AccountId: 011433970860
ContactId: f4a22ce1-15b2-4f48-9cb3-c02485c1f6bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 467239 ms
Total Talk Time (AGENT): 152318 ms
Total Talk Time (CUSTOMER): 103758 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/f4a22ce1-15b2-4f48-9cb3-c02485c1f6bf_20250521T14:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. My initial is [PII] calling from provider's office to check on claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that, [PII] And what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, the good callback number is [PII].
[AGENT][NEUTRAL] I'm sorry, what was the [PII], [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you. And how many claims [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Only one claim.
[AGENT][NEUTRAL] OK, and what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, for the member ID starts with 02.
[CUSTOMER][NEUTRAL] 556-914.
[AGENT][NEUTRAL] OK [PII], thank you. One moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, for this member's name, it starts with uh [PII]. The last name starts with [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so we have the last name is [PII]
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, for the member's date of birth is uh [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the data service and total bill amount?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, for this date of service is [PII]. This total bill amount is $320 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was denied. The claim number is 354-475-5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial on this claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] States
[AGENT][NEUTRAL] Covered diagnostic benefits are limited to want to, OK, let me start over. Covered diagnostic benefits are limited to.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] MRI
[AGENT][NEUTRAL] CT, colonoscopy, or other diagnostic testing is not covered under the policy. Therefore, no benefits are payable for this state of service.
[CUSTOMER][NEUTRAL] Like, uh, for this birth safety was non-covered, right?
[AGENT][NEUTRAL] That is correct for the member's plan.
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One second, ma'am.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Yes, sir. And if you're gonna need a copy of this explanation of benefits, Max, you can print it. You should be able to print it from our portal at [PII].
[CUSTOMER][POSITIVE] So we can be patient for this.
[AGENT][NEUTRAL] We do not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] Amount
[CUSTOMER][NEUTRAL] Sorry, ma'am?
[AGENT][NEUTRAL] We do not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, one second.
[CUSTOMER][NEUTRAL] Uh, one second, still loading.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, for this CPT, uh, like, uh, for this book, CPT was, uh, non-cor and patients plan only, right?
[AGENT][NEUTRAL] That is correct. Both CPTs were denied for the same reason.
[CUSTOMER][POSITIVE] Yes, thank you. Just a second.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] What was the patient's plan have? Patient's plan name?
[AGENT][NEUTRAL] This is a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] Hospital.
[AGENT][NEUTRAL] Indemnity limited benefit plan. This is not major medical insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, thank you so much, ma'am. Uh.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Call reference number?
[AGENT][NEUTRAL] Yes, sir, it would be my name along with today's date.
[CUSTOMER][NEUTRAL] Your name once
[AGENT][NEUTRAL] Again, it's [PII]. I gave it to you initially.
[CUSTOMER][POSITIVE] Thank you, ma'am for this too.
[AGENT][NEUTRAL] First initial to last name is [PII].
[CUSTOMER][POSITIVE] Yeah, have a great day.
[CUSTOMER][POSITIVE] Thank you, ma'am, for this info. Have a great day. Bye for now.
[AGENT][POSITIVE] OK, well, you're very welcome, [PII] So again, if that's all I can help you with, thank you for calling APL and I hope you have a nice day as well.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.