AccountId: 011433970860
ContactId: 59695366-3579-4150-9155-d43edee65276
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1378760 ms
Total Talk Time (AGENT): 424918 ms
Total Talk Time (CUSTOMER): 322753 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/59695366-3579-4150-9155-d43edee65276_20250206T14:04_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII] calling for provider office check on a claim status.
[AGENT][NEUTRAL] I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[AGENT][NEUTRAL] Will you spell your name, please? Yes, please.
[CUSTOMER][NEUTRAL] Can you spell it?
[CUSTOMER][NEUTRAL] Yeah, sure. Yeah. It's spells like [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and you have one claim solution to check claim status on, is that correct?
[CUSTOMER][NEUTRAL] Uh yes, and we have 3 claims.
[AGENT][NEUTRAL] You have 3 claims.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, OK. And are they for the same patient in different dates of service or three different patients?
[CUSTOMER][NEUTRAL] Uh, it's, um, different patients.
[AGENT][NEUTRAL] For multiple types of service?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK, yes ma'am. I can help you with this, and you will use my name that I gave you, [PII] along with today's date as your call reference number.
[CUSTOMER][NEUTRAL] Yeah, sure. Can you spell your name for me?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] And any information, you're welcome. Any information that is provided will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] And lastly, if we do have the claims on file and you need any of the explanation of benefits, you can go to our portal to print those yourself and our portal website is secured.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]. Again, that's where you would go if you need a copy of the any of the explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] The member's ID 10605, hm.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Can you start again, please?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] A member's ID 10.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 60
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 51
[CUSTOMER][NEUTRAL] 84
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 7.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you did say 010, or excuse me, 1060518. Is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes. And the patients, uh, first name, [PII], and the last name, [PII], and the middle initial should be, yeah.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, so something is not correct with that policy number.
[AGENT][NEUTRAL] That you gave me, uh, what is, give me the policy number again because that's pulling up a completely different number.
[CUSTOMER][NEUTRAL] Yeah, uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah. Can you verify that's, it's 10605184 M as in Mike, L as in Lima.
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] OK. And again, that is not a valid policy number. There is one number that is extra or not enough. Can you please look at the ID card?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, that's just a moment.
[CUSTOMER][NEUTRAL] Yeah, it's
[AGENT][NEUTRAL] OK, so let me give you the correct phone number. I mean, excuse me, the correct policy number.
[CUSTOMER][NEUTRAL] Yeah, just a moment and uh hm.
[AGENT][POSITIVE] The, yes, ma'am, I have it. I figured it out. I have it.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] So it should be 01.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm hm.
[AGENT][NEUTRAL] 60.
[CUSTOMER][NEUTRAL] 5184.
[AGENT][NEGATIVE] 5184, correct, but you were giving me 1060, and that is not correct.
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, sure. Sorry for that. And uh I, uh, the current member ID 01605184 and the next?
[AGENT][NEUTRAL] That is all.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. And again, your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] And the patients, uh,
[CUSTOMER][NEUTRAL] Name, uh, the first name [PII] and the last name [PII], and the middle initial should be [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. And what is the first date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Yes. Uh, the date of service uh [PII] and the total charge amount, $728 even.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so this claim was received on 1-28-2025.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3557616.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And the reason for the denial states this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Uh, are not covered by the patient plan or pro provider's plan?
[AGENT][NEUTRAL] Patient.
[CUSTOMER][NEUTRAL] Yeah, OK. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, what is the reason for non-covered in the patient plan is the provider is out of network or anything else?
[AGENT][NEGATIVE] This supplemental policy does not cover it.
[CUSTOMER][NEUTRAL] Coverage, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And are you ready to move on to your next data service?
[CUSTOMER][NEUTRAL] Yes, so just a moment but what coverage OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the claim number is 3357616, right?
[AGENT][NEUTRAL] 3557616
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mm, the will be was downloaded in a portal, right? Secure. [PII], right?
[AGENT][NEUTRAL] No, ma'am, it is secured. [PII].
[CUSTOMER][NEUTRAL] Hmm.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, are you ready with the next number?
[AGENT][NEUTRAL] Yes ma'am, I am.
[CUSTOMER][POSITIVE] Yeah, nice.
[AGENT][NEUTRAL] Oh, you said it was for the same patient, multiple dates of service.
[AGENT][NEUTRAL] Is it not the same policy?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] I asked if it was the same policy. Mhm.
[CUSTOMER][NEUTRAL] The same poli
[CUSTOMER][NEUTRAL] Yes, yes, same policy but we, uh, it's a different member.
