AccountId: 011433970860
ContactId: f2e20136-3482-4221-978a-30cda07156e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 198960 ms
Total Talk Time (AGENT): 73968 ms
Total Talk Time (CUSTOMER): 100086 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/f2e20136-3482-4221-978a-30cda07156e1_20250312T20:02_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, [PII], this is [PII] calling from provider's office to check on our denial status.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the denial and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, that is [PII] and it is a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, that is 246-588-889.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [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 date of service or the claim number for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Yes, I do have a claim number that is 35098007.
[CUSTOMER][NEUTRAL] Data service is on [PII] for the bill amount $291 even.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was 35098007.
[CUSTOMER][NEUTRAL] 807, yes.
[AGENT][NEUTRAL] OK, and the claim was denied because office visits are not covered on this policy and what questions did you have?
[CUSTOMER][NEUTRAL] Sir, could you please repeat the general reason?
[AGENT][NEUTRAL] The claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEGATIVE] The office visits are not covered by this.
[CUSTOMER][NEUTRAL] Secondary
[CUSTOMER][NEUTRAL] Uh, according to the member's policy or, uh, under the provider's contract.
[AGENT][NEUTRAL] It's not covered under the member's the patient's policy.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] That's all for today and uh is there any possible way to get this claim to be paid or uh?
[CUSTOMER][POSITIVE] That's the numberless responsibility and we need to build the patient.
[AGENT][NEUTRAL] Well, I mean, we don't determine patient responsibility, so as far as the members uh portion, we can't really advise you on that. The claim can't be overturned unless the place of service changes for the secondary policy because that's what's not covered.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] At
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and is there any active insurance, uh, act as a secondary for this number?
[AGENT][NEUTRAL] This is the secondary insurance.
[CUSTOMER][NEUTRAL] OK, and then more, there is no tertiary, right? Then we can build the patient.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] There is no 3 insurance sector for this member and so we can bill the patient, right?
[AGENT][NEUTRAL] Uh, that would be up to your whatever your um procedures are for outstanding and remaining balances.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's all for the day, [PII], and um
[CUSTOMER][NEUTRAL] Can I have the call reference number for this one?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you now. That's this one and have a great day ahead. Take care. Bye-bye.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah