AccountId: 011433970860
ContactId: 1ddb8b86-70e5-42c2-af42-1921976916e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 718989 ms
Total Talk Time (AGENT): 239799 ms
Total Talk Time (CUSTOMER): 212476 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/1ddb8b86-70e5-42c2-af42-1921976916e7_20250131T15:36_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]. I'm calling from Platinum Dermatology billing office. How are you doing today?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][NEUTRAL] Yeah, I'm good. Thank you for asking, [PII]. Uh, but before proceeding, let me inform you that this call is being recorded for quality and training purposes. Would you like us to continue the recording?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][POSITIVE] Yeah, thank you so much, [PII]. Actually, I'm checking on a claim status. Uh, would you please help me out with that?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I do have a uh.
[CUSTOMER][NEUTRAL] Just give me a second, let me check. I just have 3 claims.
[AGENT][NEUTRAL] OK, and um [PII], may I have a good contact number in case we're disconnected and then the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, but before that, may I know your
[CUSTOMER][NEUTRAL] Initial to your last name, please?
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] Yeah, thank you, [PII]. And the callback number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the first member's policy? Well, are all the claims for one person or they're different um policies?
[CUSTOMER][NEUTRAL] No, different person.
[AGENT][NEUTRAL] OK. May I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 01823452. M as in
[CUSTOMER][NEUTRAL] Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, member's name is uh [PII] and the date of birth is [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 for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yes, and the date of services.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $359 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, there's a skin and the cancer associates.
[AGENT][NEUTRAL] Thank you for that, and I'm showing that we received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 354.
[AGENT][NEUTRAL] 2272.
[AGENT][NEUTRAL] And on the, I'm sorry, on [PII], the claim was denied.
[AGENT][NEUTRAL] As office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Uh, is the member active for the date of service, [PII]?
[AGENT][NEUTRAL] Yes, the policy has been active since [PII].
[CUSTOMER][NEUTRAL] And uh is there any term date?
[AGENT][NEUTRAL] There's no term date?
[CUSTOMER][NEGATIVE] May I know that uh why it is not covered by this payer?
[AGENT][NEGATIVE] The it's just not covered by the patient's policy. Office visits are not a benefit on the policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Uh, for this, uh, patient responsibility, we, uh, can we be patient for this?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility because we're not the major medical insurance, um, so that would be between primary and the provider or whatever your options are, um, when a claim is denied.
[CUSTOMER][NEUTRAL] No, actually, uh, this claim.
[CUSTOMER][NEUTRAL] Previously processed by United Healthcare. So there is a patient responsibility of co-pay.
[AGENT][NEUTRAL] So the sec, the primary?
[CUSTOMER][NEUTRAL] So then it builder to.
[AGENT][NEUTRAL] The primary insurance has their own benefits and the secondary policy has its own benefits. Because office visits are not covered on this secondary policy, we cannot pay out on the claim. Had it been something that was covered, then yes, we could pay towards the copay, the the the deductible, or the co-insurance, but it's not a covered charge, so we cannot apply.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, thank you, [PII], can you please send us the ID you to a fax?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And attention to?
[CUSTOMER][NEUTRAL] Yeah, attention to my name, [PII]
[AGENT][NEUTRAL] And is that [PII] or how do you spell your first name?
[CUSTOMER][NEUTRAL] Yes, yes. [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And will you need copies of the explanation of benefits for all of the, the other two claims as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's the next member's policy number?
[CUSTOMER][NEUTRAL] Uh, actually, the, uh, next claim is also, um, the CT of, uh,
[CUSTOMER][NEUTRAL] Office visit that is 99203. So, uh just now you have said that uh you don't cover the office visit.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] If it's a different member, I don't know if it's the same policy, but I can check for you to see if the reason would be the same.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, and the policy number is 1480322ML8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. Member's name is uh
[CUSTOMER][NEUTRAL] Yeah, the member's name is uh [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim you want me to check on?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $285 even.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[AGENT][NEUTRAL] So is it 2885 is the total bill you said?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] No, uh, [PII], can you check it with the bill amount which is $241?
[AGENT][NEUTRAL] 241. Yes, this is it. Hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, so I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 353-077-1.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy as well.
[CUSTOMER][NEUTRAL] Yeah, thank you, [PII]. Uh, uh, can you send us this OB as well to the fax?
[AGENT][POSITIVE] Yes, I'll be sending them for all 3.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And the policy number is 02064011.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, members, member's name is
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $428 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I'm not showing a claim on file for [PII] for March.
[CUSTOMER][NEUTRAL] Uh, can you please verify the mailing address?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] And uh payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] May I know the timely filing limit to build the claim?
[AGENT][NEUTRAL] So there's no timely filing limit as long as the policy is active on the data service. um, and this policy, let me check the eligibility. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] This policy has been active since [PII].
[CUSTOMER][NEUTRAL] And there is no term date, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you for this information. And uh can I get the call reference?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. First initials of my last name is [PII].
[CUSTOMER][POSITIVE] Yeah, thank you, [PII]. Thank you so much for this information. You were very helpful today and have a nice day, [PII].
[AGENT][POSITIVE] Thank you, [PII], you also, and thanks for calling APL.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.