AccountId: 011433970860
ContactId: 3e46e350-9b37-46e5-af08-d4f6e395709b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 520080 ms
Total Talk Time (AGENT): 220875 ms
Total Talk Time (CUSTOMER): 143461 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/3e46e350-9b37-46e5-af08-d4f6e395709b_20250424T14:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, this is [PII]. I'm calling from our office. How are you?
[AGENT][NEUTRAL] I'm fine. Did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] OK, I want to know the claim. Can you assist me?
[AGENT][NEUTRAL] You, OK, you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII]. And the extension is [PII].
[AGENT][NEUTRAL] Thank you and how many claims do you have to check status on [PII]?
[CUSTOMER][NEUTRAL] Uh, we have just one of them.
[AGENT][NEUTRAL] OK, and what is that member's policy number please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. The member policy number is 01994078 M as in Mary, L as in Lima 8.
[AGENT][POSITIVE] OK, thank you, [PII]. Give me a couple of moments please to get all of the members' information pulled up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information [PII], that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] OK. The first name is [PII]. Last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] And I'm sorry, what was the first name again?
[CUSTOMER][NEUTRAL] OK. The first name is [PII] sorry, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You're like.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And again, any information provided will be a verification of benefits and not a guarantee of payment. What is the data service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] OK, the date of service is.
[CUSTOMER][NEUTRAL] [PII], the bill amount is $440 even.
[AGENT][NEUTRAL] 440.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][POSITIVE] OK, and again, I'm so sorry, to build them out one more time, please.
[CUSTOMER][NEUTRAL] $440 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] OK, so I do show that this claim was received. The received date was [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 693 2.
[AGENT][NEUTRAL] And the reason for the denial states office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] The member's plan does not, the member supplemental plan, [PII], does not cover office visits.
[AGENT][NEUTRAL] Office visits rather.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, you may print that now that you have our the the claim number by going to our portal website which is located at [PII].
[CUSTOMER][NEUTRAL] OK, so you said the members supplement, uh,
[CUSTOMER][NEUTRAL] Plan is not covered office visit.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So, let me check. Just one moment.
[CUSTOMER][NEUTRAL] OK. I read the uh the date of services.
[CUSTOMER][NEUTRAL] [PII], the insurance uh covered the office visit.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] OK, I'm sorry, you have another data service for this member that you're wanting to check? OK, you said that you have one data service.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Uh, no, no, no. I, I.
[CUSTOMER][NEUTRAL] No, no, I have a reference date, the date of service is uh [PII]. I already insurance cover the uh office service and already insurance paid this, uh, allowed the uh payment on this uh claim.
[AGENT][NEUTRAL] OK, so what is the total bill amount for your data service on [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The bill amount is $1,132.
[CUSTOMER][NEUTRAL] So, Medicare allowed the co-pay and uh the secondary insurance.
[AGENT][NEUTRAL] OK, this is
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this policy is not a Medicare supplemental policy. This is a supplemental policy to her private primary health care insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm, I'm, I'm sorry. Can, can you repeat it?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] This is not a Medicare supplemental policy.
[AGENT][NEUTRAL] This is a supplemental policy to her primary healthcare insurance, or major medical.
[CUSTOMER][NEUTRAL] So
[AGENT][NEGATIVE] We did receive a claim for that data service. That claim was also denied as office visits are not covered.
[CUSTOMER][NEUTRAL] OK, but on the uh [PII], the insurance allowed the co-pay.
[AGENT][NEUTRAL] OK, again, this supplemental policy.
[AGENT][NEUTRAL] Does not cover office visits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] No, no, you, you can't understand my question. I said the [PII] date of service is [PII]. The primary primary.
[AGENT][NEUTRAL] Yes, sir. For 1000.
[CUSTOMER][NEUTRAL] Yes, primary insurance allowed co-pay, and the secondary insurance uh allowed co-pay on this claim is a secondary.
[AGENT][NEUTRAL] This supplemental policy. Yes, sir. I'm, I'm looking at the only insurance that matters on this claim is her primary health care insurance. Her primary health care insurance is United Healthcare, but I'm sorry, you're not understanding that.
[CUSTOMER][NEUTRAL] You check in your system, the secondary insurance.
[AGENT][NEUTRAL] The supplemental policy that she has with APL, the company that I'm with.
[AGENT][NEUTRAL] Her policy does not cover office visits.
[AGENT][NEUTRAL] And we did deny the claim for [PII].
[AGENT][NEUTRAL] As office visits are not covered.
[CUSTOMER][NEUTRAL] OK, so let me check.
[CUSTOMER][NEUTRAL] OK. Can you provide your name?
[AGENT][NEUTRAL] Again, my name is [PII], and you would use my name along with today's date, [PII], as your call reference number.
[CUSTOMER][POSITIVE] OK, fine, sir. Thank you so much for asking. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You're very welcome. Yes, sir. That's all I can help you with. Thank you again for calling APL and I hope you have a nice day also.
[CUSTOMER][NEUTRAL] OK [PII], bye bye.