AccountId: 011433970860
ContactId: 2591cfb3-3623-4dea-b1c8-fb58ff5cbe2a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553580 ms
Total Talk Time (AGENT): 182518 ms
Total Talk Time (CUSTOMER): 182201 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/2591cfb3-3623-4dea-b1c8-fb58ff5cbe2a_20250312T18:45_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office and looking on a claim status. Can you help me?
[AGENT][POSITIVE] Yes, 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] Two claims.
[AGENT][POSITIVE] Alright, I'll be more than happy to help you with your two claims, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes. It's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. May I have
[CUSTOMER][NEUTRAL] And the policy number?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's uh 02451768 ML 8.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII].
[CUSTOMER][NEUTRAL] For $230 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there's no claims on file yet for [PII].
[CUSTOMER][NEUTRAL] OK. And may I know the effective date of the policy?
[AGENT][NEUTRAL] The policy has been effective since [PII].
[CUSTOMER][NEUTRAL] And still active as secondary.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And may I know the payer ID?
[AGENT][NEUTRAL] Our pay ID is 60801.
[CUSTOMER][NEUTRAL] And the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] And the timely filing?
[AGENT][NEUTRAL] Um, there's no timely filing as long as the policy was active on the date of service, you can file at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And call reference number will be the same for the entire call.
[AGENT][NEUTRAL] Yes, it'll be my name and today's date. The first initial to my last name is [PII]. My first name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the last [PII] call reference your name and today's date. And shall I provide you the next uh member ID?
[AGENT][POSITIVE] Yes, I'm ready when you are.
[CUSTOMER][POSITIVE] Yes, thank you. And the next member ID is
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 480528
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you. May I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] For $511 even.
[AGENT][NEUTRAL] Thank you and again just for the call, all the information provided is a verification of benefits, not a guarantee of payment, and hold on one moment while I locate the claim.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And it was $511?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Integrated dermatology of South Miami.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 365 8.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And hold on one moment, I'm getting that reason for you.
[AGENT][NEGATIVE] It was denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEGATIVE] So, you stated it was received on [PII] and denied on [PII].
[AGENT][NEUTRAL] It was received and processed on [PII].
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And the claim number is 3563658.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh may I know, so the office visit is denied as not covered under the patient's visit. And what about the procedure code 11104 and 11105?
[AGENT][NEUTRAL] OK, wait, hold on one second. Let me go back.
[AGENT][NEUTRAL] OK, so code 99214 was denied because office visits are not covered on the policy. Code 11104 and 11105 were denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK. So the both visit is not covered.
[CUSTOMER][NEUTRAL] Under the Ming supplement gap policy.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. And upon checking, uh, I have found another claim number for this date of service which was received on [PII] and denied on [PII]. And the claim number is 35576775.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Right, we received it twice. So that's the first time we received it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it was denied for the same reason.
[CUSTOMER][NEUTRAL] OK. So the claim was uh received.
[CUSTOMER][NEGATIVE] Uh, twice and denied the same.
[AGENT][NEUTRAL] We received it on
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And uh can you fax me the EUB?
[AGENT][NEUTRAL] OK, did you want the one from January or February or both?
[CUSTOMER][NEUTRAL] Both
[AGENT][NEUTRAL] OK, and what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, would that be attention ya?
[CUSTOMER][NEUTRAL] Yeah, yeah, R [PII] Y [PII]
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, when I will receive the fax?
[AGENT][POSITIVE] Um, I'm sending them to you now, so we usually say for a fax to give it at least an hour. If you don't receive it by end of day today, you can definitely give us a call and we'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] OK, uh thank you. And the call reference will be your name in the state.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much for the information you provided me. Mhm.
[AGENT][POSITIVE] You're welcome, ma'am.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling AP over here. I hope you have a great day.
[CUSTOMER][POSITIVE] You too as well. Thank you. Bye.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye.