AccountId: 011433970860
ContactId: e9977b70-2664-4c4f-875c-300ec5828b0f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 181860 ms
Total Talk Time (AGENT): 70480 ms
Total Talk Time (CUSTOMER): 78583 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/e9977b70-2664-4c4f-875c-300ec5828b0f_20250213T21:54_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, this is [PII], and I'm calling for the provider to check on the additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. Yes please, [PII].
[AGENT][NEUTRAL] OK, well, I'll be more than happy to assist you with the claim denial clarity. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure. The best callback number will be [PII].
[CUSTOMER][NEUTRAL] [PII] and it's a direct line?
[CUSTOMER][NEUTRAL] The policy number starts with 024.
[CUSTOMER][NEUTRAL] 222
[CUSTOMER][NEUTRAL] 97, M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][POSITIVE] Yes please
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Remember, first name is [PII]. Last name is [PII]. Date of birth is on [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 um claim number for the claim you'd like me to go over with you?
[CUSTOMER][NEUTRAL] Yes, um, for this patient, I have two claim numbers. First, claim number is 3556713.
[AGENT][NEUTRAL] Um, you can give me both claim numbers at the same time.
[CUSTOMER][NEUTRAL] Sure. The next claim number is 3556882. Um, so it's like a secondary plan leaves the only co-pay from the primary. So,
[CUSTOMER][NEGATIVE] That's why it's denied.
[AGENT][NEUTRAL] So just for the call, all the information provided is a verification of benefits, not a guarantee of payment. So both claims were denied because office visits are not covered on the policy. So yes, we are second to primary, but primary has their own benefits for their policy and APL has our own benefits for our policy, and on our policy, office visits are not covered.
[CUSTOMER][NEUTRAL] Patient
[CUSTOMER][NEUTRAL] A patient's plan name, please?
[AGENT][NEUTRAL] This is a Medlik supplemental gap insurance.
[CUSTOMER][NEUTRAL] Thank you. And here for this, both the claims are denied for the same reason. Is it correct? And I'm showing uh all, thank you. May I get the call reference number for the both the claims conversation, please?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, my name is [PII], first initial to my last name is [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for your assistance on the past two claims clarifications and have a great day.
[AGENT][POSITIVE] You're also and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.