AccountId: 011433970860
ContactId: 332f14ae-2d00-4f54-ad10-02205db390ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263940 ms
Total Talk Time (AGENT): 111867 ms
Total Talk Time (CUSTOMER): 96312 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/332f14ae-2d00-4f54-ad10-02205db390ed_20250418T20:25_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. Uh, my name is [PII] and I need to check claim status for a patient.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, the callback number, that's the [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, that's the 01740502 M as in Mary, L as in Lima, 7.
[AGENT][NEUTRAL] And that was 1740502?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the member's name is [PII] with the 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. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah. The date of service that's the 7-21-2024 with the bill amount 245.28.
[AGENT][NEUTRAL] Thank you, hold on one moment and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, only one.
[CUSTOMER][NEUTRAL] I guess, yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Nicholas Children's Pediatric.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 644-7.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, it is not covered under the patient plan. We can bill it to patient.
[AGENT][NEUTRAL] Um, it's not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK, so we can bill it to patient, right?
[AGENT][NEUTRAL] We don't determine patient responsibility, um, because we're not the major medical insurance company. So it'll be whatever your um policy is for outstanding balances.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, OK. Just a, just a minute. And can you spell your name, please, again?
[AGENT][NEUTRAL] Sure, my name is [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, and can you confirm me the reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh, and also can you confirm me the, what, what kind of plan is this?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So this is a Medin supplemental gap insurance policy. So we apply to the co-pay, deductible and co-insurance of covered charges after primary.
[CUSTOMER][NEUTRAL] OK, uh, you don't, uh, uh, uh, cover this, uh.
[CUSTOMER][NEUTRAL] After a primary payment, right? The patient responsibilities.
[CUSTOMER][NEUTRAL] Um, OK, that's all I guess.
[AGENT][NEUTRAL] So we cover.
[AGENT][NEUTRAL] All right. Was there anything else I can assist you with?
[CUSTOMER][NEUTRAL] You cover after the primary payment.
[AGENT][NEUTRAL] What is the question, sir?
[CUSTOMER][NEUTRAL] Uh, sorry.
[CUSTOMER][NEUTRAL] I was confused. Uh, you said uh that you, uh, your insurance covered the, uh, amount after the primary payment, right?
[AGENT][NEUTRAL] Of covered charges. The the secondary policy has its own coverage. So for this, yes, we do apply if it's covered on the policy, but office visits are not covered on this member's policy.
[CUSTOMER][NEUTRAL] you're
[CUSTOMER][POSITIVE] OK, no issue. Thank you so much. And I guess that's all. So you have a nice day. Bye-bye.
[AGENT][POSITIVE] Thank you. You also, [PII], and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you.