AccountId: 011433970860
ContactId: 2adc9099-72eb-4287-b2bc-caaf0381fb2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 557080 ms
Total Talk Time (AGENT): 156302 ms
Total Talk Time (CUSTOMER): 185948 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/2adc9099-72eb-4287-b2bc-caaf0381fb2b_20250210T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, I'm [PII] calling from NYU. You're looking for the claim status. How are you doing today?
[AGENT][POSITIVE] OK. I'm doing well. How are you?
[CUSTOMER][POSITIVE] I'm doing great here. Can you please spell your name?
[AGENT][NEUTRAL] Sure, it's [PII] Would you mind spelling yours too?
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][POSITIVE] Could you repeat that? I'm so sorry.
[CUSTOMER][NEUTRAL] That's OK. [PII], [PII].
[AGENT][POSITIVE] Got you. OK, and I can definitely check on a claim for you, [PII]. Uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII], extension of [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then uh do you have a policy number?
[CUSTOMER][NEUTRAL] Oh yeah, sure.
[CUSTOMER][NEUTRAL] 0184731.
[CUSTOMER][NEUTRAL] 0 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the patient?
[CUSTOMER][NEUTRAL] Um [PII]. Date of birth will be [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that, [PII]. Uh, what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] I'm sorry, that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you have the bill amount?
[CUSTOMER][NEUTRAL] 688, 688.
[AGENT][POSITIVE] Got it OK thank you one moment please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII], looks like we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, do you have the claim number?
[AGENT][NEUTRAL] Yes, that is 352-744-7.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, can you repeat it again, uh, [PII]?
[AGENT][NEUTRAL] Sure. 35.
[AGENT][NEUTRAL] 27
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 447.
[CUSTOMER][NEUTRAL] OK. Um, before that, I have one claim number with me that is a mismatch with this. That is 35547005.
[AGENT][NEUTRAL] Yes, it looks like this uh we've received it twice, um, so that would be the duplicate claim.
[CUSTOMER][NEUTRAL] This is the
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, may I know the original claim number?
[AGENT][NEUTRAL] Yeah, the original claim number was the one I gave you ending in 447.
[CUSTOMER][NEUTRAL] Uh, that is the original claim number?
[AGENT][NEUTRAL] That was the original, yes.
[CUSTOMER][NEUTRAL] OK, OK. When was the date?
[AGENT][NEUTRAL] That was [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] But the date of services um [PII], right?
[AGENT][POSITIVE] Oh yes, oh my goodness, I'm so sorry you're right.
[AGENT][POSITIVE] I just saw that you are right, yes, so that is the claim number. So sorry about that, the one ending in 705, but then our reason is the same now. I am so sorry about that.
[CUSTOMER][NEUTRAL] No, that's OK.
[CUSTOMER][NEUTRAL] That's OK. Yeah, may I know what the claim receive it?
[AGENT][NEUTRAL] Yes, one moment, let's see.
[AGENT][NEUTRAL] That was [PII].
[AGENT][POSITIVE] And then it was processed on [PII]. I'm so sorry about that, [PII], my goodness.
[CUSTOMER][NEUTRAL] Yeah, that's OK.
[CUSTOMER][NEUTRAL] So may I know what your claim number that is 705 or 447?
[AGENT][NEUTRAL] Right, yes, it was the 705.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, before that, I have a specific question for this claim. Uh, so initially, uh, United Healthcare was paid and cross over $60.00.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So this is a recent claim status, right?
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] Uh, no, I initially, uh, you would see United Healthcare was paid and they cross over to you $60.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that is the claim status?
[AGENT][NEUTRAL] Yeah, we were just
[AGENT][NEGATIVE] Sure we were just unable to pay that as we don't uh cover office visits under this policy.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Just allow me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, can you place this call on hold for a while?
[AGENT][NEUTRAL] Yeah, you're fine.
[CUSTOMER][POSITIVE] Yeah, sure. Thank you.
[CUSTOMER][NEUTRAL] Yeah, thank you for being online, [PII]. Can you please verify me if the patient has any another insurance?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, not that I am able to see [PII]. This is the only policy they have with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you, uh, can you provide the office code, is it code that is once again that is 98214, right?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But the procedure code I'm sorry.
[CUSTOMER][NEUTRAL] Yes, that is 98214, right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you want me to send you a copy of this EOV, [PII]?
[CUSTOMER][NEUTRAL] Uh, would you be better?
[CUSTOMER][NEUTRAL] They need your
[AGENT][NEUTRAL] Do you want uh this the one from us with the denial reason?
[CUSTOMER][POSITIVE] Yeah, I have you with me, that is.
[AGENT][NEUTRAL] Oh, you do have it, OK.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah, the claim number include uh 705 only, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just give me a moment. I'm just documenting here, [PII].
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, do you have any additional information for this claim, [PII], uh, except for this?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Uh, do you have any additional information on this claim except for this?
[AGENT][NEUTRAL] Um, no, I don't. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] Yeah, let me just check here.
[CUSTOMER][NEGATIVE] Because uh previously there is no payment was made for this provider.
[AGENT][NEUTRAL] The what? I'm sorry?
[CUSTOMER][NEUTRAL] No, I'm just checking here, just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Actually
[CUSTOMER][NEUTRAL] Uh, so the office is not covered under this policy or under this patient's plan?
[AGENT][NEUTRAL] It's under this patient's policy or this patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, uh, then that's it for this call. Thank you so much for your assistance.
[AGENT][NEUTRAL] Of course, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, that is for this claim. Can I get the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII]
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Yeah, thank you so much for your assistance. Have a great day. Bye for now.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Yeah. Bye-bye. Take care.
[AGENT][NEUTRAL] You too.