AccountId: 011433970860
ContactId: 54b21c0b-c9a5-418c-9bbd-feb9d2534211
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 224490 ms
Total Talk Time (AGENT): 109776 ms
Total Talk Time (CUSTOMER): 63157 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/54b21c0b-c9a5-418c-9bbd-feb9d2534211_20250102T14:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], spelled as [PII] Last name to initial is [PII]. And I need a claim status. Can you please help me with that?
[AGENT][NEUTRAL] Yes, far as you're needing one claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you and what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] The Policy number starts with 01848859.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] is the first name and the last name is [PII] date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] 828 2024 and the bill amount is.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Say that one more time.
[CUSTOMER][NEUTRAL] 8 28 2024.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well the amount is $959. 10 cents.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Can you please spell me your name till that?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thanks so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And what is, let's verify this first, the name of the facility, the name of the group?
[CUSTOMER][NEUTRAL] Forefront dermatology.
[AGENT][NEUTRAL] OK. So the claim number is 352.
[CUSTOMER][NEUTRAL] My
[AGENT][NEUTRAL] 9776.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, this claim was denied. One of the reasons state's office visits are not covered.
[AGENT][NEUTRAL] By the above number policy, this supplemental policy does not cover office visits, and the other codes were denied as outpatient benefits for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so can we bring this to the patient?
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of that EOB we do have a portal that you can print that from, and our portal website is secured.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can I get the call reference for this?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] Thank you so much for assisting, pleasure talking to you. Have a nice day.
[AGENT][POSITIVE] Yeah, I hope you have a nice day too, and if that's all I can help you with, thank you again for calling APL.