AccountId: 011433970860
ContactId: bc879606-20f8-4b1b-a9cc-df676db967ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 256399 ms
Total Talk Time (AGENT): 72822 ms
Total Talk Time (CUSTOMER): 65919 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/bc879606-20f8-4b1b-a9cc-df676db967ce_20250310T17:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], um, I was calling on a claim that, um, I got a denial back on, um, but it, my question is if it can be changed to where it says that the, uh, member is liable for what's left. I don't know if you guys can do that or not.
[AGENT][NEUTRAL] Yeah, I mean, we unfortunately don't advise on patient responsibility that's up to the facility or provider as far as anything remaining.
[CUSTOMER][NEUTRAL] Because this is a secondary plan and it just, well I think everything everywhere so now that I say that out loud um but because usually like on the remits it will say, you know, like this is not covered by you guys so it'd be a patient responsibility and then uh and it doesn't say that on our remit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Let me take a look. Do you have the uh claim number or policy number?
[CUSTOMER][NEUTRAL] Uh, I have the claim number, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is 356-067-5.
[AGENT][NEUTRAL] Alright, let me take a look at this. Give me just a sec.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then for security, if you could just give me the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It is [PII], [PII].
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] I'm gonna pull this EOB and look at it here. Give me just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I can resubmit this explanation of benefits. I'm not sure if this would be more helpful. So on page 2, under the denial, it does state the above reference policy does not provide a benefit for physical therapy, occupational therapy or speech therapy.
[CUSTOMER][NEUTRAL] Yeah, and for me that would work but the my company they like to have it where it actually says, you know, the remainder balances the the patient responsibility or however that needs to be worded.
[AGENT][NEUTRAL] Yeah, we don't have any way to unfortunately add any of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, well then I guess that is all I needed other than a call reference number if you have one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, not a problem. Call reference is my name with my last initial and then today's date. My name again is [PII], which is [PII] and my last initial is gonna be [PII].
[CUSTOMER][POSITIVE] All right, well, I appreciate it. Thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] Mhm.