AccountId: 011433970860
ContactId: 070ccf54-7694-4b0e-ac5f-366e660a24e8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 489640 ms
Total Talk Time (AGENT): 85307 ms
Total Talk Time (CUSTOMER): 123732 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/070ccf54-7694-4b0e-ac5f-366e660a24e8_20250416T15:17_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], this is [PII] calling from the provider's office for Fast Care LLC.
[AGENT][NEUTRAL] Hi, [PII]. How can I help?
[CUSTOMER][NEUTRAL] And this is regarding a bill status, yeah, this is regarding a bill status.
[AGENT][NEUTRAL] Alright, do we have a policy number?
[CUSTOMER][NEUTRAL] Uh, yes, I do have one with me. Give me a moment. I'm just pulling up that for you.
[CUSTOMER][POSITIVE] And that uh I can go ahead with that whenever you're ready.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah, it's 014.
[CUSTOMER][NEUTRAL] 190
[CUSTOMER][NEUTRAL] 54
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, and the number 8.
[AGENT][NEUTRAL] And do you have a good call back?
[CUSTOMER][NEUTRAL] And [PII], may I have the first initial your last?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][POSITIVE] Thank you, one moment and you asked me for my callback number, right?
[AGENT][POSITIVE] You have a good
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] And I just changed my line. Give me a moment, getting that for you.
[CUSTOMER][NEUTRAL] Yeah, that would be 786.
[CUSTOMER][NEUTRAL] 923, 4000.
[CUSTOMER][NEUTRAL] And I do have an extension. It's gonna be 305.
[AGENT][NEUTRAL] Thank you. Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, yes, it's for [PII] and the date of birth is gonna be [PII].
[AGENT][NEUTRAL] Thank you for that. And then what is the date of service?
[CUSTOMER][NEUTRAL] Yeah, it's gonna be [PII]. It's for $361.90.
[AGENT][NEUTRAL] Alright, let me see what we got here one moment.
[CUSTOMER][NEUTRAL] And I do have a question with the [PII]. Uh, yesterday I spoke, uh, I spoke with another representative and her name was [PII]. Uh, she stated, uh, I have the information that the claim has been denied, uh, but for stating that the policy will not cover the services done in the physician's office. Uh, but for the same patient, uh, we have received payments, uh, for the same services. So I just need to know, is there any change in policy?
[AGENT][NEUTRAL] Let me see here.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] So I'm not showing that the members had any plan type change. The policy looks like it's been effective since [PII].
[CUSTOMER][NEUTRAL] Yeah, uh, so if that's the situation, or what's the reason the claim has been denied?
[AGENT][NEUTRAL] So it shows that let me see, do you have a date of service when it was processed as a paid claim?
[CUSTOMER][POSITIVE] Uh, yes, I can go ahead with that whenever you're ready.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII]. It's for $475479.95.
[CUSTOMER][NEUTRAL] And we have received a payment of $40 and it's been processed as secondary.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] 5423.
[AGENT][NEUTRAL] Alright, so let me see, there was a new policy certificate issued in [PII].
[AGENT][NEUTRAL] So let me see if the member's plans changed when the new certificate was issued.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 162.
[AGENT][NEUTRAL] So it looks like when the certificate was issued on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The office visit fee is not covered under this policy, so it looks like there was a new certificate issued in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need me to check on anything else then?
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] Uh, so the same, right, so it won't be covered. So that's the one. what was the date as of [PII]?
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], there's a policy change, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, perfect, uh, [PII]. Thank you. You have a good evening. Take care. Bye.
[AGENT][NEUTRAL] You too, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.