AccountId: 011433970860
ContactId: 50830609-f153-4942-b459-4af197ec037d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 870229 ms
Total Talk Time (AGENT): 221024 ms
Total Talk Time (CUSTOMER): 255406 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/50830609-f153-4942-b459-4af197ec037d_20250605T15:34_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. I'm calling from billing office. How are you doing today?
[AGENT][NEUTRAL] Uh, fine, and yourself?
[CUSTOMER][NEUTRAL] Yeah, I'm fine, thank you. I want to know the claim status, but before I proceed, this call is being recorded for quality and training purpose. Shall we continue recording?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that's fine and you say you're calling for claim status and your name is again?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[AGENT][NEUTRAL] Spell that for me, please.
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] OK, thank you. Sure, [PII].
[CUSTOMER][NEUTRAL] And can you spell your name, please?
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, it is 01.
[CUSTOMER][NEUTRAL] 914-718 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK, thank you one moment and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes. Callback number is [PII]. It is direct line.
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah. Patient name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Yeah, data service is [PII].
[CUSTOMER][NEUTRAL] And the total charge amount is $197 even.
[AGENT][NEUTRAL] OK, thank you. And do you have the balance after primary has processed the claim?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Do you have the balance after the primary has processed the claim?
[CUSTOMER][NEUTRAL] Yes, correct. Primary process claim balance is 59. Balance amount is
[CUSTOMER][NEUTRAL] Let's give
[CUSTOMER][NEUTRAL] $25.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And the name of the provider's office?
[CUSTOMER][NEUTRAL] Yeah, it is skin and cancer associates.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, I show that claim processes office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] So under patient plan?
[AGENT][NEUTRAL] Yes, for the patient's policy, office visits are not covered.
[CUSTOMER][NEUTRAL] So, should be well patient?
[AGENT][NEUTRAL] We can't give patient responsibility. We can only verify how the claim was processed, which was not covered.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I need one more claim, few more claims. How many claims you will give one for?
[AGENT][NEUTRAL] For the same patient or different?
[AGENT][NEUTRAL] It's for the same person or different? OK, one moment.
[CUSTOMER][NEUTRAL] Different
[CUSTOMER][NEUTRAL] Different.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. And uh, what is the next policy number, please?
[CUSTOMER][NEUTRAL] Yeah, it is 17678.
[AGENT][NEUTRAL] That's not a policy number. What is the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah, first name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Uh, spell that first and last name for me, please.
[CUSTOMER][NEUTRAL] Yeah, sure. Last name is [PII]. And first name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Uh, when you're ready, I can give you the correct policy number.
[CUSTOMER][POSITIVE] Yes, please give me.
[AGENT][NEUTRAL] OK, it's 258-512-6.
[AGENT][NEUTRAL] And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Yeah, data source is [PII] and the total charge amount is $277 even.
[AGENT][NEUTRAL] OK and the balance after primary?
[CUSTOMER][NEUTRAL] Uh, one moment, please.
[CUSTOMER][NEUTRAL] $50 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And the name of this provider's office?
[CUSTOMER][NEUTRAL] Yeah, same, skin and cancer associates.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I show that claim also processed as office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] Your father these are the same, we need to be patient, right?
[AGENT][NEGATIVE] Oh, I can't tell you the bill patient or not. It was processed, it's not covered.
[CUSTOMER][POSITIVE] Yeah. Thank you.
[CUSTOMER][POSITIVE] Just give want I will next month.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Alright, I'm ready for the next policy when you are.
[CUSTOMER][NEUTRAL] Yeah, sure. It is 15185.
[AGENT][NEUTRAL] That is not a policy number. Do you have a copy of the patient's card in front of you?
[CUSTOMER][NEUTRAL] Yeah, but in, in that also showing group number only. We have billed out as well.
[AGENT][NEUTRAL] No, on the card, it should show a policy number or policy certificate number, maybe at the bottom.
[CUSTOMER][NEUTRAL] Yeah, in, uh, yeah, it is 0161.
[CUSTOMER][NEUTRAL] 7703
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 8. Yeah.
[AGENT][NEUTRAL] OK. And patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah. Patient name is [PII].
[AGENT][NEUTRAL] OK. Date of birth?
[CUSTOMER][NEUTRAL] Yes, date of birth is [PII].
[AGENT][NEUTRAL] OK, data service and amount of the charge.
[CUSTOMER][NEUTRAL] Yeah, data service is [PII] and the total charge amount is $277 even.
[AGENT][NEUTRAL] I don't show that claim has been received. Can you verify the mailing address it was submitted to?
[AGENT][NEUTRAL] Oh, I apologize. Hold on one moment. Uh, show that claim process as well as office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, thank you. And one moment, and this one is the same, need to be patient, right?
[AGENT][NEUTRAL] As I said previously, we can't tell you patient responsibility or to bill the patient. We can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] Yeah, yeah. OK. Just gonna will open next, next.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. Yeah, are you ready?
[AGENT][NEUTRAL] Uh, yes. What is the next policy number?
[CUSTOMER][NEUTRAL] Yeah, it will be 01902299 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK, patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah, first name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, data service now the charge.
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII].
[CUSTOMER][NEUTRAL] And the total charge amount is $359 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and I show that claim also processed as office visits are not covered per the policy.
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[CUSTOMER][NEUTRAL] And last 11 more.
[AGENT][NEUTRAL] 01 moment.
[CUSTOMER][NEUTRAL] That it will be done.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] OK, and what is the last policy number?
[CUSTOMER][NEUTRAL] Yeah, it is, will be 02465362 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK, patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah, first name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, data service amount of the charge.
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII].
[CUSTOMER][NEUTRAL] And the total charge amount is $500 even.
[AGENT][NEUTRAL] And one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the claim process says office visits are not covered per the policy nor procedures performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Uh, but, uh, we have two cities.
[CUSTOMER][NEUTRAL] One surgery and one E and um which office.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Correct. So, like I said, office visits are not covered and procedures in a doctor's office or clinic is not covered.
[CUSTOMER][NEUTRAL] I so
[AGENT][NEUTRAL] So for procedure code 99203, office visits are not covered. The other code 17,110 procedures in office are not covered.
[CUSTOMER][NEGATIVE] Oh, this one also not good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Does the patient have another active insurance?
[AGENT][NEGATIVE] Not with our company.
[CUSTOMER][NEUTRAL] Yeah, OK. If patient have another, shall I, shall I, shall I will do that?
[AGENT][NEGATIVE] Again, I cannot give you patient responsibility or tell you how to bill. I can only tell you how the claim was processed and that was that's not covered.
[CUSTOMER][NEUTRAL] Yeah, OK, OK.
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] You know, give reference numbers if you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] Oh thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Uh, thanks so much. You are so helpful. Have a great day. Bye-bye.
[AGENT][POSITIVE] You too. Thanks for calling APL. Bye.
[CUSTOMER][NEUTRAL] Bye.