AccountId: 011433970860
ContactId: 31c7193c-b35c-4c57-8e25-e5075bfc76b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 584150 ms
Total Talk Time (AGENT): 186656 ms
Total Talk Time (CUSTOMER): 148591 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/31c7193c-b35c-4c57-8e25-e5075bfc76b9_20250123T21:14_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], uh, calling from [PII] office.
[AGENT][NEUTRAL] [PII], were you and I just speaking?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, what is your extension number, Mac? Yes, sir. I tried to call you back, but it wants an extension.
[CUSTOMER][NEUTRAL] Uh, I don't know what happened.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] Give me just one moment to pull that number's information back up that we were discussing and if you would re-verify for me the name and date of birth.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, my name is uh [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The amount is $65.49.
[AGENT][NEUTRAL] Total bill amount?
[AGENT][NEUTRAL] One moment please.
[AGENT][NEUTRAL] And as I previously stated to you, any information that I provide for you on any of the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still loading the information that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEGATIVE] The received date was [PII] and it was processed the same day. It was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the reason for the denial on this claim?
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] States this service is not covered when performed in a doctor's office or clinic. The member's plan, the member supplemental policy does not cover this.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Got
[CUSTOMER][NEUTRAL] OK. So this is not covered.
[AGENT][NEUTRAL] Mhm. When performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the date?
[AGENT][NEUTRAL] The same date as the process date?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. And just one moment for me to finish my note before we move on to the next one.
[CUSTOMER][NEUTRAL] Let's go.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so this claim is also for uh same patient.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, let me pull the policy back up, Mac.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the next date of service and total bill amount?
[CUSTOMER][NEUTRAL] Uh, we have data services.
[CUSTOMER][NEUTRAL] [PII] and bill amount is $245.28.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 245.28. Is that correct?
[CUSTOMER][NEUTRAL] Yeah yes.
[AGENT][NEUTRAL] Thank you. OK, there is no claim on file for data service 721-2024.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, it's the last one.
[AGENT][NEUTRAL] And this one, OK, just, and is it for the same member? Is it for the same patient, Mac, or is it a different policy?
[CUSTOMER][NEUTRAL] No, if
[CUSTOMER][NEUTRAL] Different.
[AGENT][NEUTRAL] OK, so give me a moment to finish this one first.
[CUSTOMER][POSITIVE] So, please take your time.
[AGENT][NEUTRAL] Mhm. Thank you. Now, on this one that we just checked that we do not have it on file, you will have to also send us a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] OK. And what is your next policy number?
[CUSTOMER][NEUTRAL] The policy number is 025013777.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 77, is that correct? OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, I think I got it.
[AGENT][NEUTRAL] And your patient's name and date of birth.
[CUSTOMER][NEUTRAL] His name is [PII] and um
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Uh, date of services [PII] and bill amount is $245.28.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] OK, so this claim was also received Mac, just one moment, I'll provide you that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this claim was received on 122-2024.
[AGENT][NEUTRAL] It was processed and denied on 124-2024.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 353-6987.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] 353.
[AGENT][POSITIVE] And the reason for the, I'm so sorry, uh-huh.
[CUSTOMER][NEUTRAL] 69
[AGENT][NEUTRAL] 87.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Again, I'll repeat the whole number 353-6987.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the reason for the denial states office visits are not covered by the above numbered policy. The member supplemental policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Allow me a moment though.
[CUSTOMER][NEUTRAL] So what?
[CUSTOMER][NEUTRAL] offices.
[CUSTOMER][NEUTRAL] Uh, could you please, um, repeat the reason for denial once again?
[AGENT][NEUTRAL] Office visits?
[AGENT][NEGATIVE] are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] By the above numbered policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much uh.
[AGENT][POSITIVE] You are very welcome, Mac, and is there anything else I can help you with?
[CUSTOMER][POSITIVE] Uh, no, um, thank you so much for helping me out and have a good day.
[AGENT][POSITIVE] Well, you, you too, [PII], and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yeah bye bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.