AccountId: 011433970860
ContactId: 4619f0e3-73e6-4849-9111-885d19abdda4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304679 ms
Total Talk Time (AGENT): 165513 ms
Total Talk Time (CUSTOMER): 68602 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/4619f0e3-73e6-4849-9111-885d19abdda4_20250411T13:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I need to check on claim status please for a secondary claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you're needing to check claim status for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm with Chattanooga Allergy clinic.
[AGENT][NEUTRAL] OK, [PII], thank you. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And [PII], what is the member's policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 018412777.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], any information 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] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the data service place and total bill amount for her?
[CUSTOMER][NEUTRAL] $2525423.
[AGENT][NEUTRAL] OK, you said 25 of $25 for $423 is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] $4428. I'm sorry.
[AGENT][NEUTRAL] 0, 428. OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so this claim was received. It was received on 3-24-25, processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 358-0307.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This claim was denied, [PII]. Uh, the first remark on here states office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] And the other codes uh state all payable benefits were applied to the policy deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So on code 95017, there was $39.73 applied to the deductible.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] On code 95012 1546.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And code 940102761.
[CUSTOMER][NEUTRAL] OK, OK, now, even as you are secondary, did you all not always pick up secondary or you don't own this non-covered chart.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I've covered services.
[AGENT][NEUTRAL] Right, there's, if it's, if it's a covered service under the supplemental policy, of course, if it's not covered at all by the primary insurance, it would also not be covered at all by APL. And on the supplemental policy, um, it's just that office visits are not covered.
[CUSTOMER][NEUTRAL] Oh, only covered services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] She does have a treatment rider, but the, again, she does have a $250.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Calendar year deductible on the on outpatient so these additional benefits were applied towards that deductible.
[CUSTOMER][POSITIVE] OK, alrighty then that's what I needed to know. I do appreciate your help.
[AGENT][NEUTRAL] All right. Well, you're welcome and then one last thing, [PII], you should be getting the EOB in the mail, but you can also print it by going to our portal.
[AGENT][NEUTRAL] It's a self registering portal and now that you have the claim number, you should be able to access that the website for the portal is secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, can I, you're welcome. And can I help you with anything else?
[CUSTOMER][POSITIVE] Alrighty I appreciate it.
[CUSTOMER][POSITIVE] That's it I appreciate it.
[AGENT][POSITIVE] OK. Well, you're certainly welcome and thank you again for calling.
[CUSTOMER][NEUTRAL] You'd have to
[CUSTOMER][POSITIVE] You have a good weekend. Mhm.
[AGENT][POSITIVE] Yes, ma'am. I hope you have a good weekend too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh huh bye bye.
[AGENT][NEUTRAL] Bye bye.