AccountId: 011433970860
ContactId: 61878c43-95fb-4ced-ad91-a6e2ec9455d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 462929 ms
Total Talk Time (AGENT): 248046 ms
Total Talk Time (CUSTOMER): 215405 ms
Interruptions: 7
Overall Sentiment: AGENT=2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/61878c43-95fb-4ced-ad91-a6e2ec9455d7_20250220T21:20_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm trying to find out about a claim please. I'm calling from the provider's office.
[AGENT][NEUTRAL] OK, you're needing
[AGENT][NEUTRAL] OK, you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][POSITIVE] Yes, I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your patient's policy number?
[CUSTOMER][NEUTRAL] Policy number is gonna be 1262468M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information, [PII], that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's gonna be [PII], uh, let me just spell the last name for you [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], that might be it. Um, [PII] is the date of birth.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. All right. Thank you.
[CUSTOMER][POSITIVE] I'm good at butchering names. I'm sorry, very good at butchering names.
[AGENT][NEUTRAL] That's OK.
[AGENT][POSITIVE] That's OK. Some names are very easy for all of us to do that with, so no worries.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please [PII]?
[CUSTOMER][NEUTRAL] It's gonna be [PII] for $459.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Whenever I call you guys, you guys are always so nice over the phone.
[AGENT][NEUTRAL] Oh well thank you we certainly try to be we do and but that's very nice of you to say. So yes ma'am, we did receive that claim uh the claim number, well, are you gonna need to receive date and process date or just the claim number and status?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, you're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I have the claim number? Can I just have it all?
[AGENT][NEUTRAL] Yeah, OK. So it was received on 25. It was processed on.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me make sure. Hold on just one.
[AGENT][NEUTRAL] Yes, and it was processed on [PII].
[AGENT][NEUTRAL] The claim number is 356-0492.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, this claim was denied, [PII], and the reason for the.
[AGENT][NEUTRAL] on here is that office visits are not covered.
[AGENT][NEUTRAL] By this policy?
[CUSTOMER][NEUTRAL] Oh, some other words, like some other words what you're saying is just like an urgent care or like an ENM.
[AGENT][NEUTRAL] Well, this was an office, the 992, the 99214, yes, an office visit is not covered under this supplemental policy, correct?
[CUSTOMER][NEUTRAL] Like like you say you're an office visit.
[CUSTOMER][NEUTRAL] Right. 214. Mhm mhm.
[CUSTOMER][NEUTRAL] OK, this is OK.
[AGENT][NEUTRAL] And then the other two codes that were on this claim were denied stating benefits are payable only if your major medical insurance provider provides benefits. If the claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So can I ask a question? That $30 that we were looking for, that actually is the patient's responsibility, is it not?
[AGENT][NEUTRAL] We do not determine patient responsibility since we're not a major medical insurance carrier, that would be up to the provider. Mhm. And if you need a copy of this EOB, [PII], well, you all should be getting it in the mail, but you can also go to our portal and print that.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] By going to our our portal website is [PII] if you don't already have that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, uh.
[CUSTOMER][NEGATIVE] Sometimes I have a hard time getting on your website that's the only thing I know that sounds sad.
[AGENT][NEUTRAL] If a claim is not on, no, but if a claim is not on file or it's not yet been processed, that would be one reason that you would not be able to locate it.
[AGENT][NEUTRAL] But with the claim number usually people can are able to.
[CUSTOMER][NEUTRAL] OK, so give me a second here.
[AGENT][NEUTRAL] Located.
[CUSTOMER][POSITIVE] You're right because I'm sorry, I have a cold, I apologize. Um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry, there's so much going around. Oh.
[CUSTOMER][NEGATIVE] I don't know. Um, I just, I feel bad coughing in your ear. Um,
[AGENT][NEUTRAL] Oh, you're OK.
[CUSTOMER][NEGATIVE] Issue is is that yes your website is a little.
[CUSTOMER][NEUTRAL] Pernickety because it doesn't like, like what is the provider patient account number is that the claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is the, no, that is the account number that you all have for the member that you submit on the claim.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Inbox
[CUSTOMER][NEUTRAL] I'm trying to think of a box that's in.
[AGENT][NEUTRAL] Yeah, it's like 2
[AGENT][NEUTRAL] Uh, is it 23? I this one starts with a P.
[CUSTOMER][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] I think it's 23. It's a PE number? Yeah, I put that in and they're like, we can't find the claim. I was like, really? You, you can't find the claim? I gave you, I gave you everything I can give you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Give me, give me the number, yeah, give me the number, um.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Give me that number.
[CUSTOMER][NEUTRAL] Sure, it's P1403691841.
[AGENT][NEUTRAL] And that is what we show for the member. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what tax ID do you have?
[CUSTOMER][NEUTRAL] I'm just being uh
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The tax ID number?
[CUSTOMER][NEUTRAL] Oh, tax ID. I'm sorry, I, I was like, what?
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[AGENT][POSITIVE] Because that number is correct. Sometimes I was thinking maybe we had it, you know, a digital, but that is correct. That is what we say.
[CUSTOMER][NEUTRAL] Well, the thing is is that.
[CUSTOMER][POSITIVE] It's just funny. They love slipping these in. Uh, I usually do urgent care.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] This is not urgent care. This is just an office visit, but the federal ID is gonna be [PII] is what it is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh. Mhm. And that is what we have for this claim also. Mhm. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Um, OK. Well, I'm actually on your guys' website right now. I was trying to pull something cause I felt, I always feel bad calling cause I'm like you got a website, so I, I feel bad.
[AGENT][POSITIVE] Oh, well, no, that's what we're here for because, you know, don't feel bad at all. If you're not able to pull the information online then you should call us and we'll be happy to give it to you.
[CUSTOMER][NEUTRAL] See, this is, I found it.
[CUSTOMER][POSITIVE] I'm so excited. I found it. Oh my gosh, it came up.
[AGENT][POSITIVE] Oh good.
[AGENT][POSITIVE] Yay!
[CUSTOMER][POSITIVE] Sorry, I get excited about, I get easily excited about easy things. I'm sorry.
[AGENT][POSITIVE] That's OK. As long as we have something to get excited about, [PII], whatever that is that brings us some happiness, that's all that matters, doesn't matter what it is.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you so much. So I do have the EOB or the EOP EOB, um, and I'm gonna send this off to my, uh, when did you guys do this? I wanted to see, oh, I can't do it yet. I gotta give him a little time, um.
[AGENT][POSITIVE] OK, good.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] But I will, I thank you so much for the information. I appreciate it. It makes my life a lot easier. Um, do you do reference numbers, [PII]?
[AGENT][POSITIVE] Oh, absolutely.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Sure, you will actually use my name [PII] along with today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, well thank you so much. You were so helpful today I appreciate it.
[AGENT][POSITIVE] Well, you are so, oh, hopefully, it was my pleasure in helping you. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, thank you, but thank you so much for everything and you have a great rest of the day.
[AGENT][POSITIVE] Well yes ma'am you too and thank you again [PII] for calling APL.
[CUSTOMER][POSITIVE] Thank you. Mhm.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm bye.