AccountId: 011433970860
ContactId: 2e8d9763-299c-4fd5-b1b9-af77731d42ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306589 ms
Total Talk Time (AGENT): 148226 ms
Total Talk Time (CUSTOMER): 247561 ms
Interruptions: 21
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/2e8d9763-299c-4fd5-b1b9-af77731d42ac_20250122T17:43_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] OK
[CUSTOMER][NEUTRAL] Good, uh, good morning, [PII]. My name is [PII]. I'm calling to check on a claim status.
[AGENT][POSITIVE] [PII], it would be a pleasure to assist you today. What is a good call back number?
[CUSTOMER][NEUTRAL] Thank you, that's gonna be [PII]. That's my direct line.
[AGENT][NEUTRAL] Thank you. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Thank you. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] The policy number is 02363908ML8.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth please, ma'am.
[CUSTOMER][NEUTRAL] Thank you and the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, sure, he is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right. And you're needing eligibility for Lucas, and it would be a pleasure to assist you with that, [PII].
[CUSTOMER][POSITIVE] Alright, and you're needing eligibility for Lucas, and it would be a pleasure to assist you with that, [PII].
[AGENT][NEUTRAL] I am showing that Lucas's policy is active. Effective date is [PII].
[CUSTOMER][NEUTRAL] I thank you that Lucas's policy is active. Effective date is [PII].
[AGENT][NEUTRAL] And this is a secondary policy to the policyholder's major medical.
[CUSTOMER][NEUTRAL] And this is the secondary policy to the policy holder Major Major. Thank you. We sent a claim uh with data of service [PII].
[CUSTOMER][NEUTRAL] Um, do you see that one on file?
[AGENT][NEUTRAL] I'm checking that for data service 8-19-2024.
[CUSTOMER][NEUTRAL] I'm checking that I'm sorry, [PII]. That's what I said I'm sorry.
[AGENT][POSITIVE] That's what I typed and I said a big day. I'm sorry.
[AGENT][NEUTRAL] What was that the amount?
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Uh, 1,06458 cents.
[AGENT][NEUTRAL] And what is the provider name?
[CUSTOMER][NEUTRAL] Um, sports medicine or Alexander Bertat.
[AGENT][NEUTRAL] Is that sports medicine associates?
[CUSTOMER][POSITIVE] Mhm, that's correct.
[AGENT][NEUTRAL] Two CPTs uh 99203 and 72114.
[CUSTOMER][NEUTRAL] CPT 992032114. That's correct.
[AGENT][NEUTRAL] Alright, we do have that on file and I can give you that claim information as well.
[CUSTOMER][POSITIVE] Alright, we do have that on file and I can give you that claim information as well. Thank you. Looks like we've actually received it twice.
[AGENT][NEGATIVE] Looks like we've actually received it twice.
[AGENT][NEUTRAL] So the original claim,
[CUSTOMER][NEUTRAL] So the original claim.
[AGENT][NEUTRAL] We received on.
[CUSTOMER][NEUTRAL] We received on.
[AGENT][NEUTRAL] 61824.
[CUSTOMER][NEUTRAL] 618 24 and processed on 2024.
[AGENT][NEUTRAL] And processed on 6-20-24.
[AGENT][NEUTRAL] The 99203.
[CUSTOMER][NEUTRAL] The 99203.
[AGENT][NEGATIVE] Was denied as office visits are not covered.
[CUSTOMER][NEGATIVE] Was denied as offices are not covered.
[AGENT][NEUTRAL] And the 72114 was denied as insurance insured's primary insurance provided full benefits, therefore, there are no benefits payable.
[CUSTOMER][NEUTRAL] And the 72114 was denied as insurance insured primary insurance provided full benefits, therefore there are no benefits payable. No benefits. Alright, so [PII], is there any way that we could um check the benefits online?
[AGENT][NEUTRAL] I can
[AGENT][NEUTRAL] So the
[CUSTOMER][NEUTRAL] Or this, I'm sorry, go ahead.
[AGENT][NEUTRAL] The benefits are not available online. You can get EOBs online.
[AGENT][NEUTRAL] Submit claim status.
[AGENT][NEUTRAL] And check claim status.
[CUSTOMER][NEUTRAL] I have submitted some claims, um, but if we want to like if we would like to check the claim or the bill status it it's asking for the actual claim, the APA claim number which we don't have until we got the EOB so it's kind of.
[AGENT][NEUTRAL] Yeah. I can give you the claim number if you need that EOB.
[CUSTOMER][NEUTRAL] Um, it's kind of tricky. All right, thank you. What's gonna be done?
[AGENT][NEUTRAL] It's 347.
[CUSTOMER][NEUTRAL] 347. Thank you so much, but I wanted it to um.
[AGENT][NEUTRAL] 1684.
[CUSTOMER][NEUTRAL] I wanted to ask you if there's because all of this we got a lot of patients with the same or similar policy right? and what I have understood is that they don't covered, they only cover outpatient center like major procedures right not office visit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me check that.
[AGENT][NEUTRAL] Well, they do cover the um any procedures or treatments performed in the office, but not for the visit.
[CUSTOMER][NEUTRAL] Well, they do cover the um any procedures or treatments performed in the office, but not for the visit.
[AGENT][NEUTRAL] With this policy, I can't speak to all the policies that you have, but with this group.
[CUSTOMER][NEUTRAL] Mm I can't speak to all the policies that you have, but with this group.
[AGENT][NEUTRAL] They do not cover the office visit, only procedures or treatments in office. For example, on that 72114, if the primary had applied a deductible or co-insurance or co-pay for that procedure, it could have been considered for benefits.
[CUSTOMER][NEUTRAL] They do not cover the office visit procedures or treatments in office, for example, on that 72114 if the primary had applied a deductible or co-insurance or copay for that procedure, it could have been considered for benefits.
[CUSTOMER][POSITIVE] Hm, I see. All right, that's gonna be, that's gonna be all. Thank you so much for your help today.
[AGENT][POSITIVE] Well [PII], it was such a pleasure to assist you with that claim status. Thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Well [PII], it was such a pleasure to assist you with that claim status. Thank you for calling APL, and I hope you have a wonderful day. You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.