AccountId: 011433970860
ContactId: fdded109-2788-4782-97d5-7973d69ea78c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420260 ms
Total Talk Time (AGENT): 118340 ms
Total Talk Time (CUSTOMER): 126033 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/fdded109-2788-4782-97d5-7973d69ea78c_20250606T19:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII] calling from Apsar Wellness Center.
[AGENT][NEUTRAL] Um, where are you calling from again?
[CUSTOMER][NEUTRAL] I'm calling from Upstar Wellness Center.
[AGENT][NEUTRAL] And can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] It's a pet
[CUSTOMER][NEUTRAL] Yeah, yeah. It's uh 302.
[CUSTOMER][NEUTRAL] 214
[CUSTOMER][NEUTRAL] 2566.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Uh, just a second.
[CUSTOMER][NEUTRAL] It's uh 021 3.
[CUSTOMER][NEUTRAL] 7783.
[AGENT][NEUTRAL] OK give me just a moment.
[CUSTOMER][POSITIVE] Sure, not a problem.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me please?
[CUSTOMER][NEUTRAL] Sure. Uh, patient name is [PII], and date of birth is [PII].
[AGENT][POSITIVE] Thank you so much for verifying that with me.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And uh what were the questions that you have?
[CUSTOMER][NEUTRAL] Uh, I have a question about the denial claim for the [PII].
[CUSTOMER][NEUTRAL] I have a particular date of service.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, uh, it's uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And what was the provider's name?
[CUSTOMER][NEUTRAL] Uh, provider name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It looks like we received this claim on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And what was the total bill amount?
[AGENT][NEUTRAL] Because I'm not showing it being denied.
[CUSTOMER][NEUTRAL] Uh, total bill amount.
[CUSTOMER][NEUTRAL] Uh, one, there are two CPT. Uh, one is 90833, and another one is 99213. So 99213 is denied.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] You said 99213?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it looks like that was.
[AGENT][NEUTRAL] Denied the claim number for that is different. It's 351-3108.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] Let me see why it was denied um it's not a covered service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the
[CUSTOMER][NEUTRAL] And not not covered service, right?
[AGENT][NEUTRAL] And this is a duplicate so let me see.
[AGENT][NEUTRAL] That was because it's a duplicate. Let me see what where the original is.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, this is not duplicate. That's why.
[AGENT][NEUTRAL] OK, so it is this one.
[AGENT][NEUTRAL] And you said 99213 was the procedure code.
[CUSTOMER][NEUTRAL] Uh, how it's duplicate.
[AGENT][NEUTRAL] What was the procedure code that was denied?
[CUSTOMER][NEUTRAL] We will for the one.
[CUSTOMER][NEUTRAL] Uh sorry?
[AGENT][NEUTRAL] What was the procedure code that you said was denied?
[CUSTOMER][NEUTRAL] 99213.
[AGENT][NEUTRAL] OK, so it, it's the original claim that I gave you that 3491733 that claim that I gave you, it does have that procedure code 99213 that is the original.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it looks like that.
[AGENT][NEUTRAL] Procedure code was denied because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Office is not covered by the policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, but, uh, on
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, OK. Got it, got it. No problem. OK is not covered by the American Public Life Insurance, no problem. Thank you so much for your information. Can you give me the call reference number?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] So I don't have call reference numbers. You can use my name and last initial in today's date, so [PII]
[CUSTOMER][NEUTRAL] Oh, what is your last name? Yeah.
[AGENT][NEUTRAL] And then today's date. Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. OK, thank you so much, [PII], for your help. Thank you so much.
[AGENT][NEUTRAL] Alright, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, no, thank you so much. Have a good day.
[AGENT][POSITIVE] Great, thank you for calling APL have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yeah.