AccountId: 011433970860
ContactId: 5242f954-d9e5-4c61-adfd-1b0ee1ed5b03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 578989 ms
Total Talk Time (AGENT): 205271 ms
Total Talk Time (CUSTOMER): 199270 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/5242f954-d9e5-4c61-adfd-1b0ee1ed5b03_20250130T16:28_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling on behalf of office. I'm here to check on a claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, and did you say your name was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] Alright, may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah, uh, the first policy number is 02129473.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] It's $213 even.
[AGENT][NEUTRAL] 215.
[CUSTOMER][NEUTRAL] 213
[AGENT][NEUTRAL] OK, and again just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim for you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] OK, so the policy number that you provided, that policy was active from [PII].
[CUSTOMER][NEUTRAL] OK, I do one.
[AGENT][NEUTRAL] She does have a policy after that, um, 2543935.
[CUSTOMER][NEUTRAL] 254
[AGENT][NEUTRAL] 393 5.
[CUSTOMER][NEUTRAL] 25
[AGENT][NEUTRAL] And that policy was active from [PII]. I'm going to check that policy to see if the claim is there.
[CUSTOMER][NEUTRAL] So [PII].
[AGENT][NEUTRAL] And yes, it is here on the new policy. Hold on one moment, I'm pulling it now.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, it's uh neurosurgery and neurology LLC.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Received on [PII] and
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed on [PII]?
[CUSTOMER][NEUTRAL] OK. A [PII] OK.
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] 354.
[AGENT][NEUTRAL] 0611.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it was denied because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] That office that's it.
[CUSTOMER][NEUTRAL] Or not
[CUSTOMER][NEUTRAL] OK. Uh, so for this, can we build this claim to the patient?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we're not the major medical. That would be between primary and the provider to deem the responsibility.
[CUSTOMER][NEUTRAL] OK. So it's processed as non-covered at 204 or 96?
[AGENT][NEUTRAL] 204 or 96, what are those numbers?
[CUSTOMER][NEUTRAL] OK. I just need the remark of how under which code this claim has been denied as non-covered.
[AGENT][NEUTRAL] OK, hold on one moment, let me see.
[AGENT][NEUTRAL] Uh, this is 99214. It's the only code on the claim.
[CUSTOMER][NEUTRAL] OK, yeah, OK, [PII], thanks. So.
[CUSTOMER][NEUTRAL] and the plan policy, OK.
[CUSTOMER][NEUTRAL] Mm, yup. Uh, could you please fax me a copy of your B?
[AGENT][NEUTRAL] OK, and what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, so I'll fax this one. Did you, um, the other claim that we're gonna go over, did you need the explanation for that one as well?
[CUSTOMER][NEUTRAL] Uh, yup, I, we don't receive any in, uh, you will be a correspondence for that too.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It needs to be attention, [PII].
[CUSTOMER][NEUTRAL] OK. So you're going to send those.
[CUSTOMER][NEUTRAL] No, uh, the attention is going to be different, which is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, we can move on to the next member if you like.
[CUSTOMER][NEUTRAL] Yep, and before that, is there any conference number for this claim?
[AGENT][NEUTRAL] Um, the call reference number for the entire call will be my name in today's date. So that's [PII], and then today's date.
[CUSTOMER][NEUTRAL] Thank you, hang on, just allow me a moment. Let me take a note and pull the next claim for you.
[CUSTOMER][NEUTRAL] Excuse me
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, uh, the next member ID and.
[CUSTOMER][NEUTRAL] That is going to be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $145 even.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number is 353.
[AGENT][NEUTRAL] 2850.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No about 20.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] It was denied
[CUSTOMER][NEUTRAL] OK. So,
[AGENT][NEUTRAL] Because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] OK, and yep, uh, could you please fax me a copy of your B?
[AGENT][NEUTRAL] I sure can, and to the same number, what would the attention for this claim be or would it be the same?
[CUSTOMER][NEUTRAL] Oh, the attention is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII]. Yes, correct.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] All right, well, I will go ahead and send both of these over to you now. Was there anything else I could assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK, yeah, uh, yeah, uh, that's all. And uh may I know, uh, when can we export the copy of UB? How long does it take to receive?
[AGENT][POSITIVE] Um, we usually say to wait at least an hour if something's being faxed. Um, if you haven't received it by end of day today, you can definitely give us a call and we'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, thank you so we're just making a 24 hours then.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thanks for assisting through this call. Have a great day ahead. Take care. Bye-bye.
[AGENT][POSITIVE] Thank you, you also, and thanks for calling AOP. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][POSITIVE] Have a good day. Bye-bye.
[AGENT][NEUTRAL] Bye bye.