AccountId: 011433970860
ContactId: 54090270-03b2-45ce-ad79-2c69c4ae3f7a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 348369 ms
Total Talk Time (AGENT): 170094 ms
Total Talk Time (CUSTOMER): 122639 ms
Interruptions: 5
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/54090270-03b2-45ce-ad79-2c69c4ae3f7a_20250604T19:20_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm just calling to get a little clarification on a, a claim, please.
[AGENT][NEUTRAL] OK, [PII], are you with a provider's office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you're needing a status on a claim, is that correct?
[CUSTOMER][NEUTRAL] Well, I think it was a denial, but I just want the clarification for it.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] I have a direct line of [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] That is 01947017.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And secondly, any information that is provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] [PII] $830.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And do you have the claim number?
[CUSTOMER][NEUTRAL] Yes, it was provided to this last rep of 3573602.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, thank you. One moment. And again, data services [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so that particular explanation of benefits for that claim, this was denied as a
[AGENT][NEUTRAL] Oh, well, I'm speaking before my system is ready for me to be speaking. So just one second.
[CUSTOMER][POSITIVE] Sure, no problem.
[CUSTOMER][NEUTRAL] This other rep had stated the service equipment drug is not covered under the plan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm just trying to make sure that this is a limited benefit, yeah.
[AGENT][NEUTRAL] Yeah, it's still just.
[AGENT][NEUTRAL] No. OK. So for that claim number?
[AGENT][NEUTRAL] The denial, there's 2 denial remarks.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For that bill
[AGENT][NEUTRAL] I'm so sorry, just bear with me a second. It's just taking a moment. 1.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of the
[AGENT][NEUTRAL] Um, one of the line items states office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the other two line items state this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, so it would have had to have been performed like in an emergency situation or something for it to be covered.
[AGENT][NEUTRAL] Yeah. Yes, this supplemental policy does not cover office visits or office treatments.
[CUSTOMER][NEUTRAL] Does that show that
[CUSTOMER][NEUTRAL] OK, so it is patient responsibility. I could treat that as a like I could discount it for her.
[AGENT][NEUTRAL] We do not determine patient responsibility, [PII], since we're not a primary insurance, that would be up to the provider.
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There you go. All right, [PII], if I could just get our reference number that answers my question.
[AGENT][NEUTRAL] Sure. Yes, ma'am. You would use my name along with today's date. And you can also, [PII], go to our portal and you should be able to print out that explanation of benefits. I mean, the, there is going to be one that is mailed, but we have a portal. Well, you should have already received it. And the, our EOBs are 2 pages, and each, um, all the remark codes are on the 2nd page.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it may be on the back. It may just, but you can print it if you needed to.
[CUSTOMER][NEUTRAL] OK, so yes, no.
[CUSTOMER][NEUTRAL] Yeah, I don't know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] From our portal and that website. Mhm, you do, mhm.
[CUSTOMER][NEUTRAL] So I just register?
[CUSTOMER][NEUTRAL] So yeah, tell me that please uh huh yep.
[AGENT][POSITIVE] It's secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So, the website is secured. [PII].
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] You've got it. Yes, ma'am. All right.
[CUSTOMER][POSITIVE] Excellent. And the spelling of your name, how do you spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Oh, [PII]. OK, [PII] Thank you so kindly. I appreciate all your help.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Absolutely, [PII]. You're very welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, ma'am. That was it.
[AGENT][POSITIVE] OK, well then, thank you very much for calling APL and I hope that you have a great rest of your day.
[CUSTOMER][POSITIVE] Yes, ma'am. You as well. Thank you.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.