AccountId: 011433970860
ContactId: 3943b556-1234-465a-9c81-623b61b2b6ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263100 ms
Total Talk Time (AGENT): 138505 ms
Total Talk Time (CUSTOMER): 77440 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/3943b556-1234-465a-9c81-623b61b2b6ee_20250127T16:04_UTC.wav
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[AGENT][POSITIVE] Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, this is [PII] calling from Doctor [PII], and I was calling to, um, ask in regards to a claim, please.
[AGENT][NEUTRAL] Is it would be my pleasure to assist you. What is the callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the policy number for the patient?
[CUSTOMER][NEUTRAL] I have 01868735.
[AGENT][NEUTRAL] And the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And you were calling in reference to a claim?
[CUSTOMER][NEUTRAL] Yeah, I wanted to see what the status on it if you received it and what the status is.
[AGENT][POSITIVE] It would be my pleasure to help you with that claim status. [PII], what is the data service?
[CUSTOMER][NEUTRAL] I have [PII] was [PII].
[AGENT][NEUTRAL] And what was the bill amount?
[CUSTOMER][NEUTRAL] That was $177?
[AGENT][NEUTRAL] And the facility name please, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then well I'm gonna call you again.
[AGENT][NEUTRAL] All right, for that date of service, we did receive that claim on [PII]. That claim was processed on [PII] and denied as office visits are not covered under the patient's plan, and I can give you that claim number if you would like.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] That claim number is 3549018.
[CUSTOMER][NEUTRAL] OK, so she doesn't have any coverage for office visit?
[AGENT][MIXED] That's correct, not for the visit.
[CUSTOMER][NEUTRAL] OK, so what type of plan does she have?
[AGENT][NEUTRAL] It's a secondary gap policy.
[AGENT][NEUTRAL] Now, on this policy, it does cover procedures and treatments in office, but not for the office visit.
[CUSTOMER][NEUTRAL] Oh, OK, alright, so I'm assuming then the one for the December would be the same thing.
[AGENT][NEUTRAL] Would you like for me to see if we've received that claim as well?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] And that build out?
[CUSTOMER][NEUTRAL] That is $228.
[AGENT][NEUTRAL] OK, so we did receive that claim on [PII].
[AGENT][NEUTRAL] And processed on [PII]. Now the offices it was denied um the.
[AGENT][NEUTRAL] G 2252.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that was denied because primary insurance provided full benefits, therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] OK, uh, I have a question. Do you all send out explanation of payment?
[AGENT][NEUTRAL] We do, that is, and we also have a provider portal and that is at secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can create a login and password using your tax ID number and the patient's account number inbox 26 on the HIA.
[AGENT][NEUTRAL] And in this case, the patient account number is 51461.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can have 24/7 access to claim status, EOBs, and claim submission.
[CUSTOMER][POSITIVE] OK, alrighty, thank you very much. Can I get a call reference I'm sorry, what was your name?
[AGENT][NEUTRAL] I, well, the call reference number is my name and today's date, and I spell my name [PII].
[AGENT][NEUTRAL] And [PII], anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you.
[AGENT][POSITIVE] Well thank you for calling APL. It's a pleasure to assist you with that claim status. Have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye.