AccountId: 011433970860
ContactId: 0a3d3c11-6841-40ff-b904-0fa030a8825d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387980 ms
Total Talk Time (AGENT): 139588 ms
Total Talk Time (CUSTOMER): 84527 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/0a3d3c11-6841-40ff-b904-0fa030a8825d_20250220T14:13_UTC.wav
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[AGENT][NEUTRAL] I thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII] and initial of my last name is [PII], and I've called you to check on a claim, [PII].
[AGENT][NEUTRAL] OK, you're needing to check claim status, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, I can help you with that. Could you please spell your first name for me?
[CUSTOMER][POSITIVE] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And you said the first initial to your last name is [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Thank you and what is your call back number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And what is your, I can help you with claim status. What is the patient's policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes, it's 22392.
[AGENT][NEUTRAL] OK, so that is not a policy number, that is a group number. There should be another number on the member's ID card.
[CUSTOMER][NEUTRAL] Uh, just one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh hello [PII].
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] All right. It's 01611565 M as in Mary, L as in Lima, number 8.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And demo, any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name, place, and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount please?
[CUSTOMER][NEUTRAL] Uh, [PII]. The amount is $750 even.
[AGENT][NEUTRAL] OK, the data service is 9-10-2024?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And again the bill amount 700.
[CUSTOMER][NEUTRAL] $50.50.
[AGENT][POSITIVE] $50. OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] It was processed also the same date.
[AGENT][NEUTRAL] The claim number is 3,551,140.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] OK, 99213 was denied as office visits are not covered.
[AGENT][NEUTRAL] By the policy by the member's plan.
[AGENT][NEUTRAL] And 76,830 was denied stating to please send the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 76,830. All right.
[CUSTOMER][NEUTRAL] And the uh 99213 is denied as a uh non-covered as for patient plan and patient plan, am I right?
[AGENT][POSITIVE] That is correct. That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, but it's an office visit that should be covered under.
[AGENT][NEUTRAL] Under this supplemental policy, it is not covered. This is not major medical insurance. It is a supplemental policy and office visits are not covered.
[CUSTOMER][NEUTRAL] The patient plan I think.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] OK. All right, [PII]. Thank you so much for this and we have to send the primary UV for 76,830 to process.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much for this and help me with the call reference number.
[AGENT][NEUTRAL] Yes, she would use my name along with today's date and if you need a copy of this explanation of benefits and all, you may print that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] All right. Thank you. And uh can you spell out your first name?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, [PII], thank you so much.
[AGENT][POSITIVE] You're very welcome. So if that's all I can help you with them all, thank you again for calling APO, and I hope you have a great day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Hello, excuse me. There is one more thing, sorry for interrupting. Uh, can you help me with the fax number on which we can send you the, uh, primary UV?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] [PII] attention claims.
[CUSTOMER][POSITIVE] All right, thank you so much, [PII]. You have a great day.
[AGENT][POSITIVE] Yes sir, you too, and thank you again for calling APL.