's office checking on the client status.
[AGENT][NEUTRAL] Hey, your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you're needing claim status, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] And how many claims [PII], do you have to check status on today?
[CUSTOMER][NEUTRAL] Only one claim for one patient, that's all.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And what is that patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is going to be D as in Delta 46401153.
[AGENT][NEUTRAL] OK, now, [PII], that is a 90 degree benefit number. That is not a number that I can look up a policy with APL.
[CUSTOMER][NEUTRAL] One, yeah, no, no, I do have, I do have the policy number. Shall I provide you with that?
[AGENT][NEUTRAL] That's what you're saying that's what I need.
[CUSTOMER][POSITIVE] Yeah, I do have another policy number. I gave you the wrong, wrong one. I'm so sorry.
[AGENT][NEUTRAL] That's OK, that's OK.
[CUSTOMER][NEUTRAL] Yeah, that is 02457866.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Date of service [PII] $15 even 15.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] OK, so this claim was received, [PII]. The received date was [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3541644.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this claim was denied?
[AGENT][NEUTRAL] And just one moment please.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][NEUTRAL] OK, so the claim was denied and the reason for the denial, [PII] states the medical test for this state of service is not a covered diagnostic test. Therefore, no benefit is payable for this claim.
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, the DXR 07.9 is not valid?
[AGENT][NEUTRAL] The test.
[AGENT][NEUTRAL] The diagnostic, the medical test for this state of service is not covered under this limited benefit plan.
[AGENT][NEUTRAL] This is not major medical insurance, [PII].
[AGENT][NEUTRAL] The covered tests include an MRI, CAT scan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Radio, um thyroid uptake test, an RAIU, a CT PET scan.
[AGENT][NEUTRAL] Angiogram, barium minima or lower GI series. Myelogram, nuclear stress test, arteriogram, barium swallow swallow, upper GI series, a sleep study, or transesophageal echocardiogram.
[CUSTOMER][NEUTRAL] OK, so the X-ray will be not covered under this patient's plan, right?
[AGENT][POSITIVE] That is correct. Mhm.
[CUSTOMER][NEUTRAL] OK, one moment, just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Yeah, thank you so much for patiently waiting. You're stating.
[AGENT][POSITIVE] Yes, you're welcome.
[CUSTOMER][NEUTRAL] Yeah, um, only extra will be not covered or any radiology service will be not covered for this patient's plan.
[AGENT][NEUTRAL] I read the remark. The medical test.
[AGENT][NEUTRAL] For this state of service?
[AGENT][NEUTRAL] is not a covered diagnostic test.
[AGENT][NEGATIVE] Therefore, no benefit is payable for this claim.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Yes, ma'am. And if you need a copy of the
[CUSTOMER][NEUTRAL] May I get the reference number for today's call?
[AGENT][NEUTRAL] Yes, if you need a copy, [PII], of the explanation of benefits for this claim, you can print that from our portal, mhm at secured.
[CUSTOMER][NEUTRAL] Yeah, may I, yeah, yes.
[CUSTOMER][POSITIVE] Yes, yes, I do.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank, any possible, yeah, any possible way to some, uh, send the uh to the fax number?
[AGENT][NEUTRAL] And the reference number?
[AGENT][NEUTRAL] Do you not have access to the internet?
[CUSTOMER][NEUTRAL] Yeah, I will check with my supervisor. It's OK, not a problem. What is the reference number?
[AGENT][NEUTRAL] It is my name along with today my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Yeah, thank you. Your name is [PII], right? [PII]?
[AGENT][POSITIVE] That is correct. Yes, ma'am. Uh-huh.
[CUSTOMER][POSITIVE] Thank you so much for helping me. Have a wonderful day. Bye bye.
[AGENT][POSITIVE] I hope you have a wonderful day as well, and if that's all I can help you with, thank you again, [PII] for calling APL.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Uh-huh