AccountId: 011433970860
ContactId: 6222653b-b38f-4099-9700-58bb01347333
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420760 ms
Total Talk Time (AGENT): 158897 ms
Total Talk Time (CUSTOMER): 138785 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=2.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/6222653b-b38f-4099-9700-58bb01347333_20250226T15:29_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling
[AGENT][NEUTRAL] yeah.
[CUSTOMER][NEUTRAL] Hello, I'm [PII] calling from provider's office to check on a claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][POSITIVE] Yeah, I'm doing great, thanks for asking.
[AGENT][NEUTRAL] And may I please have a callback number?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] And may I please have the patient's policy number?
[CUSTOMER][NEUTRAL] OK, sure. It is 01644021.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Member name is [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] And may I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yes, the date of service is on.
[CUSTOMER][NEUTRAL] [PII], with the amount of $100.93.
[AGENT][NEUTRAL] That's $1,193 or 1,193 cents.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, no, it's 1100 and.
[CUSTOMER][NEUTRAL] It's $1100.93.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And you can also check claim status via our secured portal that is [PII] and I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] Yeah, thank you for that.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And I did pull that claim up for you.
[AGENT][NEUTRAL] And it does show that we received it on 113 of 25. It was processed on 115, I apologize, 114 of 25. That claim number is 355.
[CUSTOMER][POSITIVE] Yes, sure, take your time.
[AGENT][NEUTRAL] 12
[AGENT][NEGATIVE] 25, the claim processed and denied.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] That office visits and office procedures are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Thank you. And office visits and office procedure courses are not covered under the patient's plan type, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And may I have the patient's plan type?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] This is their supplemental plan.
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] And it is the patient's responsibility?
[AGENT][NEUTRAL] That is to provide its discretion.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And can we bill a patient for this service?
[AGENT][NEUTRAL] That is the provider's discretion. We can't tell the provider how to bill.
[CUSTOMER][NEUTRAL] OK, we can bill the provider.
[AGENT][NEUTRAL] We can't tell the provider how to build, that is the provider's choice.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] And uh uh is there any authorization can be available on this claim?
[AGENT][NEUTRAL] An authorization
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] For services that was rendered.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. We don't require an off.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that.
[AGENT][POSITIVE] You're welcome. And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Oh, yes, may I have the contact line's mailing address?
[AGENT][NEUTRAL] Yes, the mailing address is [PII].
[AGENT][NEUTRAL] And that is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] and you did ask for our mailing address again?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is, may I have the time limit?
[AGENT][NEGATIVE] We have no timely filing.
[CUSTOMER][POSITIVE] Thank you so much for that. And I do have one more claim with me. It's for a different number. Could you please help me with that?
[AGENT][NEUTRAL] May I have that policy number?
[CUSTOMER][NEUTRAL] Oh yes, sure. The policy number is.
[CUSTOMER][NEUTRAL] 982-078
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] My full name is [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] And may I have that date of service and total bill?
[CUSTOMER][NEUTRAL] Oh yes, the date of service is on [PII], with the amount of $927.52.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] And I did pull that claim up for you as well.
[CUSTOMER][NEUTRAL] Yeah, sure. Could you please spell your name for documentation?
[AGENT][NEUTRAL] Yes, it is spelled [PII] Last initial [PII] and today's date will be the call reference.
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] You're welcome. And for this claim, we did receive it on [PII]. It was processed on [PII]. The claim number is 3497511.
[AGENT][NEUTRAL] That claim shows that a process and it denied that office visits and or procedures are not covered. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Oh, yes. May I have the, uh, could you please repeat the process it once more?
[AGENT][NEUTRAL] Yes, it was processed on [PII].
[CUSTOMER][POSITIVE] Thank you so much for that. And OK, it's also from the uh same as from the previous one.
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] Uh the previous, yeah, sure, no problem. It's also uh same denial from the previous number, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you. Thank you so much for your assistance and have a great day.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life. Have a great day as well.
[CUSTOMER][POSITIVE] You have a great day bye bye.
[AGENT][POSITIVE] Thank you bye.