AccountId: 011433970860
ContactId: 1cee43c6-747b-4612-9d63-8ee88be390bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313420 ms
Total Talk Time (AGENT): 106134 ms
Total Talk Time (CUSTOMER): 182773 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/1cee43c6-747b-4612-9d63-8ee88be390bb_20250430T13:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office. That's your current claim status.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one claim?
[AGENT][NEUTRAL] Alright and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. My contact number is [PII]. It's a direct line, no extension.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Sure, the member ID is 02350220.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The member's name is [PII] date of birth of [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] I know I'm gonna leave with.
[CUSTOMER][NEUTRAL] Sure. The date of service is [PII] with the total charge amount of $253.69.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yes, I didn't.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, feeling it.
[CUSTOMER][NEUTRAL] Rockford Health Physicians.
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh I didn't.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 341-9788.
[CUSTOMER][NEUTRAL] Mobile.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And on [PII], the claim was denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I feel like I'm on.
[CUSTOMER][NEUTRAL] Well, no, don't bother with it.
[CUSTOMER][NEUTRAL] Yes, well, as you stated, uh, the CPT was received on.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] 78, yeah, the claim number is 341-9788. Is that right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah, it was non-covered uh sitting when performed in doctor's office or the clinic, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, sir, may I know what will be the time refunding limit to file and a claim to the insurance?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, there's no timely filing as long as the policy is active on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] Can I get a patient, uh, termination date?
[AGENT][NEUTRAL] The policy is still active.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Well, I do phone on the date of service, patient has a Blue Cross of Illinois as primary insurance and primary process as deductable.
[CUSTOMER][NEUTRAL] There's a.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, do you have the primary insurance on your hand? The primary will be?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yes, we have the primary EOB. The claim was denied because of the place of service. So unless the place of service changes, the claim is going to be denied because they're not covered when performed in the doctor's office or clinic. So we received the explanation of benefits.
[CUSTOMER][NEUTRAL] Come on
[CUSTOMER][NEUTRAL] Let.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, sir. Yeah. Can I get the copy of your my fax?
[AGENT][NEUTRAL] Copy of EOB for this claim from us?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And does that need to be attention, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, and that was [PII]?
[CUSTOMER][NEUTRAL] So uh.
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][POSITIVE] Alright, so I'm sending this over to you now. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] Yes, well, can I, could you please spell out your name for me, your name?
[AGENT][NEUTRAL] Sure, my name is [PII] [PII] name [PII] [PII].
[CUSTOMER][NEUTRAL] Can I get the call reference number, [PII]?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Thank you for your assistance and have a great day and while we take care.
[AGENT][POSITIVE] Thank you and thanks for calling APL Thomas. Is there anything else I can help with?
[CUSTOMER][POSITIVE] No, thank you for your assistance.
[AGENT][POSITIVE] Alright, have a great day. Bye bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh man, we're probably about it.