AccountId: 011433970860
ContactId: e8714ee5-9709-4502-a0b5-753d36cd1d28
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 210160 ms
Total Talk Time (AGENT): 38056 ms
Total Talk Time (CUSTOMER): 57099 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/e8714ee5-9709-4502-a0b5-753d36cd1d28_20250423T14:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from the provider's office regarding a claim that was denied.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Sure it's [PII] direct line.
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Oh yes, it's 02545740.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK thank you
[AGENT][NEUTRAL] And do you have the claim number?
[CUSTOMER][NEUTRAL] Uh yes, it's 358.
[CUSTOMER][NEUTRAL] 892 4.
[AGENT][NEGATIVE] Uh, it looks like we denied it for service not covered when performed in doctor's office or clinic.
[CUSTOMER][NEUTRAL] And where exactly is that and this should be covered when uh.
[CUSTOMER][NEUTRAL] Is there any specific guidelines for this?
[AGENT][NEUTRAL] Uh, let me pull up the policy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So it looks like it only covers for outpatient services performed in a hospital facility, MRI facility, physical therapy facility.
[CUSTOMER][NEUTRAL] So outpatient office visit is uh is not covered, right? Outpatient visits is not covered.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Is it specifically for this code or uh if uh it's for the doctor's visits or all the physicists are not covered?
[AGENT][NEUTRAL] All doctor visits are not covered. Correct.
[CUSTOMER][NEUTRAL] All doctors. OK. All right. Just one moment.
[CUSTOMER][POSITIVE] All right, uh, thank, thanks for helping me out with this. And can I have the card reference number?
[AGENT][NEUTRAL] Uh just my name and today's date.
[CUSTOMER][POSITIVE] Alright, [PII], thanks for helping me out. Have a great day.
[AGENT][POSITIVE] Thank you for calling APL you as well. Bye-bye.