AccountId: 011433970860
ContactId: 3dc1d51c-e315-402e-bb76-3a04daf3c1c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1342609 ms
Total Talk Time (AGENT): 163887 ms
Total Talk Time (CUSTOMER): 263073 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/3dc1d51c-e315-402e-bb76-3a04daf3c1c0_20250411T15:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for Tri and Medical Partners PLLC. Please be informed that this call is being recorded and monitored for the quality and training purposes. I verify that EOB and this call is made for the additional information about the denial, and could you please repeat your name again?
[AGENT][NEUTRAL] Yes, my name is [PII]. What was your name again?
[CUSTOMER][POSITIVE] My name is [PII]. Thank you so much for that, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, and then Cla, do you have the policy number on you?
[CUSTOMER][NEUTRAL] The policy number in the sense, member ID right?
[CUSTOMER][NEUTRAL] OK, the member ID number is 02093564. That's the member ID number I do have.
[AGENT][POSITIVE] OK, perfect. That will work.
[AGENT][NEUTRAL] And then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and that's a direct line.
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] OK. And then patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient's first name is uh I'm sorry, name of the patient is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I don't know, but uh.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] We're checking claim status today. um, you said that we are.
[CUSTOMER][NEUTRAL] Yes, the additional information about the denial.
[AGENT][NEUTRAL] Yes, ma'am. OK.
[AGENT][NEUTRAL] OK and then do you have the claim number for that one?
[CUSTOMER][NEUTRAL] Yeah, let me check it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, the claim number will be?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you looking at a um like a document? Oh.
[CUSTOMER][NEUTRAL] 358 1
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. 3581586. That's the claim number.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, and then what was the charge amount on this one?
[CUSTOMER][NEUTRAL] Charge amount is $80 even.
[AGENT][POSITIVE] Mm thank you.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, let me just put you on a brief hold really quick while I look into this claim number, OK?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] OK, thanks. Yes, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, thank you for holding. So what is the data service for that claim number you provided?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have another claim number by chance?
[CUSTOMER][NEUTRAL] Let me check it, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the claim number.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] Let me check it, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, only one claim number I do have.
[CUSTOMER][NEUTRAL] And yeah, so I provide you any other information there?
[AGENT][NEUTRAL] Uh, that's the only claim number that you have?
[CUSTOMER][NEUTRAL] Yes, I do have that one that is only one claim number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My
[AGENT][NEUTRAL] OK, so it looks like this was denied due to office visits are not covered by.
[AGENT][NEUTRAL] This policy.
[CUSTOMER][NEUTRAL] OK, so it's not uh.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I know whether it is not covered as per the pair guidelines?
[AGENT][NEUTRAL] Office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, per the patient's policy.
[CUSTOMER][NEUTRAL] OK, it's not covered as for the patient's benefit plan, is that right?
[AGENT][NEUTRAL] Uh, per the patient's policy.
[AGENT][NEUTRAL] So you can just say.
[CUSTOMER][NEUTRAL] OK, it's not covered as per the
[AGENT][NEUTRAL] Yes, you could say office visits. Office visits are not covered by the patient's policy.
[CUSTOMER][NEUTRAL] Mm, yeah, please go ahead.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, just a moment, thank you so much for that information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm, OK, just a moment, OK.
[CUSTOMER][NEUTRAL] Like to verify the time defining limit for submitting the correct claim.
[AGENT][NEUTRAL] What was that?
[CUSTOMER][NEUTRAL] May I know the time to filing limit for correcting submitting the claim again corrected claim.
[AGENT][NEUTRAL] There is no filing limit to submit a claim.
[CUSTOMER][NEUTRAL] OK, there's no time limit, right?
[AGENT][NEUTRAL] No, ma'am. There is no limit to submit submit a claim.
[CUSTOMER][NEUTRAL] OK, there is no time limit, right?
[AGENT][NEUTRAL] Right, no filing limit to submit a claim.
[CUSTOMER][NEUTRAL] OK. No time ma'am. Thank you so much for that and like to verify the, OK, just a moment, please. OK. The office, so the claim is denied as the office visits are not covered as per the patient's plan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. And would like to verify the, mm.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I know when did you receive this claim, [PII]?
[AGENT][NEUTRAL] Yes, just one moment.
[CUSTOMER][POSITIVE] Yeah, sure, no problem. Take your time.
[CUSTOMER][NEUTRAL] Because we have submitted the claim on [PII].
[AGENT][NEUTRAL] OK, so it looks like the.
[AGENT][NEUTRAL] So it looks like the received date is [PII]-2025.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And the process date is [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, so you received the correct claim and it was denied for, OK, the reason, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] You're welcome. Do you have any further questions?
[CUSTOMER][NEUTRAL] And yes.
[CUSTOMER][NEUTRAL] Yeah I'm checking the final question here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment. OK, really sorry. And uh this is the only claim I do have.
[AGENT][NEUTRAL] No, you're OK.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah. Just a moment, please. OK, I'm requesting you.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Oh, OK. I to verify the mailing address.
[AGENT][NEUTRAL] Our mailing address?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes, for submitting the collected plan.
[AGENT][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], is that right?
[AGENT][POSITIVE] Yes, ma'am. That is correct.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK then. Could you please go ahead and provide the call reference number?
[AGENT][NEUTRAL] Yes, ma'am. It is [PII], which is my first name. [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Last initial [PII]
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then today's date.
[CUSTOMER][POSITIVE] Thank you so much [PII] for that. Have a great day take care bye right now.
[AGENT][NEUTRAL] Of course. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, the information is sufficient. Have a great day day. Goodbye for now. Happy weekend.
[AGENT][POSITIVE] OK, well, thank you for calling APL and I hope that you have a good day.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Goodbye.
[CUSTOMER][NEUTRAL] It's fine.