AccountId: 011433970860
ContactId: ac1b5a31-dfc3-46fe-9131-e4301f1aa118
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317269 ms
Total Talk Time (AGENT): 54021 ms
Total Talk Time (CUSTOMER): 80711 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/ac1b5a31-dfc3-46fe-9131-e4301f1aa118_20250611T20:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, my name is [PII]. I'm calling from Last year I Center and I was needing to check on a denial, um, and it looks like the data service.
[CUSTOMER][NEGATIVE] Is going to be for [PII] and whenever I called the day that the patient was actually in our office, they mentioned that she would be covered through preventative care because she is diabetic, but I just received a denial from you all.
[AGENT][NEUTRAL] OK. Do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, of course, let me get to it, it is 02582808.
[AGENT][NEUTRAL] No, patient name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] and that's ERP Date of birth [PII].
[AGENT][NEUTRAL] And do you have the claim number?
[CUSTOMER][NEUTRAL] Um, let me see I can find it on here reference policy.
[AGENT][NEUTRAL] Or what was the date of service again?
[CUSTOMER][NEUTRAL] Claim, yes, I'm sorry, just on the claim number, um, the date of service is gonna be [PII]. Claim number is 359-799-99.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, like said the benefit maximum has been met. They do have like a specific number of visits allowed in a calendar year, so let me, let me see if that's what it was.
[CUSTOMER][NEUTRAL] OK, yeah, because whenever I call they mentioned I think it was like 150, yes, they cover a max of 150 up to 4 times a year is what they said to me that day.
[AGENT][NEUTRAL] I'm trying to see where we where it was met prior um let's see.
[AGENT][NEUTRAL] OK, physician's office.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] [PII] was the patient, correct?
[CUSTOMER][POSITIVE] That is correct, yeah, ERP ERP.
[AGENT][NEUTRAL] I only show she had 3 visits. Um, let me make sure.
[AGENT][NEUTRAL] OK, let me see
[AGENT][NEUTRAL] OK, it looks like what what happened is another provider submitted for an office visit on the same date before we received your claim and we paid out the 150 for that provider.
[AGENT][NEUTRAL] So she, it looks like
[CUSTOMER][NEUTRAL] OK, so there's nothing we can do.
[AGENT][NEUTRAL] Yeah, it looks like she went to 2 providers on the same day and we just got their plane first.
[CUSTOMER][POSITIVE] OK, alright then well thank you so much.
[AGENT][POSITIVE] Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too.