AccountId: 011433970860
ContactId: 5d0fe16d-f886-42f9-b39a-95dccaaf0219
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 741390 ms
Total Talk Time (AGENT): 200908 ms
Total Talk Time (CUSTOMER): 326984 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/5d0fe16d-f886-42f9-b39a-95dccaaf0219_20250217T18:27_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm [PII]. How are you today?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] I'm doing great. Thank you for asking. Actually, I need assistance related medical claim.
[AGENT][NEUTRAL] OK, and what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] [PII] is last name initial as well.
[AGENT][NEUTRAL] I'm sorry, can you go a little bit slower? Can you spell your name for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and do you have a phone number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Is that a direct line?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and do you have a policy number?
[CUSTOMER][NEUTRAL] Actually, I have the patient's policy number and I wanna tell you some information.
[CUSTOMER][NEUTRAL] And then before talking with you, I got a call back but it was missed by my side because uh I was uh away from my desk. So uh that's why I'm called, I called back on the same number that I found.
[CUSTOMER][NEGATIVE] A call, missed call from that one.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Yeah. The patient policy number is
[CUSTOMER][NEUTRAL] 021642
[CUSTOMER][NEUTRAL] 48.
[AGENT][NEUTRAL] And the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you're needing claim status or benefits?
[CUSTOMER][NEUTRAL] Claim status.
[AGENT][NEUTRAL] And what date of service was that for?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me look that up for you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Actually, one more thing I wanna tell you that uh uh [PII], was the last representative. Uh she sent the uh request to the claims department in order to provide me the information related to that claim.
[AGENT][NEUTRAL] What is the total charge?
[CUSTOMER][NEUTRAL] $210 they want.
[CUSTOMER][NEUTRAL] Are.
[AGENT][NEUTRAL] And what did she tell you about the claim?
[CUSTOMER][NEUTRAL] Sorry, I didn't get that.
[AGENT][NEUTRAL] And what what what did she tell you about the claim?
[CUSTOMER][NEUTRAL] Actually I wanna know about the, the claim information like uh uh.
[CUSTOMER][NEUTRAL] Under the claim number.
[AGENT][NEUTRAL] What kind of information
[CUSTOMER][NEUTRAL] 354
[AGENT][NEUTRAL] What kind of information did you want to know?
[CUSTOMER][NEUTRAL] I'm gonna
[CUSTOMER][NEUTRAL] I'm going to provide you all the information that uh the claim number for this claim 3541843. Under this claim, uh, it got denied stating as uh the services billed are non-covered the patient plan. Is it right?
[AGENT][NEUTRAL] Uh.
[AGENT][POSITIVE] Right, that's correct.
[CUSTOMER][NEUTRAL] But I wanna tell you that uh we bill CPT code 88305. It's uh related to a level 4 surgical pathology procedure and uh it only performed to the patient in order to check their skin.
[CUSTOMER][NEUTRAL] Self sample for checking that uh uh the services need to be rendered or render is uh good for patients skin or not. That's the reason we build the CPT code 88305. It's just for um
[CUSTOMER][NEUTRAL] Getting for initial analysis. So I wanna know uh why it's not covered at the patient plan because uh um previously this claim, uh, this patient's claims got paid.
[AGENT][NEUTRAL] OK, and uh, didn't uh [PII] tell you that she would get somebody to call you back on that?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so why are you calling back until and you because somebody called you back and you missed it?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on, let me see if I can get somebody who can help you with that, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] S.
[CUSTOMER][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], I have a man calling back on um
[AGENT][NEUTRAL] An HI policy for the claim status. He already talked to [PII] and she was supposed, she sent a hub for somebody to call him back.
[AGENT][NEUTRAL] And I was trying to get somebody that did HR claims. I don't know why it was denied as office visit cover. I don't process the HR, so I don't know. He said somebody tried to call him back, but he missed the call.
[CUSTOMER][NEUTRAL] And there's no note.
[CUSTOMER][NEUTRAL] I'm assignment
[AGENT][NEUTRAL] I know
[AGENT][NEUTRAL] There's a note in there, but I don't know who tried to call him, call him.
[CUSTOMER][NEUTRAL] And who called him?
[CUSTOMER][NEUTRAL] So they didn't put a note whoever tried to call him.
[AGENT][NEUTRAL] Uh uh.
[CUSTOMER][NEUTRAL] Alright, so, um, [PII], who, what's the policy number?
[AGENT][NEUTRAL] 02164248.
