AccountId: 011433970860
ContactId: 58bd7fbb-27f1-4bf7-9cfa-f81aa310d507
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 498570 ms
Total Talk Time (AGENT): 205691 ms
Total Talk Time (CUSTOMER): 153323 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/58bd7fbb-27f1-4bf7-9cfa-f81aa310d507_20250516T19:47_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]. This is [PII] calling from provider service, checking on the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh, I do have two claims to check.
[AGENT][NEUTRAL] OK. I can help you with those. And are the claims for the same patient or different patients?
[CUSTOMER][NEUTRAL] Uh, it is for same member, yeah, same patient.
[AGENT][NEUTRAL] OK. Yes, I can help you. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII] and the extension would be [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, [PII]?
[CUSTOMER][NEUTRAL] It will be 02277733.
[AGENT][POSITIVE] Thank you, one moment please.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] And [PII], and their date of birth would be [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, [PII], could you also, um, provide me the last name first initial of yours?
[AGENT][NEUTRAL] [PII], and yours?
[CUSTOMER][NEUTRAL] Uh, [PII] as well.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the first day of service and total bill amount you have for this number?
[CUSTOMER][NEUTRAL] [PII] with the charge amount of $237 even.
[AGENT][NEUTRAL] OK, so first off, this policy that you gave me, uh actually termed as of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if there's another but there's a different policy that is active with a different policy number, so give me a moment to get that information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, one moment. Sure, sure. Sure, sure, sure, sir. Take your time.
[AGENT][NEUTRAL] Yes sir, you have an old policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Like
[AGENT][NEUTRAL] OK, did you just in the policy number that's currently active?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's 259.
[AGENT][NEUTRAL] 2486.
[AGENT][NEUTRAL] And the effective date on this policy is [PII].
[AGENT][NEUTRAL] And again it is active so let me see if the claim was received and processed under the correct number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, one moment. OK. Uh, member ID would be 2572486, right?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, let me give you the entire number again.
[AGENT][NEUTRAL] 02592486.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02592486
[AGENT][NEUTRAL] And there's claim.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] This claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it was processed and denied on [PII].
[AGENT][NEUTRAL] And the reason for the denial is that office visits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are not covered by the above numbered policy. The member's plan does not cover office visits, [PII].
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, may I know the patient's plan type?
[AGENT][NEUTRAL] Medlink.
[AGENT][NEUTRAL] This is a supplemental policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is not major medical insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one moment. Let me check.
[AGENT][NEUTRAL] me.
[CUSTOMER][NEUTRAL] OK. Since it is a supplemental policy, so it covered, like, you know, it, it will cover co-pay, right?
[AGENT][NEUTRAL] Not for an office visit. An office visit is not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK. It is a plan that would be made link supplemental policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] May I get the claim number?
[AGENT][NEUTRAL] Again, the claim number is 358-816-5.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm. And what is the next date of service and total bill amount?
[CUSTOMER][NEUTRAL] Uh, so,
[CUSTOMER][NEUTRAL] OK, was it
[CUSTOMER][NEUTRAL] Oh was it a patient responsibility then?
[AGENT][NEUTRAL] We do not determine patient responsibility, that is up to the provider.
[CUSTOMER][NEUTRAL] OK, got you. Uh, one moment. Uh, give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Uh, next member ID, yeah, so, uh, next date of service would be [PII].
[AGENT][NEUTRAL] OK, so you
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] With the charge amount of uh $2,926 even.
[AGENT][NEUTRAL] Uh-huh
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And you said the data service is [PII]?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK, there is no claim on file with APL for that date of service.
[AGENT][NEUTRAL] Because this is a supplemental policy, [PII], when you do submit the claim to APL for review, you must also send us a copy of the primary insurance company's explanation of benefits because we do have to have that.
[CUSTOMER][NEUTRAL] OK, got you. Um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once the claim has been processed, we can you excuse me, we have a portal in which you should be able to check the claim status or if you need to print that other explanation of benefits you can do that by going to [PII].
[CUSTOMER][NEUTRAL] OK, got you. I'm done.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I know the portal name?
[AGENT][NEUTRAL] I just gave that to you.
[CUSTOMER][NEUTRAL] OK, got you. I'm done. May I get the color reference number?
[AGENT][NEUTRAL] Secured. [PII]. My name in today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. I'm done. Thanks for your assistance. You have a great day. Bye for now.
[AGENT][POSITIVE] OK. Well, you're very welcome, [PII], and thank you for calling APL. I hope you have a nice weekend.
[CUSTOMER][NEUTRAL] Mhm. You too as well. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.