AccountId: 011433970860
ContactId: 35ebc404-b294-4702-996d-ba490d433878
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 626440 ms
Total Talk Time (AGENT): 277016 ms
Total Talk Time (CUSTOMER): 128973 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/35ebc404-b294-4702-996d-ba490d433878_20250617T19:52_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] Hi, [PII]. This is [PII]. I'm calling on behalf of provider's office regarding claim status.
[AGENT][NEUTRAL] OK, you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][POSITIVE] Yes, I can help you with that. And could you please spell your name for me?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, [PII], and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] Yeah, sure. It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] 01880925 and [PII] number 8.
[AGENT][NEUTRAL] Thank you. One moment while I get the member's information pulled up please, [PII].
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] And the first name is uh [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is your data service and total bill amount for her place?
[CUSTOMER][NEUTRAL] That's uh [PII].
[CUSTOMER][NEUTRAL] The claim amount is $1130.97.
[AGENT][NEUTRAL] OK, now the policy number that you provided for me.
[AGENT][NEUTRAL] Was not active for your data service this policy number that you provided for me, [PII], termed as of 912023.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me see if there's another policy. Yes sir, so you just have an older policy number. One moment and I'll provide you the active policy information.
[CUSTOMER][NEUTRAL] I know I don't.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the correct policy number that you need to have for your data service, it's gonna be under policy 0237.
[AGENT][NEUTRAL] 0332.
[AGENT][NEUTRAL] And this policy has an effective date of [PII].
[AGENT][NEUTRAL] And give me a moment to check for the, the your data service.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And you did say it was [PII] and the bill amount was 1000.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. I'm sorry, yeah, [PII].
[AGENT][NEUTRAL] OK. So, I was correct, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and the bill amount was $1130.97. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] For this policy active which you have given to me starts from [PII].
[AGENT][NEUTRAL] And it's active, yes, sir.
[CUSTOMER][NEUTRAL] Uh, since, uh, [PII], what is the term date for this one?
[AGENT][NEUTRAL] There is no term date. The policy is active.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I see. All right. So did you find this claim for this data service?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I did.
[AGENT][NEUTRAL] And this claim was received on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number is 358.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2648.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] Code 99203 was denied because office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] The supplemental policy, the member's plan does not cover office visits?
[AGENT][NEGATIVE] And the other two codes were denied.
[AGENT][NEUTRAL] With the reason this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] So this, uh, you're talking about the security code 93,000 and 933068?
[AGENT][NEUTRAL] Correct, are not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] And it's
[CUSTOMER][POSITIVE] Thank you so much. And have the call number for this one.
[AGENT][NEUTRAL] You're welcome. And then, yes, it's going to be my name in today's date. And [PII], if you need a copy of the explanation of benefits with those remarks that I read to you on there, you may print that by going to our portal website which is located at [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And again with that claim number you should be able to print the explanation of benefits.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And I do have one more claim for different members, so can you please help me with that?
[AGENT][NEUTRAL] Oh, you did. OK, I can, but you have not said that you had more than one.
[AGENT][NEUTRAL] So just a moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And what is the next member's policy number?
[CUSTOMER][NEUTRAL] So the next one policy number is
[CUSTOMER][NEUTRAL] 02481567
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And the same as the last, any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] So [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] date of [PII]. The bill amount is $409.86.
[AGENT][NEUTRAL] 409. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, 409-86.
[AGENT][NEUTRAL] 86409.86. Is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received on [PII] also processed on [PII].
[AGENT][NEUTRAL] The claim number is 3582713.
[AGENT][NEGATIVE] This claim was also denied.
[AGENT][NEUTRAL] And the reason for the denial on here is that office visits are not covered.
[AGENT][NEUTRAL] By the above numbered policy, the member's plan does not cover office visits.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And what is the process date, [PII]?
[AGENT][NEUTRAL] That's the receipt date. The process date was the [PII].
[CUSTOMER][NEUTRAL] [PII]. What about the other one CPT code 73,650?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] 73,650, there were no benefits paid on that because the insured's primary insurance provided full benefits. There are no benefits payable under the supplemental policy.
[CUSTOMER][POSITIVE] Uh, all right. No problem. Thank you so much. May I have the call number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] My name and today's date and if you need a copy of either of these explanation of benefits, you may go to our website where our portal is located. It's [PII].
[CUSTOMER][NEUTRAL] So you cannot fax to us the copy of the UV.
[AGENT][POSITIVE] And be able to print those directly.
[CUSTOMER][POSITIVE] All right, no problem. Thank you so much. Have a good day.
[AGENT][NEUTRAL] All right, well, you're welcome. Is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] OK, well then, thank you for calling APL and I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.
[AGENT][NEUTRAL] Mm