AccountId: 011433970860
ContactId: fa3c9606-f122-43e6-b713-432b86b872ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 208839 ms
Total Talk Time (AGENT): 54492 ms
Total Talk Time (CUSTOMER): 78271 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/fa3c9606-f122-43e6-b713-432b86b872ba_20250609T14:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm calling to check on the denial of the claim. Um, I don't see a reason on there, so I just wanted to double check what it was.
[AGENT][NEUTRAL] OK, and is it for yourself or are you with the provider?
[CUSTOMER][NEUTRAL] I'm calling from a provider's office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, could I get your name and a good callback number, please?
[CUSTOMER][NEUTRAL] My name is [PII] and the phone number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And then do you have the policy number for that patient?
[CUSTOMER][NEUTRAL] Yes, give me one moment. OK, it's 02262371 M like Mary L like Lima 8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient is [PII] and it's [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have the uh claim number?
[CUSTOMER][NEUTRAL] Um, let me see if I have it. One moment. I should have it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, actually I don't I'm sorry it's not on here.
[AGENT][NEUTRAL] OK, uh, what was the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Is that for DME for durable medical equipment?
[CUSTOMER][NEUTRAL] It's for hearing aid devices, so yeah, I think, I think so.
[AGENT][NEUTRAL] Uh, looks like we had denied it as
[AGENT][NEUTRAL] Benefis are only payable if major medical insurance provider provides benefits.
[AGENT][NEUTRAL] So they would have to consider the claim for this to be covered under this policy.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] So under because his primary is Aetna.
[CUSTOMER][NEUTRAL] Um, so you guys are saying that if they cover, you will cover the rest, but if they do not cover hearing aids, then you guys won't cover hearing aids as well?
[AGENT][NEUTRAL] That's correct. So the primary, if the primary doesn't cover the service that's rendered and it's covered under our policy, we won't cover it because primary didn't.
[CUSTOMER][NEUTRAL] OK, I understand.
[CUSTOMER][NEUTRAL] All right perfect then would I just be able to get a reference for the call today?
[AGENT][NEUTRAL] Yeah, it's my name, [PII], first initial to last name, [PII], and today's date. And anything else I can help with today, [PII]?
[CUSTOMER][POSITIVE] That was it for today thank you for your help.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye.