AccountId: 011433970860
ContactId: 53404bc9-678c-406d-8d21-758a2715205a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 605219 ms
Total Talk Time (AGENT): 141219 ms
Total Talk Time (CUSTOMER): 106942 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/53404bc9-678c-406d-8d21-758a2715205a_20250124T16:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider office to check the claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] So, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Patients first name is [PII] and last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and then what's the patient's policy number?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] It's 01914394 M as in Mike L as in Lima, 7 as in number.
[AGENT][NEUTRAL] OK, thank you and then what is the date of service?
[CUSTOMER][NEUTRAL] Data services.
[CUSTOMER][NEUTRAL] Just a second, it's
[CUSTOMER][NEUTRAL] [PII] with bill amount $570 even.
[AGENT][NEUTRAL] OK, and that's [PII], is that correct?
[CUSTOMER][POSITIVE] Yes, it's correct.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary paid their part?
[CUSTOMER][NEGATIVE] There is no primary insurance. It's uh uh $570 full amount.
[AGENT][NEUTRAL] OK, thank you, and then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Holy Cross Medical Group.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I pull up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] So, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. I do have the claim for you. The claim number is 347-5283, and the claim was denied for two reasons. One is office visits are not covered under the patient's policy.
[AGENT][NEUTRAL] And the second is this policy does not provide a benefit for services in which no charges were incurred.
[CUSTOMER][NEUTRAL] Actually, initially this claim was denied as duplicate and uh we have sent this claim back for reproces on [PII].
[AGENT][NEUTRAL] OK, let me look and see if I received anything then.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] The claim has been processed and denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] It's on the patient plan or provider plan?
[AGENT][NEUTRAL] The patient's plan.
[CUSTOMER][NEUTRAL] Can I know the patient plan type?
[AGENT][NEUTRAL] Medlink
[CUSTOMER][POSITIVE] Thank you. And can you spell your name for me?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 828
[CUSTOMER][NEUTRAL] 40
[CUSTOMER][NEUTRAL] And your last initial?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Thank you. And uh you said that uh this claim was denied for the non-payable for and the patient plan. Uh, is that for the same bill amount $570?
[AGENT][NEUTRAL] Let me tell you what it's for.
[CUSTOMER][NEUTRAL] Because I have that DOB which you provided the claim number.
[AGENT][NEUTRAL] OK, so, um.
[AGENT][NEUTRAL] For procedure 99204.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was denied because those visits are not covered under the patient's policy and for procedure 30179 and 3074F that was denied because.
[AGENT][NEGATIVE] The plan does not covered.
[AGENT][NEUTRAL] Let me look at it up again. Let me give you the room again.
[CUSTOMER][NEUTRAL] Is that bill amount the same as $570?
[AGENT][NEGATIVE] That was denied the policy does not provide a benefit for services in which no charges were incurred.
[AGENT][NEUTRAL] And the bill amount is the same as what you gave me, right, and the billed amount is what you gave me.
[CUSTOMER][NEUTRAL] Yeah, which you gave the claim number.
[CUSTOMER][NEUTRAL] So then, can you fax the UV to us?
[AGENT][NEUTRAL] Yes, what is your fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, I'm gonna put you on a brief hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] again. I have that fax on its way to you.
[CUSTOMER][NEUTRAL] Thank you. And also, can I get the call reference number?
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you so much for assisting with me. Have a great day and stay safe.
[AGENT][POSITIVE] You too have a good weekend [PII]. Thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK.