AccountId: 011433970860
ContactId: 46211ba5-6068-44e3-ac56-c1d4fe404492
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 668979 ms
Total Talk Time (AGENT): 164975 ms
Total Talk Time (CUSTOMER): 170034 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/46211ba5-6068-44e3-ac56-c1d4fe404492_20250324T14:15_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for Vicus to check on a claim status. Please be informed that this call has been recorded and monitored for quality and training purposes. May I know if I can help you with the patient's information or the provider's information?
[AGENT][POSITIVE] I'd be happy to assist with claim status today. I'm sorry, can you repeat your first name for me?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] [PII] and [PII], if I can get a good callback number for you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure, it's [PII]. That's a direct line, no extension.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you for that and what is the policy number?
[CUSTOMER][NEUTRAL] It's D as in Delta 43,302,090.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] I'm sorry, repeat that for me please.
[CUSTOMER][NEUTRAL] D as in Delta 43,302,090.
[AGENT][NEUTRAL] Thank you for that. OK, I believe that is their wellness policy number. Do you have a social?
[CUSTOMER][NEUTRAL] No, I don't have
[AGENT][NEUTRAL] What's their name?
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] And do you have an address?
[CUSTOMER][NEUTRAL] Uh, [PII], right?
[AGENT][NEUTRAL] Yes, do you have an address?
[CUSTOMER][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I don't see.
[AGENT][NEUTRAL] What about date of birth?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] OK, I found it. Let me give you the policy number.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It's 024.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 749.
[AGENT][NEUTRAL] 24.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] Alright, please be advised a verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII], and are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] I'm calling for inpatient and we have submitted the claim on [PII] and its status of that claim.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] It's [PII]. And the date of service is [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][POSITIVE] That's correct, [PII].
[AGENT][NEUTRAL] And what's your tax ID?
[CUSTOMER][NEUTRAL] The tax ID is [PII].
[AGENT][NEUTRAL] OK, it looks like we received a claim.
[AGENT][NEUTRAL] More than once, um.
[AGENT][NEUTRAL] So the second time it denied as a duplicate, let me get the, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] Yes, go ahead, go ahead.
[AGENT][NEGATIVE] I was gonna get the denial for the first time, one moment.
[AGENT][NEUTRAL] I'm showing that the, um, it did not because the doctor's inpatient visit charges are not covered under the policy.
[CUSTOMER][NEUTRAL] What is the denied date of uh latest claim?
[AGENT][NEUTRAL] Uh, this claim denied on.
[CUSTOMER][POSITIVE] Share me both received and detected.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] I.
[AGENT][NEUTRAL] OK, claim was received on [PII]. Claim denied on [PII].
[CUSTOMER][NEUTRAL] Is uh [PII] is uh claim is on file or not?
[CUSTOMER][NEUTRAL] Because we have resubmitted the claim.
[AGENT][NEGATIVE] Right, you resubmitted it and it denied as a duplicate.
[AGENT][NEGATIVE] I was giving you the information on the first time, the original denial.
[CUSTOMER][NEUTRAL] And the number.
[AGENT][NEUTRAL] So for the claim that denied as a duplicate, one moment.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] That was 9.
[AGENT][NEUTRAL] I'm sorry, what was that data service again?
[CUSTOMER][NEUTRAL] The January or September.
[AGENT][NEUTRAL] The September date, what was the September date?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Alright, so the 2nd time we received it.
[AGENT][NEUTRAL] 2492.
[AGENT][NEUTRAL] OK, so the second time we received the claim it was [PII].
[AGENT][NEGATIVE] And it denied on [PII] and it denied as a duplicate.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Uh, could you please share me the uh original claim number?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Original claim number is 35.
[CUSTOMER][NEGATIVE] And received and denied date of original.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] March, so the original claim we received [PII] and it denied on [PII] and the claim number is 3537051.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what was the original claim delayed is it?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Denial reason.
[AGENT][NEUTRAL] I told you, doctors inpatient visit charges are not covered under the policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the member's plan or provider plan?
[AGENT][NEUTRAL] I'm sorry, repeat that.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Under the member of uh provider.
[AGENT][NEUTRAL] It's the member's policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, which CPT was not covered under my policy?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I'm sorry, repeat that for me.
[CUSTOMER][NEUTRAL] Which CPT was not covered under members policy?
[AGENT][NEUTRAL] All of them, none of them were.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] OK. Could you please specify?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] The entire claim denied because it's not covered under the member's policy. Do you have the CPT code in front of you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh