AccountId: 011433970860
ContactId: 23f9702a-557a-48b6-bca6-947009a969b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 884330 ms
Total Talk Time (AGENT): 272583 ms
Total Talk Time (CUSTOMER): 166912 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/23f9702a-557a-48b6-bca6-947009a969b0_20250509T20:21_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I am calling from Multi-are Health System, and I'm calling to verify coverage on a patient.
[AGENT][POSITIVE] Sure, I can assist you with the eligibility and benefits, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] It is 025650007.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] This is for [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, perfect, thank you.
[AGENT][NEUTRAL] And see what type of service is being render Miss [PII].
[CUSTOMER][NEUTRAL] Uh, this is for medical.
[AGENT][NEUTRAL] Is it office listed?
[CUSTOMER][NEUTRAL] So like for office visits, yeah.
[AGENT][NEUTRAL] OK. All right. Before I give you any benefit information, I need to let you know that this is not a guaranteed payment, just a verification of coverage and that's just a disclaimer. We have an effective date of [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And this is one of our limited hospital indemnity plans?
[AGENT][NEUTRAL] The amount that we cover for an office visit is $50 per visit, maximum of 4 visits per person per calendar year, and that's a flat amount.
[CUSTOMER][NEUTRAL] For office visits a year, OK, and is her plan still in effect?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, it's active at the moment.
[CUSTOMER][NEUTRAL] OK, and she is active.
[CUSTOMER][NEUTRAL] OK, can I check uh claim status?
[AGENT][NEUTRAL] Uh sure, yes. What is the date of service?
[CUSTOMER][NEUTRAL] Uh, this is for.
[CUSTOMER][NEUTRAL] Where is it? [PII] for $490.
[AGENT][NEUTRAL] OK, let me pull this EB one moment.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, here we go.
[AGENT][NEUTRAL] OK. So for that claim, it looks like we process, let's see.
[AGENT][NEUTRAL] On [PII] and the claim was denied. Let me get the denial reason for this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] What I have here is indicating we're unable to assign benefits to the provider of records due to a discrepancy with the provider's tax ID number.
[AGENT][NEUTRAL] A letter has been mailed to the provider with instructions on resolving the discrepancy. And let's see.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And what is wrong with the tax ID number?
[AGENT][NEUTRAL] Uh, let me check how that needs to be handled. Bear with me just a sec.
[AGENT][NEUTRAL] Uh let's see do do do do.
[AGENT][NEUTRAL] Because, um, yeah, they should have received a letter that they they need to send back to us, but let me check and see if there's anything we can do work on.
[CUSTOMER][NEUTRAL] OK, I'm looking for a letter too.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so here I got we're unable to accept a sign off benefits and screpancy reported by us to by the IRS, um, combination of the name taxpayer identification number on your account.
[AGENT][NEUTRAL] So it looks like it's discrepancy with the IRS.
[CUSTOMER][NEUTRAL] Which I have no idea what that would even
[CUSTOMER][NEUTRAL] I mean, let's see, I've got a letter on here.
[AGENT][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Treatment in an outpatient hospital not covered by this policy, is that correct?
[AGENT][NEUTRAL] Uh, let me look at the.
[AGENT][NEUTRAL] The other do, give me just a second. OK, um.
[AGENT][NEUTRAL] OK, so there's a 2nd denial on the claim. The 2nd denial on the claim is indicated the outpatient treatment benefits provide an indemnity amount when the a covered person receives treatments in an emergency room, urgent care facility, physician's office, speech or occupational therapy.
[AGENT][NEUTRAL] So, um, yes, it looks like outpatient hospital is not covered by the policy.
[CUSTOMER][NEUTRAL] OK, now it looks like she was getting.
[CUSTOMER][NEUTRAL] See if this is outpatient.
[CUSTOMER][NEUTRAL] Yeah, radiation therapy.
[AGENT][NEGATIVE] Oh yeah, that's not covered under this plan. This is a limited policy.
[CUSTOMER][NEUTRAL] OK, so that would be transferred to the other one.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEGATIVE] That one's probably not covered either.
[CUSTOMER][NEUTRAL] Um, and I think that's radiation as well.
[CUSTOMER][NEUTRAL] Clean
[CUSTOMER][NEUTRAL] Oh maybe not, um, OK, so that's, so the one that you said that was there's an issue with our tax ID number?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Has that been resolved?
[AGENT][NEUTRAL] OK, uh,
[AGENT][NEUTRAL] I'm not gonna know that because it doesn't come to us, it goes to another department um they get the notices and they put it in in the system and they correct the system um, have you sent that back to us? Do you know if they send it back to us?
[CUSTOMER][NEUTRAL] That I don't know. I'm looking to see if I have a letter.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] This letter just says that your.
[CUSTOMER][NEUTRAL] Radiation therapy's not covered.
[AGENT][NEUTRAL] Let me see if I have any other note here.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 12 patient responsibility. This is a dental only policy. There's no medical benefits.
[CUSTOMER][NEUTRAL] Um, and that was with.
[CUSTOMER][NEUTRAL] APL
[CUSTOMER][NEUTRAL] And that was data service [PII].
[CUSTOMER][NEUTRAL] So these are all no I don't have a letter on file that says anything about a tax ID number.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] It looks like the letter was sent on [PII] based on the notes I got here.
[CUSTOMER][NEUTRAL] OK, here's oh that's of [PII].
[CUSTOMER][NEUTRAL] The only one I have is dated [PII].
[CUSTOMER][NEUTRAL] It just says.
[CUSTOMER][NEUTRAL] Uh, radiation not a covered benefit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I don't have anything else for can you or can you fax me a copy or email me a copy of that letter?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see who can send you a copy um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, let me see if I can get Miss [PII] on the line. If I cannot get her, then I probably need to just send a request. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII]. OK. So I, I was not able to get her on the line, but I'm sending her an email. I'm just finalizing the email so she can give you a call back. And is it OK for her to call you back at the number you gave me [PII]?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, that'd be fine.
[AGENT][NEUTRAL] OK. Do you have an email?
[CUSTOMER][NEUTRAL] I do. It is [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it's
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, so I'll go ahead and send this over to her and you should be hearing back from them either from [PII] or [PII]. They will call you and give you a little bit more information. I asked um to give you a little bit more information and see if you can get another copy of that letter, OK?
[CUSTOMER][POSITIVE] OK, that sounds great thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Um, do, is there a reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you like.
[CUSTOMER][POSITIVE] OK, I can do that thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day, Miss [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.