AccountId: 011433970860
ContactId: dd7f164d-8df8-41cd-8bb0-ad1d8b75a412
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231220 ms
Total Talk Time (AGENT): 121418 ms
Total Talk Time (CUSTOMER): 80841 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/dd7f164d-8df8-41cd-8bb0-ad1d8b75a412_20250320T13:51_UTC.wav
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[AGENT][NEUTRAL] Hello, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Good morning, [PII]. I'm calling from F5 Test Medical OGS. Um, I have a patient here. Her name is [PII] Date of birth is [PII], and I have a claim number that didn't, if you need it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, please. What is that claim number?
[CUSTOMER][NEUTRAL] 33357-4191 I mean deny as a duplicate for data service 103124.
[AGENT][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] Let me just look that up. And uh are you saying that it's not a duplicate or?
[CUSTOMER][NEUTRAL] It's not a duplicate, but it denies a duplicate.
[AGENT][NEGATIVE] It's not. OK.
[AGENT][NEUTRAL] Yes, OK, let me just check here. And if I could just verify um.
[AGENT][NEUTRAL] Uh, I just need the patient's, uh, date of birth. I'm sorry if, if you gave me that, I didn't catch it. And then a phone number, uh, in the event that we're disconnected.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And is there a callback number I can have in the events that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, give me a second.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, I appreciate that. Thank you.
[AGENT][NEUTRAL] Well, um, what I'm showing on here is that, uh, we received it twice before. Um, let me just look here that it's, uh,
[AGENT][NEUTRAL] It looks like we've got um
[CUSTOMER][NEUTRAL] But he has a
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] But I never got paid.
[AGENT][NEGATIVE] OK, yeah, it looks like it was denied uh.
[AGENT][NEUTRAL] They don't have treatment for conditions other than a sickness or injury uh is defined by the policy. Let me just check some of the other things here. So it looks like this was a, uh, a wellness check. Um.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEGATIVE] So yeah, it wouldn't, it would not have been, uh, it would not have been uh paid. It looks like uh it was um denied twice, uh, being, uh, this is, it's not a sickness or an accident. It looks like the DX code was for a wellness check and so it would not be paid.
[CUSTOMER][NEUTRAL] Oh, because it wasn't an accident?
[AGENT][NEUTRAL] It wasn't a sickness or an accident, uh, the, these policies, now the, the insured probably has wellness benefits through their benefits in the card. It's just that it doesn't have it doesn't have wellness benefits through this policy. So it's not that they don't have wellness benefits at all. It's, yeah.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] So it doesn't
[CUSTOMER][NEUTRAL] Oh, so it only covers sickness and accidents.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, can we build the patient?
[AGENT][NEUTRAL] Well, I can't tell you to bill the patient because I, the only thing I can tell you is that we aren't contractually obligated to pay the claim. So, uh, as I mentioned before, they probably do benefits in a card, they probably do have wellness benefits. So I would, I would contact the insured and ask them if they do.
[CUSTOMER][NEUTRAL] to
[CUSTOMER][NEUTRAL] OK, and can I, can you fax me a copy of that EOB that you have there to denial, please?
[AGENT][NEUTRAL] Sure. Um, what is your fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Attention, [PII], please. [PII]
[AGENT][NEUTRAL] [PII], yes, of course.
[AGENT][NEUTRAL] Um, I can certainly send that to you. Um, [PII], is there anything else at all that I may help with?
[CUSTOMER][NEUTRAL] Yes, please, can I have a reference number please?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my [PII], and we're gonna use that today's date as a reference.
[CUSTOMER][POSITIVE] OK, thank you so much. Have a wonderful rest of your day. Bye bye.
[AGENT][POSITIVE] And thanks for contacting AP I'll.