AccountId: 011433970860
ContactId: 56e68715-9e5c-4d03-aac7-5306d468b74c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 442269 ms
Total Talk Time (AGENT): 208192 ms
Total Talk Time (CUSTOMER): 156329 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/56e68715-9e5c-4d03-aac7-5306d468b74c_20250620T13:14_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from Pros office for claims. Uh, can you please help me out?
[AGENT][NEUTRAL] OK, [PII], you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, I can help you with that and [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Sure. Uh, the callback number is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And how many claimstain do you have to check status on?
[CUSTOMER][NEUTRAL] Uh, only one claim I have.
[AGENT][NEUTRAL] OK, yes, I can help you with that. And what is that patient's policy number?
[CUSTOMER][NEUTRAL] Sure, the policy number is 016.
[CUSTOMER][NEUTRAL] 635.
[CUSTOMER][NEUTRAL] 26 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK thank you one moment [PII] while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Can you please spell your name for me?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And any information, [PII] that I did provide today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] discount.
[CUSTOMER][NEUTRAL] Sure, one moment please.
[CUSTOMER][NEUTRAL] The member name is [PII] [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] It's [PII] and the bill amount is $237.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And your last initial prey.
[AGENT][NEUTRAL] [PII] and yours?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show that this claim was received. Uh, the received date was on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 3603227.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And this claim was denied, and the reason for the denial is that office visits are not covered by the policy.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, [PII], now that you have the claim number, you can print the explanation of benefits by going to our portal which is located at secured.
[CUSTOMER][NEUTRAL] Is it patient's responsibility, [PII]?
[AGENT][NEUTRAL] The portal, first off, the portal website is [PII] and APL does not determine patient responsibility.
[AGENT][NEUTRAL] That would be up to the provider.
[CUSTOMER][NEUTRAL] OK. So it's not covered as the provider's contract.
[AGENT][NEUTRAL] Her patient's policy for the member's policy.
[AGENT][NEUTRAL] There is no contract for a provider with APL. We're not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK. Uh, I was asking, uh, the claim is denied as the officers are, uh, not covered as per member's policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, is it, is it patient's responsibility, the amount?
[AGENT][NEUTRAL] Again, again, APL does not determine patient responsibility. That would be up to the provider to determine that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you ask me do you be [PII]?
[AGENT][NEUTRAL] Do you not have the ability to print, [PII]?
[AGENT][NEUTRAL] I gave you the website that you can print it directly from.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Can you please uh spell it for me, the website?
[AGENT][NEUTRAL] Again, it is the website is [PII].
[AGENT][NEUTRAL] You are.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] It is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, [PII].
[AGENT][NEUTRAL] And then [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That is correct, yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Uh, can I have the booking number, oh sorry, call reference number?
[AGENT][NEUTRAL] Yes, ma'am, the call reference number will be my name along with today's date.
[CUSTOMER][NEUTRAL] And uh [PII], can we appeal on this?
[AGENT][NEUTRAL] An appeal must be filed in writing within 180 days from the date of the decision.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] It would be sent to the same address as claims but put to attention appeals department.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Attention to bills. Do you have any fax number?
[AGENT][NEUTRAL] [PII]. Again attention appeals department.
[CUSTOMER][NEUTRAL] OK, and the fax number is [PII]. Is that right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Yeah, thank you so much. Can I have the caller reference number, [PII]?
[AGENT][NEUTRAL] My name along with today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much. Thanks for your assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] Oh, you're very welcome. Yes, ma'am. Well, I hope you have a nice day too, [PII], if that's all I can help you with. Thank you again for calling APL.
[CUSTOMER][POSITIVE] Yeah. Take care. Bye-bye.
[AGENT][NEUTRAL] Uh-huh. Bye bye. You too. Bye-bye.