AccountId: 011433970860
ContactId: 345454f5-a570-4cd0-8d60-95366dd4128e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346420 ms
Total Talk Time (AGENT): 127591 ms
Total Talk Time (CUSTOMER): 198707 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/345454f5-a570-4cd0-8d60-95366dd4128e_20250108T16:55_UTC.wav
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[AGENT][POSITIVE] Good, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good morning. So my name is [PII]. I'm calling from the provider's office and I have a question about a claim.
[AGENT][NEUTRAL] OK, sure. I can assist you with, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Um, 022840428 or ML8.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you. Um, do you have the claim number or do you have the date of service and the amount?
[CUSTOMER][NEUTRAL] Uh, I have a claim number. Claim number is 353.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 8514.
[AGENT][POSITIVE] Thank you. Let me pull the image up that one.
[CUSTOMER][NEUTRAL] You're
[CUSTOMER][NEUTRAL] What DNA?
[CUSTOMER][NEUTRAL] Maus shares identity segments of X chromosome with renowned actor [PII].
[CUSTOMER][NEUTRAL] That the two descent from a common ancestor somewhere.
[AGENT][NEUTRAL] OK, and this is for [PII]?
[CUSTOMER][NEGATIVE] smaller.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] OK. How may I assist you with this claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So this claim was denied stating that you guys were unable to determine the, the, oh, it says the patient's name and ID didn't match or the patient's ID number or something crazy and I'm like, what does that mean?
[CUSTOMER][NEUTRAL] Patient insured health ID name does not match.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] That's not our denial. If um, if you look at the claim in the back where it says remarks description, on the remarks description for the denial is office visits are not covered by the policy and policy does not provide benefits which no charges were incurred.
[CUSTOMER][NEGATIVE] The offices are not covered and they don't pay for charges that were not incurred. What do you mean charges that weren't incurred?
[AGENT][NEUTRAL] Those are the two deadlines.
[AGENT][NEUTRAL] Um, the J codes, it looks like they, they were fully paid by the major medical.
[AGENT][NEUTRAL] So it looks like the um the only charge that was there was for the office visit, which is not covered with this policy. We do not cover the office visit.
[CUSTOMER][NEUTRAL] OK, so this, this plan that she has because not all of the plans are like that, just her plan doesn't cover office visits. OK, I'm just confirming it. OK, so that's not the denial we have with the denial I have access to it saying that the ID number and the patient's name didn't match and I'm like, I'm looking at the card. Every everything is exactly the same. OK, um, so if you, I know at one point, and maybe I lost it and I don't have access to it, you guys have a portal I can pull that on because that's not the denial I have and I wanna put the correct.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct. Mhm. Yes, yeah.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Yeah, yeah, that's, yeah, that's.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, pull the correct, you know, being and put it on my system.
[AGENT][NEUTRAL] Mhm. Correct, yes, um, you can go to um [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oops. I need to learn how to spell here we go. No, does that work? What did I spell wrong? I spell something wrong.
[CUSTOMER][NEUTRAL] You said AM or AM?
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Secure, so it's a secure.
[AGENT][POSITIVE] It's gonna be secure first and then Am like in the morningub.com. So secure.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, I got it backwards, so [PII]. OK, I got it backwards. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, yes, there we go.
[CUSTOMER][NEUTRAL] So that that.
[CUSTOMER][NEUTRAL] OK, listen.
[CUSTOMER][NEUTRAL] This is her and we're gonna go here.
[CUSTOMER][NEUTRAL] I was securing done with the ED. There we go. That's why there was secured.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] There we go.
[CUSTOMER][POSITIVE] All right, perfect. I'll pull it from there. I think I have access to this because that's not what we.
[AGENT][NEUTRAL] Um, do you need the claim number so you can pull it up faster?
[CUSTOMER][NEUTRAL] Um, let's see. Oh wait, let me make sure I have one for these because I might not I usually keep a note of all the the sites that I have. I just wanna make sure you're on my list because I this one I did this before. Is I used this before, but yes, what's the claim number?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The claim number is 353-8514.
[CUSTOMER][NEUTRAL] That's perfect. OK, perfect. That over here. That's over here. So I'll create an account. well, OK, it doesn't look like I have an account. I have to register for one. What's the turnaround time for approval?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh, it's immediately.
[AGENT][NEUTRAL] You get an email and you just verify that email um through your email and that's it.
[CUSTOMER][POSITIVE] OK, perfect. I'll try it.
[CUSTOMER][NEUTRAL] OK, I'm a medical pro I'm a medical or dental provider. That's the one we need, uh, tax ID. OK, perfect. Thank you so much. I appreciate your help today. So is there a reference number for our call?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers, Ms. [PII]. You can use my name in today's day. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Just the spelling of your name.
[AGENT][NEUTRAL] OK, sure. That's [PII], last initial [PII].
[CUSTOMER][POSITIVE] Perfect. You have a good one. Enjoy the rest of your day.
[AGENT][POSITIVE] You as well, and thank you for calling APR. Have a good day. Mm bye bye.
[CUSTOMER][NEUTRAL] OK.