AccountId: 011433970860
ContactId: 0464335c-d402-4a8e-822f-c6b6ba76bba7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451880 ms
Total Talk Time (AGENT): 164762 ms
Total Talk Time (CUSTOMER): 133031 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/0464335c-d402-4a8e-822f-c6b6ba76bba7_20250218T19:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm calling from provider office and looking the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh, I have 3 claims for 1 member.
[AGENT][NEUTRAL] OK, yes, ma'am. I can help you with those claims, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, sure. That is [PII] and it's a direct line extension.
[AGENT][NEUTRAL] Thank you. And what is your patient's policy number, [PII]?
[CUSTOMER][NEUTRAL] Uh, yeah, I'm giving you, just give me a moment.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][POSITIVE] Thank you so much. Yeah, the member's ID I have that is starting with the letters uh that is 02433267.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. [PII], what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And you said it was for 3 dates of service, is that correct?
[CUSTOMER][NEUTRAL] Yeah, that is right. Member is the same and the date of service for this number.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, what is your first date of service and total bill amount for this number?
[CUSTOMER][NEUTRAL] Yeah, sure. The first date of service I have that is [PII] and the bill amount is $433.88.
[AGENT][NEUTRAL] OK. OK. I'm sorry, we have a bad connection, [PII]. Your voice is breaking up. What was the date of service and build them out again?
[CUSTOMER][NEUTRAL] Yeah, sure. That is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] Yeah, that is $433.88.
[AGENT][NEUTRAL] 433.88. Is that correct?
[CUSTOMER][POSITIVE] Yeah, that is right. Yeah, yeah.
[AGENT][NEUTRAL] Thank you and again, any information that I provide for you on any of the claims will be a verification of benefits and not a guarantee of payments, so one moment.
[CUSTOMER][NEUTRAL] Mhm. And could you help me with last initial if possible?
[AGENT][NEUTRAL] S
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the claim this claim was received. The received date was [PII]. It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3555532.
[AGENT][NEUTRAL] And the remarks on this claim.
[AGENT][NEUTRAL] One of them state office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] And the other denial remarks states, please provide copies of your explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Uh, OK, got it. But may I know why office visit visit is not covered because it's a normal regular outpatient visit.
[AGENT][NEUTRAL] The patient's plan does not, the patient's plan with APL, the supplemental policy does not cover office visits.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Could you help me with the patient plan name, please?
[AGENT][NEUTRAL] This is a supplemental plan called Medlik, M E D L I N K.
[CUSTOMER][POSITIVE] Uh, just give me a moment. Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you said the patient plan name is supplement Plan Madeline, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and you said the CPT code that is 99214 is not covered under the patient current benefit plan and you guys need the primary career, right?
[AGENT][NEUTRAL] Yes, 99214 office visits are not covered and the other codes we need the primary insurance company's explanation of benefits sent in.
[CUSTOMER][NEUTRAL] OK, just give me a moment.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And may I know, uh, based on the updated of view with the primary insurance at your end?
[AGENT][NEUTRAL] We are not a major medical insurance company.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no problem. Thank you so much. And uh what is the timely filing to submit the EOB?
[AGENT][NEGATIVE] There is no timely filing?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, thank you. And what is the call reference number?
[AGENT][NEUTRAL] My name and today's date?
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for the help. Have a great rest of your day. Bye-bye. Take care.
[AGENT][NEUTRAL] So that was
[AGENT][NEUTRAL] OK, so that was the only data service you had? I thought you had 3 data service.
[CUSTOMER][NEUTRAL] I have the 3 data services, but on other data services we have the same thing, so I think I have have the answer on this, all of them.
[AGENT][NEUTRAL] OK, then. Well, OK, and if you need a copy of this explanation of benefits, [PII], you may go to our website at [PII] to print that out.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, thank you. Thank you for the help by take your.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Yes, ma'am. And if that's all I can help you with, thank you again for calling APL and I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] You too. Bye-bye