AccountId: 011433970860
ContactId: 3473f1d5-5ff3-4254-be8e-44bd32526701
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 626919 ms
Total Talk Time (AGENT): 190831 ms
Total Talk Time (CUSTOMER): 201431 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/3473f1d5-5ff3-4254-be8e-44bd32526701_20250319T21:09_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Yeah, very good afternoon. This is [PII]. May I know your name, please, please?
[AGENT][NEUTRAL] It's [PII], last initial [PII]
[CUSTOMER][NEUTRAL] Uh sorry. Can you reconfirm your name, please, with spelling?
[AGENT][NEUTRAL] Sure. [PII].
[CUSTOMER][NEUTRAL] OK, [PII], right.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah, I'm looking for a claim review.
[AGENT][NEUTRAL] OK, I can verify claim status for you and your name is again?
[CUSTOMER][NEUTRAL] [PII]. It's [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. And what is
[CUSTOMER][NEUTRAL] Last name initial is [PII]
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] It's OK. Last name initially is [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the policy number, please?
[CUSTOMER][NEUTRAL] It's 02433284.
[AGENT][NEUTRAL] OK, thank you, hold on one moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah. It's [PII].
[AGENT][NEUTRAL] Thank you, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] It's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Date of service is [PII], and total charge amount is?
[CUSTOMER][NEUTRAL] Give me a second, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Total charge amount is $253.
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call, not callback number, what's the balance after primary has processed the claim?
[CUSTOMER][NEGATIVE] Uh, there is no balance.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, I just hope and I think the different claim. Wait a second, please, give me a second. Just hold on a minute.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] Yeah, it's incorrect.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Hello, are you there?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah. Uh, it's pending balance is $143.98.
[AGENT][NEUTRAL] OK, thank you. And while I'm looking at this claim information and let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[AGENT][NEUTRAL] And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] Worker Home Medical.
[AGENT][NEUTRAL] OK. Um, one moment.
[CUSTOMER][NEUTRAL] Can you confirm the name of the plan the patient has?
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] Medlink.
[AGENT][NEUTRAL] Yes, and I show this claim processed on [PII] and the check was mailed in the amount of 143.98.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Is this patient [PII] date of birth is [PII] and date of service is [PII], right?
[AGENT][NEUTRAL] Yes, based on the information you gave, we have received the claim. It was processed on [PII] and the check was mailed in the amount of 143.98.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. It's deductible transfers?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] I don't get the point. Uh.
[AGENT][NEUTRAL] You're calling for claim status, correct? The claim was paid in the amount of 143.98 and a check has been mailed.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK. Can you give me the check number?
[AGENT][NEUTRAL] Sure, 202-8294.
[CUSTOMER][NEUTRAL] It's 94.
[AGENT][NEUTRAL] 202-8294 is the check number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Processing date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Received it.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is it paid by bulk or single check?
[AGENT][NEUTRAL] Single
[CUSTOMER][NEUTRAL] OK. And uh check issue date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] OK. And the allowed amount?
[AGENT][NEUTRAL] There's not an allowed amount. The amount we paid was 143.98.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh, I have one other claim for the same patient. Can you give me the information for them, uh, for that as well?
[AGENT][NEUTRAL] Sure. What is the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Uh, give me a second.
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Uh, hold a minute, please. I just find out.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually, a little bit my server is down. Give me a second, just.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah. Date of service is [PII] and total charge amount is $13.
[CUSTOMER][NEUTRAL] And 50 cents.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] OK, I show that claim process as this item does not meet the definition of durable medical equipment under this policy contract. Therefore, we are unable to provide benefits for this charge.
[CUSTOMER][NEUTRAL] It's no going?
[AGENT][NEGATIVE] This this item does not meet the definition of durable medical equipment under the policy contract. Therefore, we are unable to provide benefits for this charge. The
[CUSTOMER][NEUTRAL] To
[AGENT][NEGATIVE] The procedure code does not.
[CUSTOMER][NEUTRAL] To prove the medical.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] No, you go ahead.
[CUSTOMER][NEUTRAL] Sorry. Uh, actually, just I'm asking that, uh,
[CUSTOMER][NEUTRAL] Uh, to prove the medical asses, we have to be submit any appeal or medical records.
[AGENT][NEGATIVE] No, it is processed, it does not meet the definition of durable medical equipment for the patient's policy.
[AGENT][NEUTRAL] So it does not meet, we have a definition on the policy of DME or doable medical equipment and that procedure does not meet the definition.
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] OK. Can you give me the call reference?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] OK. Thank you. Bye for now. Have a good day.
[AGENT][POSITIVE] You too. Thanks for calling APO Ms. [PII]. Bye.
[CUSTOMER][NEUTRAL] Yeah bye bye.