AccountId: 011433970860
ContactId: 49f94dc6-9d6f-4fc0-982c-fb45cba84666
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 334679 ms
Total Talk Time (AGENT): 141219 ms
Total Talk Time (CUSTOMER): 93633 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/49f94dc6-9d6f-4fc0-982c-fb45cba84666_20250306T13:09_UTC.wav
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[AGENT][NEUTRAL] Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from provider's office. For a clarification of the claim.
[AGENT][NEUTRAL] OK, I'll see you have one claim that you're needing clarification on, is that correct? Claim status?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh yes, ma'am, I can help you on that. And what is your callback number please, [PII]?
[CUSTOMER][NEUTRAL] It is at [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's do that again. [PII].
[CUSTOMER][NEUTRAL] Uh, no, it is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, can we please repeat it one more time in the form of a phone number please? [PII].
[CUSTOMER][NEUTRAL] Mhm. It is [PII].
[AGENT][NEUTRAL] [PII]. OK, just one moment because I'm totally mishearing you then. [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then the next 3 numbers?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the last 4 numbers.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And did you have an extension, [PII]?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] It is 02450109.
[AGENT][POSITIVE] Thank you. One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and now so 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 date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the data service and total bill amount for her place.
[CUSTOMER][NEUTRAL] It is [PII] with bill amount $160 even.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so this claim was received. Do you already have the claim number on this one also?
[CUSTOMER][NEUTRAL] Uh yes. Uh, I can see that the claim number, actually, I don't have the claim number. I just have the denial.
[AGENT][NEUTRAL] OK, this claim was received on 5-28-2024 and it was processed and denied on 5-30-2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3461982.
[AGENT][NEUTRAL] And the reason for the denial on this claim state's office visits are not covered by the above numbered policy. The members supplemental plan Elsa does not cover office visits.
[CUSTOMER][NEUTRAL] OK. So it is related to patient, right?
[AGENT][NEUTRAL] We do not determine patient responsibility that would be up to the provider.
[AGENT][NEUTRAL] And they'll say if you need a copy of this explanation of benefits you may print that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] You said uh it is not covered as per the member's plan, right? Office visit?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And for this one, I just wanted to verify like can we bill the patient for this service?
[AGENT][NEUTRAL] Yes ma'am I just explained that APL does not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, that would be all main the call reference number?
[AGENT][POSITIVE] Yes ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for your assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] Well, I hope you have a great day too, [PII] and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.