AccountId: 011433970860
ContactId: d70e288f-ba85-40c6-9c09-d28495cb3128
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320420 ms
Total Talk Time (AGENT): 108680 ms
Total Talk Time (CUSTOMER): 89276 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/d70e288f-ba85-40c6-9c09-d28495cb3128_20250310T19:47_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII].
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office regarding claim den our clarification. Could you please spell your name?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK you need.
[CUSTOMER][NEUTRAL] Sorry, [PII]
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And [PII], you said you're needing clarification on a denied claim.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII] and extension is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] The member's policy number is uh
[CUSTOMER][NEUTRAL] 982-078.
[AGENT][NEUTRAL] Did you say 982-078?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] One moment please. Thank you.
[AGENT][NEUTRAL] OK, any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place, [PII]?
[CUSTOMER][NEUTRAL] The date of service is uh [PII] and the total amount is $313.31.
[AGENT][NEUTRAL] And the claim number?
[CUSTOMER][NEUTRAL] The claim number is, one moment.
[CUSTOMER][NEUTRAL] The claim number is 354-4302.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Just one moment please, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yes ma'am, I have that claim pulled up.
[AGENT][NEUTRAL] And the reason for the
[CUSTOMER][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. This claim was CPD 992.
[AGENT][NEUTRAL] Office
[CUSTOMER][NEUTRAL] Sorry. You, you can continue.
[AGENT][NEUTRAL] Yes, the code 99213 was denied as office visits are not covered by the above numbered policy. The members supplemental policy [PII] does not cover office visits.
[CUSTOMER][NEUTRAL] Um, so, we need to build the patient?
[AGENT][NEUTRAL] We do not determine patient responsibility, [PII], that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits if you don't already have it, you can print that by going to our portal and our website for our portal is [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, and one moment, uh.
[CUSTOMER][NEUTRAL] What is the policy number?
[AGENT][NEUTRAL] You gave that to me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It was not covered OK with it.
[CUSTOMER][NEUTRAL] OK. So we need, we can bill the patient, right? If we need it?
[AGENT][NEUTRAL] As I stated, as I stated, APL does not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] We need to uh coordinate with the provider whether we need to build the patient or not, right?
[AGENT][NEUTRAL] As I stated, we do not determine patient responsibility, that would be up to the provider.
[AGENT][NEUTRAL] This is a supplemental policy only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I get the call reference number?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Thank you. Thank you for your assistance. Have a great day. Bye.
[AGENT][POSITIVE] Yes ma'am. Well, you're welcome. If that's all then that I can help you with, [PII]. Thank you again for calling ATL and I hope you have a nice day also.