AccountId: 011433970860
ContactId: 2ce431be-9e6b-4bdf-ad2e-660b0b2f56b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 365549 ms
Total Talk Time (AGENT): 148826 ms
Total Talk Time (CUSTOMER): 70470 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/2ce431be-9e6b-4bdf-ad2e-660b0b2f56b9_20250606T17:34_UTC.wav
--------------------------------------------
[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'm calling for claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status and [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] Dermatology Group of Florida.
[AGENT][NEUTRAL] OK. Thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02510689 ML8.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the amount is $1,906.96.
[AGENT][NEUTRAL] OK, so [PII].
[AGENT][NEUTRAL] And let me see if I have that claim on file and for future you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] OK. Do you have the procedure codes that are on the claim?
[CUSTOMER][NEUTRAL] Um, the procedure code, one of them is 13121.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did you need all of them?
[AGENT][NEUTRAL] No, I just needed one at least. OK, so let's see, so it's gonna be this one, so we processed the claim twice the last time it was processed as a duplicate, so I'm gonna go ahead and pull up the information of the original one, OK? One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hey, I'm waiting on the EOP.
[AGENT][NEUTRAL] OK, the original claim was processed [PII] and it was denied. The reason for this denial is, let's see. Benefits are payable only if major medical insurance provide benefits. So we need the explanation of benefits showing the major medical pay.
[CUSTOMER][NEUTRAL] Yes, and
[CUSTOMER][NEUTRAL] Did you receive the fax we sent the fax of the primary EOB on [PII]?
[AGENT][NEUTRAL] OK, let me check the one that we process and not as duplicate. One moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, yes, we did receive it. um, now the reason it was denied as a duplicate is because um when I see here that information from Admit it says bill amount $1,906.96 paid 0 Re code PR 26, and then they uh put the whole amount on the member's responsibility which um if they don't pay, we do not pay.
[CUSTOMER][NEUTRAL] Oh, OK. So that fax was received.
[AGENT][NEUTRAL] Yes, mhm, and it was processed on let's see what day it was processed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me give you the process day we received it on [PII] process on [PII].
[CUSTOMER][NEUTRAL] OK. And since the primary didn't pay, they didn't pay.
[AGENT][NEUTRAL] Yes, we only pay if major medical pays.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Just a moment please. I just wanna double check why the primary didn't pay.
[CUSTOMER][NEUTRAL] Oh, OK. I see they don't have coverage. All right, thank you. Um, do you have a reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][POSITIVE] OK. Um, no, that'll be it. Thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good weekend, Miss [PII].
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.