AccountId: 011433970860
ContactId: e0ab0a73-eeed-4ed5-957b-4a17f00c557c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 358420 ms
Total Talk Time (AGENT): 140678 ms
Total Talk Time (CUSTOMER): 107289 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/e0ab0a73-eeed-4ed5-957b-4a17f00c557c_20250620T13:00_UTC.wav
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[AGENT][NEUTRAL] For contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII] calling from provider's office to check the claim status. Can you help me with this?
[AGENT][NEUTRAL] Yes, I can help with the claim status. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] It's uh it's [PII] and how do you spell your first name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII] How do you spell the patient's uh name, please? Because that's not one of our policy numbers.
[CUSTOMER][NEUTRAL] Uh, the patient um I will spell is [PII] Last name is [PII].
[AGENT][NEUTRAL] [PII], OK, yes, thank you. Uh, while I'm looking this up, um, can I have a callback number please in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Uh I already provided to you. It's [PII].
[AGENT][NEUTRAL] OK, thank you very much, [PII]. I'm just looking this up. I'll be right back. Excuse me, just one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you. What is [PII]'s date of birth, please?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you. It looks.
[CUSTOMER][NEUTRAL] And may I know your last name initial?
[AGENT][NEUTRAL] It's [PII]. The policy number on this is 002413429. Now you said that we had uh a claim for [PII]. What is that uh date of service, please?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] It is for [PII].
[CUSTOMER][NEUTRAL] For $425 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] That's um
[AGENT][NEUTRAL] Claim number [PII] is 360.
[AGENT][NEUTRAL] 531 7. So again it's 360.
[AGENT][NEUTRAL] 531-7 we received that claim.
[AGENT][NEUTRAL] On the [PII] we processed it on the [PII]. Now the.
[AGENT][NEUTRAL] Office visit
[AGENT][NEGATIVE] Is not covered.
[AGENT][NEUTRAL] The office visit is not covered, but.
[CUSTOMER][NEUTRAL] When it
[CUSTOMER][NEUTRAL] When it was denied?
[AGENT][NEGATIVE] The office visit was denied. That is correct. The office visit was denied. Now the other CPT code on this claim 36415 for $55 we are showing that there was, uh, that the insurance paid everything that was due on that.
[AGENT][NEUTRAL] So for that, uh.
[CUSTOMER][NEUTRAL] No, no, I'm asking.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So I understand that this claim was denied, but I just need the denial date when it was denied.
[AGENT][NEUTRAL] OK, the, the date that it, the, the claim was denied.
[AGENT][NEUTRAL] Was [PII]. Now is this the only claim that we're looking at for this individual?
[CUSTOMER][NEUTRAL] Uh, yes, uh, so actually I just uh wanted to ask a question about this denial. So you stated that the CPD 99214 is non-covered. So may I know why it is non-covered?
[AGENT][NEGATIVE] The policy does not cover office visits, so it was denied.
[AGENT][NEUTRAL] Due to the insured's policy.
[CUSTOMER][NEUTRAL] So it means the there so CBD 99214 is nonco as per patient plan.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So, can you provide me the patient plan name?
[AGENT][NEUTRAL] It is APL, A as in apple, P as in Papa, L as in.
[AGENT][NEUTRAL] It's a gap insurance?
[CUSTOMER][NEUTRAL] APL
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, so can we be patient for the services?
[AGENT][NEUTRAL] Well, I, I can't tell you that, [PII]. I can just tell you that we don't cover it. They, they may have another policy. I don't know.
[CUSTOMER][NEUTRAL] OK, so is there any other secondary or tertiary insurance available for this patient as uh for as per your COB updated uh like COB details?
[AGENT][NEUTRAL] I, I don't see any, but yeah, I would only see my own policy, so, um, you would need to get with the with the insured on that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what is the call reference number for this uh for this call?
[AGENT][NEUTRAL] My name is
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII]. We'll use that today's date of our arrest. Is there anything else that I can help you with?
[CUSTOMER][POSITIVE] Uh, no, I, I'm done with this. Thank you so much for your assistance and have a great day.
[AGENT][POSITIVE] OK, thanks for contacting me.