AccountId: 011433970860
ContactId: 0d9b47ed-3bb7-4246-89d4-9b2ca815a9be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 799849 ms
Total Talk Time (AGENT): 139118 ms
Total Talk Time (CUSTOMER): 317165 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/0d9b47ed-3bb7-4246-89d4-9b2ca815a9be_20250131T17:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling for the provider Florida Women Care LLC. Please be informed that this call is being recorded and monitored for quality and training purposes. I'm calling to check on a claim status.
[AGENT][NEUTRAL] OK I can help you with claim status. Can I please get your call back number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Uh, first name is [PII] and the last name is [PII]. And the patient's date of birth is [PII].
[AGENT][NEUTRAL] OK, and what's patient's policy number?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Sure. 01659498 M as in Mike, L as in Lima, 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let me pull that policy in real quick.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charges is $171.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you, and that was [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I'm sorry, your voice is also breaking for me.
[AGENT][NEUTRAL] OK, and the
[AGENT][NEUTRAL] OK, what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So you have total charges of $171 and the outstanding is $60 even.
[AGENT][NEUTRAL] OK, thank you. Alright, I'm gonna put you on a hold while I pull the claim up for you and I'll be right back.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That's true.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you [PII] for holding for me. I have the claim for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 883 5.
[AGENT][NEUTRAL] But the policy number you gave me was no longer active. Let me give you a good policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2502518.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] So this is the new member ID.
[AGENT][NEUTRAL] Yes, that's the active policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied because contraceptives are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So it does not covered the service as for the patient's benefits plan, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, let me verify any billing amount. So kindly bear a moment.
[CUSTOMER][NEUTRAL] Is that.
[AGENT][NEUTRAL] I'm sorry, what did you ask for?
[CUSTOMER][NEUTRAL] Just bear one minute so that I can check uh any previous payment have been made. That's.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, may I know the claim received date?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am. Let me look that up.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Good
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] May I know the CPT or diagnosis is not covered?
[CUSTOMER][NEUTRAL] I actually
[AGENT][NEUTRAL] I can send you an EOB with the um.
[CUSTOMER][NEUTRAL] I think that it's.
[AGENT][NEUTRAL] CPT code on it.
[AGENT][NEGATIVE] And the denial
[CUSTOMER][NEUTRAL] OK, may I know the CPT code which has been denied?
[CUSTOMER][POSITIVE] Yeah, take your time.
[AGENT][NEUTRAL] Hold on real quick, let me pull it up.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK just a moment. OK.
[CUSTOMER][NEUTRAL] So the one CPT code which is not covered is [PII]. Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] May I know it is not covered under their guidelines, patients plan or the provider contract?
[AGENT][NEUTRAL] It's not covered under the patient's plan.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I know the mode of resubmission whether we you can submit as some corrected claim or an appeal.
[AGENT][NEUTRAL] There's not a time limit for claim correction, you just need to send a letter while you're correcting it.
[CUSTOMER][NEUTRAL] OK, Ma, can you please verify the mailing corrected claim address?
[AGENT][NEUTRAL] Yes, it's [PII], [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]. It's [PII]. Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much. Do you require a copy of denied UB when we resubmit the corrected claim?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK and you said you'll fax the
[CUSTOMER][NEUTRAL] Uh, copy of the ID right?
[AGENT][NEUTRAL] Yes, can you give me your fax number?
[CUSTOMER][NEUTRAL] Sure. The fax number is [PII]. And pay attention to the patient's account number. It's going to be 24084468 [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I fax that claim to you. I'll be right back.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], I have that fax on its way to you now.
[CUSTOMER][POSITIVE] Thank you so much. So.
[CUSTOMER][NEUTRAL] And I have the claim number as 353-883-5. Am I right? Can the call reference number is your name? [PII] [PII] right? [PII] OK. And you said that the uh old member ID is not active, ma'am, and you give the new member ID, am I right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So you can be able to pull up the patient, right?
[AGENT][NEUTRAL] I'm sorry, what did you say?
[CUSTOMER][NEUTRAL] You have the patient, right, because you gave the new member ID so I just want to uh verify that and the new member ID you said is 2502518 active policy, right? OK, thank you. Thank you for your assistance. Have a great day.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] You too, thank you for having a you have a good day too. Thanks for calling APL.
[CUSTOMER][POSITIVE] A great weekend.
[CUSTOMER][POSITIVE] Thank you bye bye.