AccountId: 011433970860
ContactId: b76988ee-49b5-491e-87e9-3e6f770c9caa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259350 ms
Total Talk Time (AGENT): 84525 ms
Total Talk Time (CUSTOMER): 110744 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/b76988ee-49b5-491e-87e9-3e6f770c9caa_20250418T17:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling uh APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hi, my name is [PII]. How are you?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] I'm also doing good, thank you very much. Looking for a claim status, could you please help me?
[AGENT][NEUTRAL] Sure, I can check on a claim for you. um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] And uh how do you spell out your name?
[AGENT][POSITIVE] OK, thank you. Uh-huh.
[AGENT][NEUTRAL] Uh, [PII]
[CUSTOMER][POSITIVE] Thank you and uh.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] You want the member ID?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] So the member ID is uh.
[CUSTOMER][NEUTRAL] 02542962
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] It's uh [PII] for bill amount $249 even.
[AGENT][NEUTRAL] 249. OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Let me know if you if you want claim number. I have the claim number.
[AGENT][POSITIVE] Oh, that would be great. Yes, please.
[CUSTOMER][NEUTRAL] It's 3541541.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK. Let's see.
[AGENT][NEUTRAL] OK, yes, so we were unable to pay this claim as this policy does not provide a wellness expense benefit.
[CUSTOMER][NEUTRAL] Wellness.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, so this does not cover the wellness expense, um, it needs to say this is a routine service.
[CUSTOMER][NEUTRAL] And you're not covering it?
[AGENT][NEGATIVE] Correct, this policy does not.
[CUSTOMER][NEUTRAL] General medical examination DX OK.
[AGENT][NEGATIVE] This pro uh policy does not have a uh wellness benefit.
[CUSTOMER][NEUTRAL] OK, that is why it is denied, so.
[CUSTOMER][NEUTRAL] What if we can submit a correct treatment with uh a problem-oriented diagnosis?
[AGENT][NEUTRAL] Um, if it was a wellness exam, we would not be able to pay a benefit.
[CUSTOMER][NEUTRAL] OK. No, the CPT is same, but I can see here that the DX which is billed Z000.00 encounter for the general added medical examination. General examination routine checkup, you, you, you, you can say. So what if we can build the corrected claim with the problem oriented diagnosis?
[CUSTOMER][NEUTRAL] It can be paid, I think.
[AGENT][NEUTRAL] we
[AGENT][NEGATIVE] No, we were unable to pay a benefit that has anything to do with wellness exams or benefits.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It is not covered in the patient plan.
[AGENT][NEGATIVE] It is not covered under this plan, no.
[CUSTOMER][NEUTRAL] Under this plan or patient plan?
[AGENT][NEUTRAL] Uh, this is their plan, yes.
[CUSTOMER][NEUTRAL] Who is the responsible for this uh.
[CUSTOMER][NEUTRAL] Service patient is responsible.
[AGENT][NEUTRAL] Uh, we don't, we don't say what is patient, we don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, so, uh, what is the current claim timely filling limit?
[AGENT][NEUTRAL] Oh, there's no timely filing limit for a corrected claim.
[CUSTOMER][NEUTRAL] Uh, no, I just want to know what is your the correct time deferring limit for your for your insurance.
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] If you want to submit that.
[AGENT][NEUTRAL] There's no timely filing limit for a corrective claim.
[CUSTOMER][NEUTRAL] OK, no time defining limit.
[CUSTOMER][NEUTRAL] OK. OK, I just want to know the call reference number, OK.
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date, um, so my last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, [PII] That's all for the day.
[AGENT][POSITIVE] Of course, thanks for calling APL. Have a great rest of your day.
[CUSTOMER][NEUTRAL] Bye.