AccountId: 011433970860
ContactId: 52d3f971-21ff-4ddf-8af2-ecfed4988ee4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 511579 ms
Total Talk Time (AGENT): 117641 ms
Total Talk Time (CUSTOMER): 142799 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/52d3f971-21ff-4ddf-8af2-ecfed4988ee4_20250115T20:35_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and my initial to the last name is [PII]. I'm calling from provider's office to check on the time status.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh, I'd love to help you with claim status today, Ms. [PII]. Can I have a good call back number for you real quick?
[CUSTOMER][NEUTRAL] Yeah, sure. My callback number is [PII].
[AGENT][POSITIVE] Wonderful. And the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's 1426647.
[CUSTOMER][NEUTRAL] M, Mike Lima 8.
[AGENT][POSITIVE] Thank you. Give me one moment to get that pulled up for you, my friend.
[CUSTOMER][POSITIVE] Mhm. Take your time, please.
[AGENT][POSITIVE] Thank you. That's so sweet.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And would you be able to verify for me, please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, the patient's first name is [PII], the last name is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. Do you want me to spell that?
[AGENT][NEUTRAL] Um, no, that's OK. If you could just verify the date of birth.
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Perfect. I do see him right here for you and do you have the claim number on hand or do you want me to search it with the date of service for you today?
[CUSTOMER][NEUTRAL] Uh, with the date of service, please.
[AGENT][POSITIVE] Perfect. And what date of service are we looking at, Ms. [PII]?
[CUSTOMER][NEUTRAL] I don't have the claim number.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[AGENT][NEUTRAL] [PII], you betcha. Let me take a look at that. And what was that total bill amount?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] It's $740 and even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] on the
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] All right, um, and could you verify for me please the name of the facility on file for that claim?
[CUSTOMER][NEUTRAL] Yeah, sure. So, Pediatrics Medical Group of Florida INC.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. OK, I do see that claim right here. It looks like we received your claim on [PII], and we processed the claim on [PII]. I show your claim number listed as 3509286, and I show that claim was denied. The reason stating is that office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEGATIVE] It's not covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, but I do see here, just a moment, please. Let me just check, OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Uh, just a moment. I'll just place this call on hold for a minute. I'll just verify it.
[AGENT][POSITIVE] Yeah, take your time.
[CUSTOMER][POSITIVE] OK. OK, thank you.
[CUSTOMER][POSITIVE] Thank you for your patience on being on hold. I really appreciate that.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Is this for, yeah, is this for patient?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Got it.
[AGENT][POSITIVE] And I'm so sorry. What was your question, my friend?
[CUSTOMER][NEUTRAL] Uh, you said, uh, the claim has been denied due to office visit is not covered by the policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is this for patient policy?
[AGENT][NEUTRAL] It is the patient policy, yes.
[CUSTOMER][NEUTRAL] OK, can you bill the patient?
[AGENT][NEGATIVE] Unfortunately, because we're a secondary insurance, we can't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK, is there any other alternate options?
[AGENT][NEUTRAL] Is there any what options?
[CUSTOMER][NEUTRAL] Um, no problem. Uh, just a moment, uh, I'll just place this call for, uh, hold on a minute, I'll just be back. I'll just verify with my side. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Just bear with me a few more minutes. I'll just fetching my details.
[AGENT][POSITIVE] You're OK, no worries.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you for your patience on being on hold. I really appreciate that.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, could you please confirm me whether the uh is the provider contracted?
[AGENT][NEUTRAL] So we don't.
[AGENT][NEUTRAL] What do you mean the provider contracted?
[CUSTOMER][NEUTRAL] Um, OK, just, just a moment. Let me, I'll just place this hold.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, thank you for your patience. Uh, I'm sorry. Uh, I, I just want to confirm you that, uh, is there any Medicaid plan for this patient? Could you please confirm me that?
[AGENT][NEUTRAL] I can.
[AGENT][NEUTRAL] I can't see that information.
[CUSTOMER][POSITIVE] OK. Thank you, thank you for that.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Uh, can I get the call reference number?
[AGENT][NEUTRAL] Yeah, it's my name, [PII], first initial, last name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, [PII], that's all from my side. Have a nice day. Thank you.
[AGENT][POSITIVE] You too, [PII]. Take care.