AccountId: 011433970860
ContactId: c4d332b4-3553-46e8-960c-4edb2ea16f68
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 186600 ms
Total Talk Time (AGENT): 59884 ms
Total Talk Time (CUSTOMER): 91420 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/c4d332b4-3553-46e8-960c-4edb2ea16f68_20250219T19:40_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Oh yeah, I'm just calling because I had got a denial for some claims and I wanted to follow up on them to see uh what the issue is here.
[AGENT][NEUTRAL] OK, I can verify claim status for you and your name is?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] a second here.
[CUSTOMER][NEUTRAL] 02465892.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][NEUTRAL] OK, and let's see, and what was the date of service and amount of charge or do you have a claim number?
[CUSTOMER][NEUTRAL] Um, I do have a claim number. I have, uh, several of them listed here for you guys just sent us, so this first claim number is 3561914.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Oh, looks like a processed office visits are not covered.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah it was a little thrown off because it said that but then.
[AGENT][NEUTRAL] Benefits payable. Mhm.
[CUSTOMER][NEUTRAL] Yeah, but the second line says the benefits are payable only if major medical insurance providers benefits. Well, the major medical paid, which was allied, so I didn't know if Allied pays if you guys pick up the copay or you just flat out don't pay office visits at all.
[AGENT][NEUTRAL] I just, we just flat out don't pay office visits on this patient's policy.
[CUSTOMER][NEUTRAL] OK, so these, um, let me see if the rest of these are all office visits for the rest of them because, yeah, I was like wait this counteract each other because we entered in like all the COB numbers when we build out the secondary so that one's office visit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Office visit.
[AGENT][NEUTRAL] Uh, the other ones looked like, um, charges, they, there was no charges, there was zero charges on those.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it looks like all of her claims that come through. I, I have like 6 claims for her that were all denied, but they're all office charges, so that would be it. I just, I wasn't sure when it was when it said that like if major medical pays then we'll pay benefit and I'm like, well wait a second, so you don't cover office visits or you will pay it so.
[AGENT][NEUTRAL] No, it's only um.
[CUSTOMER][NEUTRAL] So I would just send these co-pays through to the member then.
[AGENT][NEUTRAL] Only treatment performed in office or procedures and office are covered as outpatient, but not the visit.
[CUSTOMER][POSITIVE] OK, well I will put a note in her um chart here, um, so everybody knows that going forward and then we just won't send you the ones for the office visits, so that's perfect. I appreciate the information.
[AGENT][NEUTRAL] Uh, you're welcome, Ms. [PII], and is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, I think that's OK. I appreciate it.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You as well bye bye.