AccountId: 011433970860
ContactId: d3a544d4-2b5c-477a-b242-cab54ea972fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 296660 ms
Total Talk Time (AGENT): 87410 ms
Total Talk Time (CUSTOMER): 59617 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/d3a544d4-2b5c-477a-b242-cab54ea972fa_20250610T20:36_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] Hi, I'm [PII] calling from provider's office to check the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, just a single claim.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, uh, the member ID is going to be.
[CUSTOMER][NEUTRAL] 025894.
[CUSTOMER][NEUTRAL] 86.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, member's name is [PII]. Date of birth will be [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] Sure, it's [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $195 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, name of the provider is [PII].
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 3508.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Code 99214 was denied because office visits are not covered on the policy.
[AGENT][NEUTRAL] Code 87,400 was denied because primary insurance provided full benefit.
[CUSTOMER][NEUTRAL] OK, uh, may I know the reason for, uh, the denial of the CP code 87,400 once again.
[AGENT][NEUTRAL] Yes, primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] OK, then how much is the allowed amount?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I mean, so the benefit is $4000 per calendar year. So I guess the allowed amount would be $4000.
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] about
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][POSITIVE] Thank you so much and could you please spell out your name for me?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Thank you. And the call reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number, um, but you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] That's all for today. Thank you.
[AGENT][POSITIVE] Alrighty thank you for calling APL and I hope you have a great day bye bye.