AccountId: 011433970860
ContactId: 4c74eefa-e1fd-4468-9e59-ee4ad4625041
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1213109 ms
Total Talk Time (AGENT): 218686 ms
Total Talk Time (CUSTOMER): 389699 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/4c74eefa-e1fd-4468-9e59-ee4ad4625041_20250604T14:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Skin and Cancer Associates. How are you doing today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Yes, I'm good, thank you. I'm also doing good, thank you for asking. And I'm calling to check the claim status.
[AGENT][NEUTRAL] OK. Can I get a good callback number?
[CUSTOMER][NEUTRAL] Yes, before I proceed with that, please be informed that this call has been recorded for quality and training purpose. Would you like us to continue the recording?
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][POSITIVE] Yes, thank you. And my good callback number is [PII] and it is a direct line.
[AGENT][NEUTRAL] And I missed your name. What was that?
[CUSTOMER][NEUTRAL] Yes. My name is [PII]. And my last name [PII] is [PII].
[AGENT][NEUTRAL] OK, so. And do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, yes. Before I go with the policy number, may I know your good name, please?
[AGENT][NEUTRAL] That's [PII]
[CUSTOMER][NEUTRAL] And may I also know your last name initial, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Thank you, [PII]. Thank you for that. And the member's policy number is 01655031.
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, and number 8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes. My first name is?
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] And what was the date of service and bill charges?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and the total bill amount is $683 even.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][POSITIVE] Yes, please take your time.
[AGENT][NEUTRAL] Uh it was received on [PII].
[AGENT][NEUTRAL] Uh, it's processed 3-19-2025.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] So office visits are not covered under the policy.
[AGENT][NEUTRAL] And then for the other two charges, the outpatient benefit dollar amount was met for the year.
[CUSTOMER][NEUTRAL] But for the year. And may I know what is the dollar amount which is covered for this calendar year?
[AGENT][NEUTRAL] Uh, it is.
[CUSTOMER][NEUTRAL] For the member?
[AGENT][NEUTRAL] 500.
[CUSTOMER][NEUTRAL] $500. And may I know on which date of service this was paid?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Uh, there, there's just a few different dates of service for different providers prior to this date.
[AGENT][NEUTRAL] Like it was from February.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You there?
[CUSTOMER][NEUTRAL] Yes, I'm there. Uh.
[CUSTOMER][NEUTRAL] So, as you mentioned that this was uh paid in the February month. And as for our record, we see that this was paid on [PII], right?
[AGENT][NEUTRAL] Uh, for which date of service? Are you saying for [PII]? Yeah.
[CUSTOMER][NEUTRAL] It is
[AGENT][POSITIVE] Yes, that's right.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And we see that uh here the paid amount is $467.18.
[AGENT][NEUTRAL] Right, and then there was another date of service, [PII].
[CUSTOMER][NEUTRAL] Was paid uh.
[AGENT][NEUTRAL] 25
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, that is for the different provider or for the same provider?
[AGENT][NEUTRAL] And it looks like the same.
[AGENT][NEUTRAL] 3282.
[CUSTOMER][NEUTRAL] Sa
[CUSTOMER][NEUTRAL] Uh, can you once again, provide the date of service?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, that is, uh, that is, yeah. Yes, as per we, we see that that is for the another CPT for, that is for the lapa uh lab charges, no.
[AGENT][NEUTRAL] Right, so it's it's a dollar amount, so it does.
[AGENT][NEUTRAL] Not per CPT code or anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So that is only for the dollar amount that this patient is eligible for only for $500 right?
[AGENT][POSITIVE] Correct, for calendar year, yes.
[CUSTOMER][NEUTRAL] OK. Please wait for a moment. I'll verifying that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes. Thank you, [PII]. Thank you for your information. And
[CUSTOMER][NEUTRAL] Can I get the call reference for this member?
[AGENT][NEUTRAL] That's my name, [PII], first initial [PII] name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK. Thank you, [PII]. Thank you for the information. And I do also have another claims on other claims to check the status. Can you please help me out with that?
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the policy number of the patient.
[CUSTOMER][NEUTRAL] Yes, please wait for a moment.
[CUSTOMER][NEUTRAL] Yes, the next member's policy number is
[CUSTOMER][NEUTRAL] It is 02262443 M as in Mike, L as in Lima, and number 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh patient's first name is [PII] and the last name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] And the date of service and bill charges?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total bill amount is $197 even.
[AGENT][NEUTRAL] OK, it looks like this policy term 51-2024, that he has a more active policy. Let me pull that up.
[AGENT][NEUTRAL] And what was the date of service again?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And those charges?
[CUSTOMER][NEUTRAL] $197 even.
[AGENT][NEUTRAL] It was received on [PII]. Process [PII].
[AGENT][NEUTRAL] Yeah, you see.
