AccountId: 011433970860
ContactId: ee5887f5-fb1c-4360-a6e3-944215aebd05
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 188100 ms
Total Talk Time (AGENT): 86831 ms
Total Talk Time (CUSTOMER): 95859 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/ee5887f5-fb1c-4360-a6e3-944215aebd05_20250228T13:48_UTC.wav
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[AGENT][POSITIVE] Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, good morning, [PII]. I'm calling for, uh, claim status.
[AGENT][POSITIVE] It would be my pleasure to help you with that claim status. And what is your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Authorization.
[AGENT][NEUTRAL] Thank you. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] 02224472 ML 8.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right, thank you. And it would be my pleasure to assist you with claim status for [PII]. What is the data service?
[CUSTOMER][NEUTRAL] 8:15 2024.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Was it a single date?
[CUSTOMER][NEUTRAL] Uh, let me see for this patient, yes, but I think the siblings came that day too, yeah.
[AGENT][NEUTRAL] I don't have a claim on file for [PII] for data service 81524.
[CUSTOMER][NEUTRAL] Let me see one second because I have a denial, but I don't know why. Give me one second. Let me see if it goes, uh, OK, OK, let me submit it again because I do see here that it was only submitted to Blue I mean to United Healthcare. um, what is covered under this patient, the procedures or the office visits?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Is it for services in the doctor's office?
[CUSTOMER][NEUTRAL] Uh, yes, they had a preventive visit and then they had a pediatrician done and a urinalysis and the insurance didn't, the primary insurance didn't pay the pediatrician or the urinalysis.
[AGENT][NEUTRAL] OK. Excuse me. So this policy provides the benefits for procedures or treatments in office.
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] And now for, of course, for wellness, it's not covered under the secondary gap policy.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, so when they do a wellness checkup they're not covered.
[AGENT][NEUTRAL] That's right. Unless, you know, we'd have to have a diagnosis uh sickness diagnosis code.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK one.
[AGENT][NEUTRAL] But the screenings and wellness is not covered.
[CUSTOMER][NEUTRAL] OK perfect all right and [PII], can I get a reference number for this?
[AGENT][NEUTRAL] It would be my name and today's date, and I spell my name [PII].
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Alright.
[AGENT][POSITIVE] And it's been a pleasure to assist you with that claim status. Anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, that'll be all, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] [PII], thank you for calling APL. Hope you have a wonderful day and a very happy weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.