AccountId: 011433970860
ContactId: 4a9a11d8-237c-4390-abd6-c8b68a471918
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226000 ms
Total Talk Time (AGENT): 105580 ms
Total Talk Time (CUSTOMER): 51657 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/4a9a11d8-237c-4390-abd6-c8b68a471918_20250113T20:12_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, this is [PII] calling from provider's office about a claim status.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] 02 I'm sorry 023.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 702.
[CUSTOMER][NEUTRAL] 91
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][POSITIVE] Thank you one moment please.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] [PII], 350.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, so I do see that this claim was most recently received on 8-27-2024.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 349-9677.
[AGENT][NEUTRAL] And the reason for this denial, Margo, is that office visits are not covered by this policy.
[AGENT][NEUTRAL] The supplemental policy does not cover office visits. And if you need a copy of this explanation of benefits, Margo, you can actually print it from our portal.
[AGENT][NEUTRAL] By going to [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] You said the office visit not covered by the policy of the member?
[AGENT][NEUTRAL] That is correct. The supplemental policy does not cover office visits. That is correct.
[CUSTOMER][NEUTRAL] So the members responsible for the balance.
[AGENT][NEUTRAL] We do not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, but, um, her policy doesn't cover, um, obviously seat, OK.
[AGENT][POSITIVE] Yes, ma'am, that is correct. Uh-huh.
[CUSTOMER][POSITIVE] OK, just a call reference please [PII] and thank you.
[AGENT][NEUTRAL] Sure, you're welcome and you would use my name along with today's date as your call reference number.
[CUSTOMER][POSITIVE] Alright thank you so much.
[AGENT][POSITIVE] Absolutely. You're very welcome. So is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][POSITIVE] OK, well then, thank you again for calling APL and I hope you have a very nice afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Yes ma'am. Thank you. Bye bye.