AccountId: 011433970860
ContactId: 171a21b9-09e5-4f6b-b243-5a6c6b55719d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 706489 ms
Total Talk Time (AGENT): 181733 ms
Total Talk Time (CUSTOMER): 145730 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/171a21b9-09e5-4f6b-b243-5a6c6b55719d_20250417T16:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office for a claim clarification. And I'm so sorry I missed your name. Can you spell your name for me?
[AGENT][NEUTRAL] Yes, ma'am. My name is [PII]. It's [PII]
[AGENT][NEUTRAL] And Ms. [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm. It is [PII].
[AGENT][NEUTRAL] OK, thank you very much. And then may I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Mhm. Patient's name is [PII] and the date of uh policy number is 02450109.
[AGENT][NEUTRAL] OK. And what's Miss [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It is uh [PII].
[AGENT][NEUTRAL] Thank you and you're looking for claim status, um, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] Mhm, um, data service is
[CUSTOMER][NEUTRAL] It is [PII], sorry, [PII] with the amount $160 even.
[AGENT][NEUTRAL] OK. Just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I can see primary insurance is paid $82.64.
[CUSTOMER][NEUTRAL] So, just a moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] T
[CUSTOMER][NEUTRAL] It is $50 even.
[AGENT][NEUTRAL] OK, and then may I have the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Mhm. Facility's name is Richmond Dermatology Specialist PC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, Miss [PII], while I look up this claim for us and I'll be right back, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Ah, come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you so much for holding for me, [PII]. I have the claim ready for you. The claim number is 3461982. The claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Uh yes, uh, you said, uh, the office visits are not covered in the patient plan, um.
[CUSTOMER][NEUTRAL] And uh for this one, I just want you to verify uh like is that uh members uh patient responsibility?
[AGENT][NEUTRAL] We do not give patient responsibility. We let the provider determine that.
[CUSTOMER][NEUTRAL] Mhm. And uh may I know why office visits are not covered?
[AGENT][NEUTRAL] It's not covered under the policy contract of the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, I, I do have like one more claim if you could help me with that as well.
[AGENT][NEUTRAL] Absolutely. What is the um member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Member's name is [PII] was, uh, the member ID is 02331433. And the member uh date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look that one up real quick.
[AGENT][NEUTRAL] OK, and then may I have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] with bill amount $108 even.
[AGENT][NEUTRAL] 180.
[AGENT][NEUTRAL] Even
[CUSTOMER][NEUTRAL] 108.
[AGENT][NEUTRAL] 108. OK, thank you. And then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] It is $60 even.
[AGENT][NEUTRAL] OK. And then, um, is it also for Richmond Dermatology Associates?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a quick hold while I look this claim up and I'll be right back with you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you very much for holding for me, [PII]. I have this claim ready for you. The claim number is 352-213-2.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was also denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] May I know on which date claim was received?
[AGENT][POSITIVE] Yes ma'am, let me look that up for you real quick.
[AGENT][NEUTRAL] The claim was received on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK. And uh for this one, actually we don't have the EOB. Can you fax the OB?
[AGENT][NEUTRAL] Yes, what is your fax number?
[CUSTOMER][NEUTRAL] Mhm. Um, the fax number is [PII].
[AGENT][NEUTRAL] OK, and let me repeat it. That's [PII].
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, and you spell your name [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me [PII]. I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] OK. And um may I know the call reference number?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for your assistance, sorry. Have a great day. Bye-bye.
[AGENT][POSITIVE] You have a wonderful day too, Ms. [PII]. Is that everything I can help you with before we go?
[CUSTOMER][POSITIVE] Yes, that would be all. Thank you.
[AGENT][POSITIVE] OK, well, thank you for calling APL. Bye-bye, Ms. [PII].