[CUSTOMER][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] I can see where [PII] sent the hub, but I don't see where who tried to call him back or whatever.
[CUSTOMER][NEUTRAL] And this is part 2 that's on the phone?
[AGENT][NEUTRAL] Uh, this is [PII] with the provider's office.
[CUSTOMER][NEUTRAL] Is it 4 part 2?
[AGENT][NEUTRAL] It is for part one.
[CUSTOMER][NEUTRAL] Did she give you a
[CUSTOMER][NEUTRAL] OK, so it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What's her call back number [PII]?
[AGENT][NEUTRAL] His callback number is, yeah.
[CUSTOMER][NEUTRAL] Oh, it's a he. [PII] is a he.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], yeah. Mhm.
[CUSTOMER][NEUTRAL] What's the data service and total bill amount?
[AGENT][NEUTRAL] Uh, the data service is 722-24.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] $210.
[AGENT][NEUTRAL] Claim number 3541843.
[CUSTOMER][POSITIVE] Thank you, ma'am. And you verified everything and all that.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, give me one second, let's see.
[AGENT][NEUTRAL] Are y'all taking all HR calls or?
[CUSTOMER][NEUTRAL] Well, when it's something that needs when it's already had a hub tickets, we have a queue that we're now supposed to be transferring if there's additional questions on something like that, um, it's called claim support.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And that would take them to an examiner that should be able to answer further questions, I mean.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And when people don't make notes even when they leave voicemails, it's hard for us to help these people.
[AGENT][NEUTRAL] It is. Mhm.
[CUSTOMER][NEUTRAL] So, um,
[AGENT][NEUTRAL] You see, ain't, ain't nobody told us that there wasn't HIQ to the examiner, so.
[CUSTOMER][NEUTRAL] Wow. OK. Uh.
[CUSTOMER][NEUTRAL] When was this? I mean, the hub request was just submitted today. I don't know. I mean, is the hub ticket, is it one of, did you look at the hub ticket to see if, I mean, and there's not, oh.
[AGENT][NEUTRAL] Right, while ago.
[AGENT][NEUTRAL] I did not.
[CUSTOMER][NEUTRAL] Hold on one second, [PII] don't release him yet. Just 1 2nd. Let me see.
[AGENT][NEGATIVE] Cause I, I couldn't help him. I don't know why the office visits, I mean, why they denied it as office visit not covered and it's a pathology report, he said.
[CUSTOMER][NEUTRAL] Roxy.
[CUSTOMER][NEUTRAL] It was Roxy that called him. If he
[AGENT][NEUTRAL] What did Roxy say in the hood?
[CUSTOMER][NEUTRAL] On the hub ticket it just says call to Ali at provider's office, unable to reach left voicemail with contact information, so he needs Roxy.
[CUSTOMER][NEUTRAL] According to this hub ticket note that she's got out there, she's waiting on.
[AGENT][NEUTRAL] Can you get him to Roxy for me?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm not quite sure how to transfer it directly to Roxy.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] And she's not available at the moment anyway.
[CUSTOMER][NEUTRAL] Can you just tell him that the examiner will need to call him back? I can give you if you wanna send her a message I can give you her number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or if you wanna email y'all send emails, changes messages, how do y'all do that?
[AGENT][NEUTRAL] We just transfer them if we don't know how to help them.
[CUSTOMER][NEUTRAL] OK, but if I have to call them if, if you were to have to.
[CUSTOMER][NEUTRAL] It doesn't matter. I mean, I'm just gonna have to tell him that I'm gonna have to send a message. I can't help him with this. She called him and left him a message.
[AGENT][NEUTRAL] OK, I'll tell him, I'll send her an IM to call him back then because I can't help him either.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, just
[CUSTOMER][NEGATIVE] Yeah, tell her that he called her, yeah, and she's apparently, I mean that yeah, I'm looking at the hub ticket and she left a message with her contact information according to this, unable to reach left voicemail with contact information.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So she'll just have to call him back again.
[AGENT][NEUTRAL] OK, I'll send her a message.
[CUSTOMER][POSITIVE] OK, you're the, thank you, ma'am. I'm glad she had a note on the ticket.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Um, so yeah.
[CUSTOMER][POSITIVE] OK. All right, [PII]. OK. Anything else I can help you with or try to help you with? OK. Thanks. You're welcome.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] That's all. That's all. Thank you.
[CUSTOMER][NEUTRAL] OK. Bye-bye.
[AGENT][NEUTRAL] So,