AccountId: 011433970860
ContactId: 4e6e83d7-2fd0-44b5-8fdc-a5dc37afbb0b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 453750 ms
Total Talk Time (AGENT): 115718 ms
Total Talk Time (CUSTOMER): 122749 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/4e6e83d7-2fd0-44b5-8fdc-a5dc37afbb0b_20250225T17:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII], my name's [PII]. I'm calling from Swedish American Home infusion. We're a provider, um, and I just had a question like follow up on a claim denial that I had a question on.
[AGENT][NEUTRAL] OK, I can help you with your claim. Yes, absolutely, Ms. [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Uh, yeah, that would be [PII].
[AGENT][NEUTRAL] Thank you and what's the patient's name, date of birth, and policy number please?
[CUSTOMER][NEUTRAL] Absolutely, um her name is [PII] Date of birth is [PII], and the policy number is 02350207.
[AGENT][NEUTRAL] OK, let me pull up her policy.
[AGENT][NEUTRAL] OK and then what is the claim number for the claim that you're wanting to get more information on?
[CUSTOMER][NEUTRAL] Absolutely it is 356-059-7.
[AGENT][NEUTRAL] OK, let me pull that claim number up real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the remark on the claim is.
[AGENT][NEGATIVE] Based on the information included on the claim form, this service was not rendered in a covered place of service as outlined in the policy contract. For this reason we are unable to provide benefits for this charge.
[CUSTOMER][NEUTRAL] Yeah, so I, I saw the letter I got I got that, um, in the mail. I got my question was, is I, so I've never worked with APL before, um, and before we agreed to take this patient on I called and spoke with one of your, um, associates. Her name was [PII], um, and we kind of went over a couple of questions that I had, um, and she had mentioned that, um, that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like there's no that's it's all based off the primary insurance that if if Blue Cross considers it medically necessary, it's medically necessary, um, and it's paid based off the Blue Cross contract so I wasn't sure if um this is, it's just like ent nutrition, so like tube feeding um and it's done in the home.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All the time because that's where you eat your food, so we build in the home so I'm just confused how how if if Blue Cross would consider it a valid place of service, um, APL would not if, if this plan is follows the Blue Cross contract.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right, I understand what you're saying. Um, so what I'm gonna do is I'm gonna put in a request for a benefit specialist to call you back, um, that way they can explain the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim and how they process it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and the number that I have is the [PII], and they can ask for you and I'll send that in.
[AGENT][NEUTRAL] I'm gonna put you on a brief hold while I request that call back for you and then I'll be right back, Miss [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] The police
[CUSTOMER][NEUTRAL] Yeah hi
[AGENT][POSITIVE] Hi, thank you for holding for me. I've got that request in for a claim specialist to call you back within 24 hours that way they can answer your questions that go beyond the remarks on the claim for you.
[CUSTOMER][POSITIVE] Perfect thank you so much for your help, [PII]. I really appreciate it.
[AGENT][POSITIVE] OK. You're very welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] That is it thank you again I really appreciate it.
[AGENT][POSITIVE] You're very welcome you have a good rest of your week and thank you for calling APL.
[CUSTOMER][POSITIVE] You as well thank you bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.