[AGENT][NEUTRAL] OK, so this policy is only for [PII]. This policy number you gave me is for this number only.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it a different policy number that you have?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So it is for a different member. Is that correct?
[CUSTOMER][POSITIVE] Yes, yes, correct.
[AGENT][NEUTRAL] Then give me just a moment because I'll need to finish my portion of this clean solution before we can move to the next.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the next policy number?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh, just a moment, I check.
[CUSTOMER][NEUTRAL] Yeah, and we have a group number. Can you check with that?
[AGENT][NEUTRAL] No, ma'am, I need the member's policy number.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, and the member ID 1130.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 252
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, 5.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And your patient's name and date of birth on this one?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The patient's uh name and the first name, [PII], and the last name [PII], and the middle initial [PII] [PII]
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now, this policy was active from [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is your, mhm, what is your date of service?
[CUSTOMER][NEUTRAL] Yes, uh, the date of service, uh, [PII].
[AGENT][NEUTRAL] Mhm. Total bill amount, please.
[CUSTOMER][NEUTRAL] Yeah, the total charge amount uh $1,173.
[AGENT][NEUTRAL] Say the amount again, please.
[CUSTOMER][NEUTRAL] Yeah, $1,173 even.
[AGENT][NEUTRAL] OK, so you have an incorrect policy number for this number. This policy number you gave me was not active for your data service.
[AGENT][NEUTRAL] The correct policy number that you should have is 1433101.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was active effective [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me a moment to see if we received and processed the claim under the correct policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, the date of service is [PII], is that correct?
[CUSTOMER][NEUTRAL] Uh yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I have not yet located a OK, yes, there we go. One moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'll get
[AGENT][NEGATIVE] OK, so this claim was received. It was received on [PII] and processed and denied the same day.
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] No?
[AGENT][NEUTRAL] 873 4.
[CUSTOMER][NEUTRAL] And that
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And this claim was denied because office visits are not covered?
[AGENT][NEUTRAL] By this policy?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the other codes were denied as the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Uh, what if the service is not covered?
[AGENT][NEUTRAL] That is correct. Office visits are not covered and the other codes were denied as the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Uh, and this is also covered by the patient's plans, right?
[AGENT][NEGATIVE] It is not covered under this correct on the patient's plan.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] Mhm. You're welcome.
[AGENT][NEUTRAL] OK. And is this all of the information that you need?
[CUSTOMER][NEUTRAL] Uh, uh, may I know the what plan?
[CUSTOMER][NEUTRAL] Other, yeah. What plan the patient has?
[AGENT][NEUTRAL] This is a supplemental Medlink policy.
[CUSTOMER][NEUTRAL] supplemental.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is there any other information you need on this member's policy?
[CUSTOMER][NEGATIVE] Yeah, yeah, no, no, uh.
[AGENT][NEUTRAL] OK, and that's
[CUSTOMER][NEUTRAL] The next member was, mhm.
[AGENT][NEUTRAL] OK, give me just a moment. Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK. And I'm ready for the next number.
[CUSTOMER][NEUTRAL] Yeah, the next member ID 02415249.
[AGENT][POSITIVE] Thank you one moment please.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And your patient's name, please, and date of birth, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. The patient's name, [PII], and the date of birth, uh [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount uh for her, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. Uh, the date of service uh [PII].
[CUSTOMER][NEUTRAL] The total charge amount, $459 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so the most recent claim that we received was denied as a duplicate. Are you needing the original claim information?
[CUSTOMER][NEUTRAL] Yeah. And we have, uh, when was I received that like, received it?
[AGENT][NEUTRAL] Mhm. I'll provide that information to you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The original claim was received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number is 353-9768.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And this claim was denied because office visits are not covered by the member's plan.
[AGENT][NEUTRAL] And the other codes were denied because the policy doesn't provide a service, a benefit for services in which no charges were incurred.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, uh, what plan does the patient has?
[AGENT][NEUTRAL] Medin supplemental.
[CUSTOMER][NEUTRAL] A supplemental, right.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment. I have one more like uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And was there any other information you needed?
[CUSTOMER][NEUTRAL] Yeah, the, before, what is the claim number?
[CUSTOMER][NEGATIVE] Not original claim number.
[AGENT][NEUTRAL] The claim number for this policy is 353-9768.
[CUSTOMER][NEUTRAL] Yeah, what is the uh duplicate claim number?
[AGENT][NEUTRAL] 3557496
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, thank you. Thanks. Uh, that's it. And thanks for assisting me. Have a good, yeah.
[AGENT][POSITIVE] OK. Well, you're certainly very welcome. Yes, ma'am. So that is all I can help you with, [PII]. Thank you again for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.