AccountId: 011433970860
ContactId: b649a277-020e-4531-b817-4a74bf6700f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 159100 ms
Total Talk Time (AGENT): 85490 ms
Total Talk Time (CUSTOMER): 40161 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/b649a277-020e-4531-b817-4a74bf6700f3_20250407T15:36_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] Hi, my name is [PII], excuse me, and I am just needing clarification on a claim denial.
[AGENT][NEUTRAL] OK, well, I can help you with the claim denial clarity and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then the policy number is 02559544.
[AGENT][POSITIVE] OK, hold on one moment, thank you for that.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [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 claim number or the date of service for the claim?
[CUSTOMER][NEUTRAL] Claim number is 358-082-3.
[AGENT][NEUTRAL] OK, and that claim was denied because office visits are not covered on the policy. And um what questions did you have in reference to the claim?
[CUSTOMER][NEUTRAL] So no type of office visit is covered?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. So for the secondary policy is broken down into inpatient and outpatient. So they, she does have the office treatment rider in which the treatment in the office could be covered, but if you're billing for like a 99213 or 99214 like place of service codes, there is no like in-office.
[AGENT][NEUTRAL] Coverage for the facility, just the treatment because of the rider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect is there a call reference number? No, not at all.
[AGENT][NEUTRAL] Did I confuse you? You OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a call reference number?
[AGENT][NEUTRAL] So there's no call reference number, um, but you can use my name and today's date. The first initial of my last name is [PII].
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're welcome, [PII], and thanks for calling APL. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] Alright, have a great week. You're welcome. Bye bye.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thank you. Bye bye.