AccountId: 011433970860
ContactId: fd219200-b81a-400d-9aa5-7862f65067a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342059 ms
Total Talk Time (AGENT): 89719 ms
Total Talk Time (CUSTOMER): 115155 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/fd219200-b81a-400d-9aa5-7862f65067a9_20250528T16:44_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII].
[AGENT][POSITIVE] Good morning. How are you?
[CUSTOMER][NEUTRAL] And I'm calling in uh good morning. I'm good. I was calling in regards to um a claim that I received that was a no pay.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] D as in dog, 46401111.
[AGENT][NEUTRAL] That's not one of our policy numbers. Do you have their social security number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Oh, that's probably why. Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] His name is [PII].
[AGENT][NEUTRAL] And his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII] and you were just needing claim status?
[AGENT][NEGATIVE] It wasn't something wasn't paid.
[CUSTOMER][NEGATIVE] Well, I'm kind of confused because you just, yeah, you just the employee ID number that's on the card, it says the D44 or the D whatever number I gave you just now I can't even read it because it's kind of blurred, but you said that's not the correct um.
[AGENT][NEUTRAL] Yeah, that
[AGENT][NEUTRAL] That's their wellness policy through IMA.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What date of service are you calling?
[CUSTOMER][NEUTRAL] All right, so.
[CUSTOMER][NEUTRAL] I'm calling in regards to data service of 42525.
[AGENT][NEUTRAL] OK, I can look that up for you just a moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And what was the procedure code on that bill?
[CUSTOMER][NEUTRAL] There were 2 because he came in um for physical but then he was also complaining about issues with his feet.
[CUSTOMER][NEUTRAL] So, um, let me go to this other part here.
[CUSTOMER][NEUTRAL] OK, so the procedure code is gonna be 99213.
[CUSTOMER][NEUTRAL] And the physical code is 99396.
[CUSTOMER][NEUTRAL] Total bill was 252.
[AGENT][NEGATIVE] OK, we did get that claim in and it was denied. The outpatient rider only allows payment for outpatient surgery in an outpatient hospital or physician's office. Therefore, no benefits are payable.
[CUSTOMER][NEGATIVE] OK, that that doesn't make sense to me.
[CUSTOMER][NEUTRAL] Is, is that his, what type of benefits does he have? Does he have any office, you know, for him to come and see the doctor?
[AGENT][NEUTRAL] Hold on just a moment, I'll check.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am. I'm not showing he has office visit writer.
[CUSTOMER][NEUTRAL] What what does that mean, writer?
[AGENT][NEUTRAL] They have different plans. They can choose certain options through their, uh, depending on their group.
[AGENT][NEUTRAL] And he does not have the office visit writer on his policy.
[CUSTOMER][NEUTRAL] Which means the physical isn't paid either, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know if he understands that.
[CUSTOMER][NEUTRAL] And what is the correct um member ID number?
[AGENT][NEUTRAL] For our policy is 02451260.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, is there a group number with that one?
[AGENT][NEUTRAL] It is 70087.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, [PII]. I appreciate your help.
[AGENT][POSITIVE] Thank you, [PII] for calling APL. You have a good day. You too. Bye-bye.
[CUSTOMER][POSITIVE] Have a good day.
[CUSTOMER][NEUTRAL] You too.