AccountId: 011433970860
ContactId: ca09dbba-5448-4ed8-93ab-24710d501b12
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243470 ms
Total Talk Time (AGENT): 101145 ms
Total Talk Time (CUSTOMER): 83664 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/ca09dbba-5448-4ed8-93ab-24710d501b12_20250611T17:48_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, this is [PII]. Hi, this is [PII] calling for provider to check on additional information about the claim that has been denied. Please note that the call will be monitored and recorded for quality and training purposes.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status and yes, that's fine to record. And may I have a good contact number in case we're disconnected, [PII]?
[CUSTOMER][NEUTRAL] Yes. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and it's a direct line?
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's 01611733 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, uh, member's name is
[CUSTOMER][NEUTRAL] [PII] and date of birth is [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 date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes, it's [PII] and total bill is $369 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so we received it twice. The original claim was denied because office visits aren't covered by this policy, and then we received it again denying it as a duplicate. And what questions did you have in reference to the claim?
[CUSTOMER][NEUTRAL] OK, so this
[CUSTOMER][NEUTRAL] CPD code 99204 is not covered as for the member's plan, sorry, it's not covered as per the pay policy, right?
[AGENT][NEUTRAL] For the patient's policy, correct. Office visits are not covered.
[CUSTOMER][NEUTRAL] OK, thank you for that. And may I know the member's plan name, please?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, this is a Metlink supplemental insurance policy.
[CUSTOMER][POSITIVE] OK, thank you for that. And uh
[CUSTOMER][NEUTRAL] Could you also please provide me the claim number?
[AGENT][NEUTRAL] Yes, the original claim number is 3604278.
[AGENT][NEUTRAL] Did you need the duplicate as well?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Um, it's 360.
[AGENT][NEUTRAL] 05, I'm sorry, I said that in reverse. The original claim.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 3,600,590 and the duplicate is 3604278.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Thank you for that. And may I know is the provider or patient responsible for the outstanding?
[AGENT][NEUTRAL] Um, we don't, um, we don't determine patient responsibility, so that would be up to the provider to determine um the next steps with the remaining balance.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK, thank you for that and thank you for providing those details. Can I get a call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initials of my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you for that and thank you for providing those details. Have a great day.
[AGENT][POSITIVE] You also and thanks for calling APL. Was there anything else I can assist with?
[CUSTOMER][NEUTRAL] Yeah, that's it. And those are the details I needed.
[AGENT][POSITIVE] Alright, have a great day. Bye bye.
[CUSTOMER][NEUTRAL] Bye.