AccountId: 011433970860
ContactId: 62269c31-7aa6-4cd4-aacb-0ac577d1a658
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 739479 ms
Total Talk Time (AGENT): 222947 ms
Total Talk Time (CUSTOMER): 209333 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/62269c31-7aa6-4cd4-aacb-0ac577d1a658_20250425T20:14_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from provider office. I want to know the claim status. What's your name?
[AGENT][NEUTRAL] My name is [PII] [PII]
[AGENT][NEUTRAL] And may I have a callback number just?
[CUSTOMER][NEUTRAL] Can you spell out your name?
[AGENT][NEUTRAL] That, that is the spelling [PII].
[CUSTOMER][NEUTRAL] OK, so, so call uh call back number is.
[AGENT][NEUTRAL] OK, may I have
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The callback number is [PII] and my extension number is [PII].
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure, one moment.
[CUSTOMER][NEUTRAL] OK, so policy number is D as in David 43716985.
[AGENT][NEUTRAL] OK, Mr. [PII], that the number is not ours, that's IMA. Do you have the policy certificate number? It's gonna start with a 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] I have a social security number.
[AGENT][NEUTRAL] OK, bear with me just a second. Let me pull another system.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Can I start?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] Yeah 667-072-389.
[AGENT][NEUTRAL] 667-072-389.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the name of the patient?
[CUSTOMER][NEUTRAL] Patient named [PII]
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Perfect. May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Data service is [PII] and the amount we have charge total which is $217.02.
[AGENT][NEUTRAL] Thank you. So I have [PII] $217.02. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, no, no, no, it's the amount is different, yeah.
[CUSTOMER][NEUTRAL] OK, so amount, uh, we have charged total which is one moment please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, one second please.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, it's a correct correct charge amount which is 217.02.
[AGENT][NEUTRAL] OK. And Mr. [PII], I have a question. Is this for medical, dental?
[CUSTOMER][NEUTRAL] Medical, medical.
[AGENT][NEUTRAL] Medical. All right. OK, bear with me just a minute.
[AGENT][NEUTRAL] OK, there is no claims on file for the medical for this member. Um, this policy has been terminated since [PII], so maybe that's the reason that we have not received that claim.
[AGENT][NEUTRAL] There's no active policies for her for that date of service.
[CUSTOMER][NEUTRAL] OK, you mean, uh, it's a no claim on file because of, uh, right, there's a no claim on file, right?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] No claim on file and we don't have an active policy for that date of service.
[CUSTOMER][NEUTRAL] Your voice is not coming, hello.
[AGENT][NEUTRAL] Yes, can you repeat?
[CUSTOMER][NEUTRAL] Yeah, I'm saying it was the policy active on the date of service or not?
[AGENT][NEUTRAL] No, the policy was terminated back in [PII].
[CUSTOMER][NEUTRAL] When, when can you repeat one more time?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I also have another member ID.
[AGENT][NEUTRAL] OK, bear with me. Do you need any of it?
[CUSTOMER][POSITIVE] Give me a call since yeah yeah yeah.
[CUSTOMER][NEUTRAL] Before completing this patient, uh please provide a conference number.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. And let me make a note on this one before moving forward and you don't need any other information on this one, correct?
[CUSTOMER][NEUTRAL] Uh, for this number is not. I have another member.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] What's the next policy number?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I'm just trying to pull up member information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So policy number is.
[CUSTOMER][NEUTRAL] Policy number is the same as the previous one which is D43731895.
[AGENT][NEUTRAL] So it's the same number?
[CUSTOMER][NEUTRAL] So you can use uh yeah yeah no no no you can use the social security number.
[AGENT][NEUTRAL] Oh, OK. So it's a different member. OK, bear with me just a second, OK?
[CUSTOMER][NEUTRAL] Can I start? Yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Go ahead.
[CUSTOMER][NEUTRAL] Yeah, social security number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] What's the name of the patient?
[CUSTOMER][NEUTRAL] Patient name Price key.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mater service in amount of the claim.
[CUSTOMER][NEUTRAL] Data services [PII].
[CUSTOMER][NEUTRAL] And amount is
[CUSTOMER][NEUTRAL] $125.03.
[AGENT][POSITIVE] Thank you. That was [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] One moment, let me see if this is your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm still waiting on the system.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm still waiting on the system.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] What is the procedure code that you're looking for?
[CUSTOMER][NEUTRAL] Uh, actually, so I didn't have any information, so we can start.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK bear with me because I have to look into all of them and see if I can find it.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Yeah, OK, OK, OK, so please, uh tell me and uh when did you receive this claim?
[AGENT][NEUTRAL] If I find it, I'll let you know. Bear with me, I'm trying to find it, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name of the facility?
[CUSTOMER][NEUTRAL] Mid now urgent care.
[AGENT][NEUTRAL] OK, is it for $125 even?
[CUSTOMER][NEUTRAL] Are you asking facility name, right?
[AGENT][NEUTRAL] Yeah, I got the facility name. The amount that you're giving me, um, is it $125 even?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. All right. So we have uh processed the claim on [PII].
[AGENT][NEGATIVE] And the claim was denied. The reason for this denial.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] Is that is
[CUSTOMER][NEUTRAL] One moment, one moment. When did you receive this claim? Tell me.
[AGENT][NEUTRAL] OK, one moment because that's not on the EOB.
[CUSTOMER][NEUTRAL] OK, but I need it.
[AGENT][NEUTRAL] 595. Yes, I'm looking for it, one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, it was received on [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and do you have a process date?
[AGENT][NEUTRAL] Process on [PII].
[CUSTOMER][NEUTRAL] OK, do you have a claim number?
[AGENT][NEUTRAL] I do, claim number 3575943.
[CUSTOMER][NEUTRAL] Anything else?
[AGENT][NEGATIVE] It was denied.
[AGENT][NEGATIVE] Denial reason, non-covered place of service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, so, uh, one second please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, so tell me one thing, uh, which, which place of service we need to build.
[AGENT][NEUTRAL] I cannot tell you what place of service you need to be. Based on the information you send, it's not a covered place of service. We only cover surgery in a in a hospital or in a physician's office, but the benefit is only for surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] OK, give me a conference number.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK, no problem. Thanks, bye.