AccountId: 011433970860
ContactId: 44a97006-9c6b-4e46-9ff7-d815583309d4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 619700 ms
Total Talk Time (AGENT): 167562 ms
Total Talk Time (CUSTOMER): 237463 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/44a97006-9c6b-4e46-9ff7-d815583309d4_20250124T14:38_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling on behalf of Fors office.
[AGENT][NEUTRAL] And it's [PII]
[CUSTOMER][NEUTRAL] Sorry, [PII], yeah, sorry for that. Uh, this is [PII] calling.
[AGENT][POSITIVE] No worries.
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I'm here to check on a claim.
[AGENT][NEUTRAL] OK, I can assist you. What's the policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is going to be.
[CUSTOMER][NEUTRAL] 01828789
[AGENT][NEUTRAL] And a phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you for holding, [PII], can you verify the patient's name and date of birth please?
[CUSTOMER][NEUTRAL] Yep, uh, it's
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Spell the first name for me?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, thank you and you said you're checking for a claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, if you can provide the date of service and the total charge, I can help you.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the charge amount is $134 even.
[AGENT][NEUTRAL] 134.
[CUSTOMER][NEUTRAL] Yeah, 134, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the procedure code on the claim?
[CUSTOMER][NEUTRAL] Uh, it's uh 93306 with a modified 26.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was received [PII].
[AGENT][NEUTRAL] Process [PII], no payment was made, um, showing that um the amount was applied towards the um calendar your deductible under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, process towards deductible.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, uh, I'm ready with the claim number. So, I'm ready for the claim number, sorry.
[AGENT][NEUTRAL] That number
[AGENT][NEUTRAL] That number is 353.
[AGENT][NEUTRAL] 2854.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And [PII], you can also check your claim status on our online service center.
[AGENT][NEUTRAL] At [PII].
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] OK. And I have one more question. Uh, uh, may I know what is the total deductible amount for the patient and how much the patient met for the, the date?
[AGENT][NEUTRAL] It's $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] $1000 yeah, current year, OK.
[AGENT][NEUTRAL] And this is for year [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So in that year they met 166.56.
[AGENT][NEUTRAL] Of the deductible.
[CUSTOMER][NEUTRAL] 15, 156.
[AGENT][NEUTRAL] 166.56.
[CUSTOMER][NEUTRAL] 16.56. OK. Including this claim.
[CUSTOMER][NEUTRAL] Is that included with this claim or else?
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] OK, including this, OK.
[CUSTOMER][NEUTRAL] And [PII], um, I do have one more claim to check for status. Could you please help me with that and uh
[AGENT][NEUTRAL] Is it the same person or a different patient?
[CUSTOMER][NEUTRAL] Uh, it's a different patient. And uh may I know what's the card reference number?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK give me one moment to document this call please.
[CUSTOMER][POSITIVE] Oh, OK. Take your time, please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] You'll use my name in today's status reference for the entire call. [PII], first initial last name is [PII] and I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh for the UB sir, could you please fax a copy of UB or else we have to get it from the online.
[AGENT][NEUTRAL] You can download it from the online service center. um, the EOB is automatically mailed when the claim is processed, so it was mailed to the address that's on the claim and is now available on the online service center. You can search it by the claim number that was provided.
[CUSTOMER][NEUTRAL] OK. So, uh, you cannot send it to the fax or mail?
[AGENT][NEUTRAL] Yeah, but I can also help you create the online account if you would like.
[CUSTOMER][NEUTRAL] OK, so we have to get it from online, uh, that's fine.
[CUSTOMER][NEUTRAL] Uh, I just make sure. OK, uh, shall we move to the next time?
[AGENT][POSITIVE] I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Yeah, and the next one is for
[CUSTOMER][NEUTRAL] ID 02129473.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, the date of service and total charge?
[CUSTOMER][NEUTRAL] Data services for [PII] and the bill amount is for $213 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so that's, uh claim was denied. Office visits are not covered under the patient's policy. I show that this claim was received.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII] process [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The EOB was mailed [PII] to the address that's on the claim, and let me know when you're ready for the claim number, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That number is 3
[CUSTOMER][NEUTRAL] Uh, please tell me the number.
[AGENT][NEUTRAL] That number is 354.
[AGENT][NEUTRAL] 0611.
[AGENT][NEUTRAL] And the policy number is 35254.
[AGENT][NEUTRAL] 3935.
[CUSTOMER][NEUTRAL] Oh, that, that's the policy number for the patient, right?
[AGENT][NEUTRAL] The one you gave me is incorrect, so that's the correct policy number for this state of service.
[CUSTOMER][NEUTRAL] OK. So could you please repeat the policy number once again?
[AGENT][NEUTRAL] 2543935
[CUSTOMER][NEUTRAL] 3935.
[CUSTOMER][NEUTRAL] OK, so the policy, uh, due to, uh, OK, offices it is not covered by the patient's policy plan type, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So can we build this camp to the patient in this, in this?
[AGENT][NEUTRAL] We do not determine patients responsibility.
[CUSTOMER][NEGATIVE] Ok, it did not come.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this claim denied as uh CO and not a patient responsibility. Am I right?
[AGENT][NEGATIVE] It denied his office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Yeah, uh, there must be a remark code or a denial code for the claim, right? I'm just asking whether it's denied as a patient responsibility or uh or a contractual obligation.
[AGENT][NEUTRAL] OK, we do not determine patients responsibility, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Just making sure of it. OK. So the reference number is going to be your name on today's date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And you'll be have to get it from the online, right?
[AGENT][NEUTRAL] Correct, using the claim number provided.
[CUSTOMER][POSITIVE] OK. So thanks for assisting to this call, [PII], and that's all I have for the day. Have a great day ahead. Take care.
[AGENT][POSITIVE] You're, you're welcome. Thanks for calling APL [PII]. Have a good day as well.
[CUSTOMER][NEUTRAL] Bye bye.