[AGENT][NEUTRAL] Office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Office visits are not covered under this policy.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So as we don't have any response on our records, can you please send us the UB through our fax number?
[AGENT][NEUTRAL] Sure, facts.
[CUSTOMER][NEUTRAL] Yes. Our fax number is [PII].
[AGENT][NEUTRAL] OK, I'll get that sent over. It just takes about 5 minutes.
[CUSTOMER][NEUTRAL] Takes 5 minutes. It's, uh, thank you, [PII]. Thank you for that. Has this office visits are not covered for this member, so can we bill these charges from the patient?
[AGENT][NEUTRAL] Uh, this is a secondary policy, so we can't determine or instruct on patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Yes. Thank you, [PII]. Thank you for this information.
[CUSTOMER][NEUTRAL] And can I go with the another member's details?
[AGENT][NEUTRAL] Uh, hold on one moment.
[AGENT][NEUTRAL] Let me fax this real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's that next
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Yeah. And the next member's policy number is 021 03443.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient's first name is?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the total bill amount is $523 even.
[AGENT][NEUTRAL] Uh, looks like we processed that on or received on [PII]. Process 3-11-2025.
[AGENT][NEUTRAL] And made a payment of $25.
[CUSTOMER][NEUTRAL] And for the other two lines of CPTs?
[AGENT][NEGATIVE] Uh, the maximum benefit amount for treatment provided during office visit was exhausted, no benefits available for services.
[CUSTOMER][NEUTRAL] For both, uh, both two lines, that is for 11901 and J 3301.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] So, for this member, uh, is this exceeded under the units dollars or visits?
[AGENT][NEUTRAL] Uh dollars. We, it's just a maximum payout of $25 for.
[CUSTOMER][NEUTRAL] Dollars.
[AGENT][NEUTRAL] and services.
[CUSTOMER][NEUTRAL] For this member, there is only $25.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] Stupid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes. Thank you, [PII]. Thank you for your information. Uh, the, and the call difference would be the same for the whole call, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for that.
[AGENT][NEUTRAL] OK. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] I have more claims to check the status. Can you please help me with that? I totally, I have 10 to 15 claims to check the status.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You have one more claim, is that right?
[CUSTOMER][NEUTRAL] One more claim.
[CUSTOMER][NEUTRAL] Yes, please wait for a moment. I'm pulling out the number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I just want to clarify that in one call, how many claim status can we begin?
[AGENT][NEUTRAL] I, I mean, as many as you have.
[AGENT][NEUTRAL] So how many do you have?
[CUSTOMER][NEUTRAL] Uh, I, I have more.
[CUSTOMER][NEUTRAL] I have more 8 claims to 89 claims to check the status with this member.
[AGENT][NEUTRAL] OK, yeah, I'll be able to do one more because I have to go to a meeting, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, thank you, [PII]. Thank you for that information. And can I go with the members uh policy number?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. It is 17678.
[AGENT][NEUTRAL] OK, 17678.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] You have the last name of the patient?
[CUSTOMER][NEUTRAL] Patient last name is [PII].
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yes, [PII]. Yes, that is right.
[AGENT][NEUTRAL] And first name?
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] You have the group number by chance or the social?
[CUSTOMER][NEUTRAL] Group number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is 00638310.
[AGENT][NEUTRAL] Um, do you have a, maybe a.
[AGENT][NEUTRAL] You don't have the social, is that right?
[CUSTOMER][NEUTRAL] No, we don't have the social security number.
[AGENT][NEUTRAL] one more.
[AGENT][NEUTRAL] Uh, I'm not able to pull her up with the information provided.
[CUSTOMER][NEUTRAL] So, as per the card copy, we see uh benefit number, can I provide that number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, it is 02477372 [PII], [PII] [PII] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Her date of birth?
[CUSTOMER][NEUTRAL] Yes, the date of birth is [PII].
[AGENT][NEUTRAL] And the date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII] and the total bill amount is $277 even.
[AGENT][NEUTRAL] Uh it was received for 1-2025.
[AGENT][NEUTRAL] Also says 43 [PII].
[AGENT][NEUTRAL] Offices not covered under the policy.
[CUSTOMER][NEUTRAL] Office visits not covered under the policy?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, so, as we don't have any information on our records, can you please send us the through our fax number?
[AGENT][NEUTRAL] Yeah, it's the same, is it the [PII]?
[CUSTOMER][NEUTRAL] Yes, that is the same fax number.
[AGENT][NEUTRAL] OK, yes, I'll get that sent over. It just takes a few minutes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And then if you can call back into our queue and then um someone can assist you with additional claims.
[CUSTOMER][POSITIVE] Yes. Thank you, [PII]. Thank you for your information.
[AGENT][NEUTRAL] OK. Thank you for calling ATM.
[CUSTOMER][POSITIVE] Have a nice day.
[CUSTOMER][POSITIVE] Thanks. Bye for now. Thank you.