AccountId: 011433970860
ContactId: cee5413f-665a-4c8a-8dc5-aeb33aebfe5e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 310369 ms
Total Talk Time (AGENT): 73104 ms
Total Talk Time (CUSTOMER): 111886 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/cee5413f-665a-4c8a-8dc5-aeb33aebfe5e_20250221T19:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office regarding claim denial clarification. Your name is uh [PII], right?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Of course I could check on that claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and extension is [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number we're having is 982078.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] The name of the member is, uh, one moment.
[CUSTOMER][NEUTRAL] The name of the member is [PII].
[AGENT][NEUTRAL] OK, do you have the date of birth?
[CUSTOMER][NEUTRAL] The date of birth is um [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and then do you have the claim number?
[CUSTOMER][NEUTRAL] Yeah, the claim number we have is, one moment.
[CUSTOMER][NEUTRAL] Just a moment, sorry for the delay.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] We have a date of service. Can I provide that for you?
[AGENT][NEUTRAL] Yeah, that's fine.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $313.31.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, so for this claim K we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Office visits are not covered under this policy. Is it right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, whether it is not covered based on this patient's plan?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] One moment. I will check that. One moment. Sorry for that.
[CUSTOMER][NEUTRAL] I'll check my ledger, one moment.
[CUSTOMER][NEUTRAL] Uh, it will not cover office visit. OK. One second.
[CUSTOMER][NEUTRAL] What guidelines are following this?
[AGENT][NEUTRAL] Uh, major medical.
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] Major medical. This is uh their secondary medical policy.
[CUSTOMER][NEUTRAL] OK, wait.
[CUSTOMER][NEUTRAL] OK. Major medical. OK.
[CUSTOMER][NEUTRAL] Just a moment. I will check.
[CUSTOMER][POSITIVE] Thank you for your patience. One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh, it is patient responsibility or providers right off.
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] It is up to the provider.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] One moment, I will check that.
[CUSTOMER][NEGATIVE] But you will not pay for this type of office, right?
[AGENT][NEGATIVE] No offices that they're not covered so we were unable to pay a benefit.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It is major medical, right?
[AGENT][NEUTRAL] Those are the guidelines this follows. This is their secondary medical policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you will not reprocess this claim, is it right?
[AGENT][NEGATIVE] The office visits are not covered, so we would be unable to pay a benefit.
[CUSTOMER][NEUTRAL] OK. What is the patient plan type?
[AGENT][NEUTRAL] This is a secondary medical policy.
[CUSTOMER][NEUTRAL] Secondary medical policy. Can I get the call reference number?
[AGENT][NEUTRAL] That would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] That's it. Thank you. Thank you for your assistance. Have a great day. Bye.
[AGENT][POSITIVE] OK, of course, thanks for calling APL. You too, bye bye.