AccountId: 011433970860
ContactId: 7017e2d7-30bb-4016-9b49-05b97be07f09
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 814280 ms
Total Talk Time (AGENT): 274956 ms
Total Talk Time (CUSTOMER): 210326 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/2025/03/26/7017e2d7-30bb-4016-9b49-05b97be07f09_20250326T19:42_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Ram Healthcare Center, and I want to check on the screen speakers. So am I connected to the right department?
[CUSTOMER][NEUTRAL] I just finish talking.
[AGENT][NEGATIVE] I was not able to understand nothing you said and your phone is breaking up and there's a big noise and it's not letting me understand what you're saying.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Am I audible now?
[AGENT][NEUTRAL] Can you repeat?
[CUSTOMER][NEUTRAL] I'm I audible now?
[AGENT][NEUTRAL] A little bit. Go ahead.
[CUSTOMER][NEUTRAL] OK. So, uh, I, I'm a provider and I'm uh calling you regarding claim. So, uh, I'm not connected to the provider service department?
[AGENT][NEUTRAL] You're calling the care team, um, but I can go ahead and try to assist you with claims. May I have your name?
[CUSTOMER][NEUTRAL] Sure, my name is [PII]. And my last name is.
[AGENT][NEUTRAL] I'm not, no. Mm mm.
[AGENT][NEGATIVE] I didn't get none of your name.
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And first initial, last name is [PII].
[AGENT][NEUTRAL] OK. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] So, that is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And can you please help me with your name as well?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me repeat this back to you. That's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Byram Healthcare Center.
[AGENT][NEUTRAL] B
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and may I have the patient's policy?
[CUSTOMER][NEUTRAL] May I have your name please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][NEUTRAL] OK. Uh, so my last name is [PII].
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] That is 01.
[CUSTOMER][NEUTRAL] 61
[CUSTOMER][NEUTRAL] 18
[CUSTOMER][NEUTRAL] 58 M as in Mike, L as in Lima, then 8.
[AGENT][NEUTRAL] OK, I got 01611858.
[CUSTOMER][NEUTRAL] Uh, can you please repeat that?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] That is 01.
[CUSTOMER][NEUTRAL] 611858
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure. My name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, that's
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] OK. And how much is the total charge of the claim?
[CUSTOMER][NEUTRAL] $3750.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if I can find this one. For a future, you can check claim status online through our website at [PII] and that's just optional, OK? One moment.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, to make sure this is the policy, um, do you mind providing me the procedure code?
[CUSTOMER][NEUTRAL] So what's the procedure code?
[AGENT][NEUTRAL] Is it for DME?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, it looks like we have processed this many, many times. 12344 times. Um.
[AGENT][NEUTRAL] I'm gonna go ahead and give you the most recent one because it was denied as the original one. So, um it looks like um we processed the claim last on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied. The denial reason is that the definition of durable equipment or DME under the policy contract, uh, the service, um, that you're trying to collect for are not covered under this plan.
[CUSTOMER][NEUTRAL] So, so the specific procedure that you have is not covered, right? That is why isn't it?
[AGENT][NEGATIVE] So they do not.
[AGENT][NEGATIVE] Correct, it is not covered under the member's plan. 84239 is not covered.
[CUSTOMER][NEUTRAL] So, can you help me if it's covered in the pharmacy, members pharmacy plan?
[CUSTOMER][NEUTRAL] For any other plan?
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] I'm not really understanding, but you said that you want to know what is cover?
[CUSTOMER][NEUTRAL] Uh, no, I'm asking that, uh, can you please help me to check if it is covered under members pharmacy plan?
[AGENT][NEUTRAL] It is not covered under the member's plan. A 4239 is not covered under the member's plan.
[CUSTOMER][NEUTRAL] OK just allow me one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh, can you help me to check if you guys have paid for the same number, uh, before?
[AGENT][NEUTRAL] That code is not payable. Um, let me go ahead and.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] Missing call, what I can do um is have a claim specialist give you a call back to discuss this claim with you because, um, I can only give you information about the claim that I'm looking at which is the data service that you provided to me, and that is the denial reason on that claim. So I'm giving you the information of the explanation of benefits.
[AGENT][NEUTRAL] But if you need more detailed information I can get a claims specialist to give you a call back in 24 hours. Do you want me to do that?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] OK, uh, you need the, the contact number.
[AGENT][NEUTRAL] OK. So, um, can they call you back at the same number that you provided to me or you have a different number that they need to call?
[CUSTOMER][NEUTRAL] Phone number.
[AGENT][NEUTRAL] Same number. So they're gonna call back [PII].
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] OK. It is [PII].
[AGENT][NEUTRAL] Let me repeat that one more time.
[AGENT][NEUTRAL] Can you repeat that one more time? I didn't get that missing.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] Uh yes. Is that correct?
[AGENT][NEUTRAL] OK. Do you have an extension or anything that they need to ask for or you, this is your direct line?
[CUSTOMER][NEUTRAL] Mm this is about the.
[CUSTOMER][NEUTRAL] And, uh, can you help me with the call.
[AGENT][NEUTRAL] OK, we have a really bad connection. There's a lot of noise. Um, I think you said you need a reference number, correct?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name and today's date if you will.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and, uh, I want to confirm one more, one more thing, uh, like, can we call, uh, to the member regarding this claim that we can confirm it to directly from the number that, um.
[AGENT][NEUTRAL] Is there anything else?
[CUSTOMER][NEUTRAL] If it is covered or not.
[CUSTOMER][NEUTRAL] And if the insurance will be paid for this uh procedure code or not. So can you come directly to the number for this?
[AGENT][NEUTRAL] I'm sorry, can we what to the number?
[CUSTOMER][NEUTRAL] I'm just asking like, can we connect directly to the number regarding this claim?
[AGENT][NEGATIVE] I still cannot understand what you're saying that there's a lot of noise in the back and it's not, I cannot hear what you're saying. I hear member, I hear, can I, um, but I don't, I don't understand what you're saying between.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'm asking that, uh, I'm I audible now?
[AGENT][NEUTRAL] Go ahead with your question and I can tell you if I heard it or not.
[CUSTOMER][NEUTRAL] OK. So I'm asking that can we uh directly connect with the member regarding this claim? Can we um ask directly to the member if this uh procedure code is covered or not?
[CUSTOMER][NEUTRAL] Or if it is previously paid or not.
[AGENT][NEUTRAL] That's not something I can answer. We're just a secondary policy and um we just process the claim for this date of service for this claim. Um, so, um, it's not something that I can tell you to call, not to call to check benefits with, I cannot tell you what to do.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much for helping and uh have a nice day. Thank you.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] OK, well, thank you for calling APL. Have a good day. Bye bye.
[CUSTOMER][NEUTRAL] Yeah, go back.
[AGENT][NEUTRAL] Mm.