AccountId: 011433970860
ContactId: 0ec27f34-b469-4253-bd7a-f12ff0b10194
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 987770 ms
Total Talk Time (AGENT): 279622 ms
Total Talk Time (CUSTOMER): 287299 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/0ec27f34-b469-4253-bd7a-f12ff0b10194_20250403T14:30_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APR. This is easy. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] calling from provider's office. How are you doing today?
[AGENT][POSITIVE] I'm good.
[AGENT][NEUTRAL] And how you
[CUSTOMER][POSITIVE] Yeah, I'm doing good. Thank you for asking. Yeah, it's for claim status. Can you please help me out?
[AGENT][NEUTRAL] I'm sure I can assist you with claim status. First I'll need to go call back number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Yeah, it will be [PII]. It's a direct line.
[AGENT][NEUTRAL] OK. And please spell your name for me.
[CUSTOMER][NEUTRAL] Yeah, it's spelled [PII], last name [PII].
[AGENT][NEUTRAL] OK, thanks. And let me get the policy number, please.
[CUSTOMER][NEUTRAL] Yeah, before proceed, this call may be recorded for quality and training purposes. Would you like to continue?
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][NEUTRAL] Yeah, your policy number 01887348.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, and number 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] OK, and the date of service and bill charges on the claim that you're calling about, please?
[CUSTOMER][NEUTRAL] [PII] and the bill amount will be $197 even.
[AGENT][NEUTRAL] OK. Thank you, [PII]. And yes, I'm showing that we received that claim on [PII].
[AGENT][NEUTRAL] It processed on [PII].
[AGENT][NEUTRAL] The claim number is 3554973.
[AGENT][NEUTRAL] And this claim denied because office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] So you said uh it was received on [PII], right?
[AGENT][NEUTRAL] It was received on [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and the process is on [PII], right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And the claim number was 3554973, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, so we can build to patient, right?
[AGENT][NEUTRAL] Yes, you can bill to patient. The service is not covered under this policy.
[CUSTOMER][POSITIVE] OK, thank you so much for confirming that. And can you please proceed with another patient?
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] Yeah, can we proceed with another patient?
[AGENT][NEUTRAL] Yes, what's the policy number, please?
[CUSTOMER][NEUTRAL] 1628029
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] OK, thank you. Now, I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount will be.
[CUSTOMER][NEUTRAL] $1,258 even.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, yes, we received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3,549,680.
[AGENT][NEUTRAL] And this claim denied because, well, just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII], and this policy expired on [PII], and that's why the claim denied.
[CUSTOMER][NEUTRAL] So claim was for inactive for data service, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. May I know the termination date of the patient?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is there any another secondary insurance for this patient?
[AGENT][NEUTRAL] No, there isn't. Not on file with us.
[CUSTOMER][NEUTRAL] OK, I'm just confirming the claim number. It is 3,549,680, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For this same patient.
[CUSTOMER][NEUTRAL] For the date of service was.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, any date of service after [PII] for this patient is denied because the policy had expired.
[CUSTOMER][NEUTRAL] Yes, but I just need a claim number to get you from the portal, right?
[AGENT][NEUTRAL] OK, and what's the uh date of service you're calling about?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm not showing a claim on file with that date of service for this patient.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, I'm not showing a claim on file for [PII]. This is for [PII], right?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yeah, there's no claim on file for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so hon, is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] So, so we can build.
[CUSTOMER][NEUTRAL] Yeah, I have a few more claims so we can be patient for the [PII] for the data service, right?
[AGENT][POSITIVE] Yes, you can.
[CUSTOMER][NEGATIVE] Which is inactive.
[CUSTOMER][POSITIVE] OK, thank you. And uh the next patient.
[AGENT][NEUTRAL] Policy number, please.
[CUSTOMER][NEUTRAL] So should I repeat that yes, 02449586 ML 8.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] [PII] and the charge amount will be $241 even.
[AGENT][NEUTRAL] OK. We received this claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3563584.
[AGENT][NEUTRAL] And the claim denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] 3563584, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, for the same patient, can you please check for the service of [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, I'm not showing that date of service. Um, could you please repeat it? I'll try again.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the bill charges?
[CUSTOMER][NEUTRAL] $197 even.
[AGENT][NEUTRAL] OK, we received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3578085.
[AGENT][NEGATIVE] And this also denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Uh, I'm just confirming your claim number 3578085, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, another patient will.
[AGENT][NEUTRAL] What's the policy number, please?
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 60,300.
[CUSTOMER][NEUTRAL] 9 ML 8.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be [PII].
[CUSTOMER][NEUTRAL] [PII], sorry.
[AGENT][NEUTRAL] The date of service and bill charges on the client?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of your bill amount will be.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Just a moment. I'm just.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] 1,682.
[AGENT][NEUTRAL] OK, and actually I'm not showing a claim on file with that date of service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I didn't get to that.
[AGENT][NEUTRAL] I'm sorry, please repeat your question.
[CUSTOMER][NEUTRAL] So you're saying there is no claim on file, right?
[AGENT][NEUTRAL] Right now with that date of service, that's correct. For [PII].
[CUSTOMER][NEUTRAL] May [PII].
[AGENT][NEUTRAL] Right. Uh, the claim is not on file with that date of service for this member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please proceed with another?
[AGENT][NEUTRAL] How many more do you have?
[CUSTOMER][NEUTRAL] I have 7 more.
[AGENT][NEUTRAL] I can only help you with one more. I'm sorry.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I can only help you with one more. I have other callers.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I'm ready for the next uh policy number.
[CUSTOMER][NEUTRAL] 02460348 ML 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Please repeat that policy number.
[CUSTOMER][NEUTRAL] Yes, 02460348 ML 8.
[AGENT][NEUTRAL] OK. Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] OK, now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] [PII] and the bill amount was $277 even.
[AGENT][NEUTRAL] OK, we received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3549849.
[AGENT][NEGATIVE] And this is denying because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK. 3549849, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh.
[CUSTOMER][NEUTRAL] Can you please spell your name and call reference for that, all the claims?
[AGENT][NEUTRAL] Um, yes, my name is [PII]. It's spelled [PII] My last initial is [PII], and my name and today's date is the reference number for all, um, calls, all.
[AGENT][NEUTRAL] Provide our members.
[CUSTOMER][NEUTRAL] Uh, for all the members, the call will be that today, your name and today's date, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII].
[AGENT][POSITIVE] OK. Thank you so ha for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] Yeah, bye bye.