AccountId: 011433970860
ContactId: 72027aff-8bf0-4693-be75-5d5b42c6fde9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385339 ms
Total Talk Time (AGENT): 159964 ms
Total Talk Time (CUSTOMER): 93168 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/72027aff-8bf0-4693-be75-5d5b42c6fde9_20250103T19:18_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider's office and looking on a claim status. Can you help me?
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with the claim status, [PII]. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] 1
[AGENT][NEUTRAL] OK, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 02519600.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Number 12024 for $377 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And it's 377.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] Hold on one moment, I'm just locating the claim.
[CUSTOMER][NEUTRAL] OK, fine.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Integrated dermatology of South Miami.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 4 51 9.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider.
[AGENT][NEUTRAL] A total of $73.74.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And did you need the check information?
[CUSTOMER][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] So it was a single check, um, I'm pulling it up now. It was issued on [PII] and of course it's still outstanding.
[AGENT][NEUTRAL] It was mailed to [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was mailed to [PII].
[AGENT][NEUTRAL] In [PII]?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And the check number?
[AGENT][NEUTRAL] The check number is 2020017.
[CUSTOMER][NEUTRAL] 2020017 and the claim number 3544519.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And uh what about the procedure code 99214?
[AGENT][NEUTRAL] Um, hold on one moment. Let me go back to the claim.
[AGENT][NEUTRAL] 99214. Hold on one moment.
[AGENT][NEGATIVE] It was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] May I know the patient plan name?
[AGENT][NEUTRAL] This is their Medlink supplemental gap insurance policy?
[CUSTOMER][NEUTRAL] OK. So the patient responsibility?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not the major medical. Um, if there is an outstanding balance, it would be between primary and the provider, um, to determine.
[CUSTOMER][NEUTRAL] OK. And uh it you be has been sent to the provider's office with the check.
[AGENT][NEUTRAL] Yes, but it was just sent last, the day after [PII], so.
[AGENT][NEUTRAL] Um, last Thursday it was sent. Well, at least a week, it's coming in the US mail, so.
[CUSTOMER][NEUTRAL] How many days we need to allow?
[AGENT][NEUTRAL] From [PII].
[AGENT][NEUTRAL] So at least a week anytime is something in the mail.
[CUSTOMER][NEUTRAL] OK. And can you also fax the EOB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do I need to put attention [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, so I'll go ahead and send this explanation of benefits over to you now. Was there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah. May I know when we will receive the EOB which you fax, no?
[AGENT][NEUTRAL] Um, I mean, I'm faxing it to you now, so at least an hour by end of day at the most.
[CUSTOMER][NEUTRAL] OK. Can you spell your name for me?
[AGENT][NEUTRAL] Yes, my name is [PII] The [PII].
[CUSTOMER][NEUTRAL] Thank you. And the call reference number?
[AGENT][NEUTRAL] Um, there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK. OK, [PII], thank you so much for the information you provided me on this call.
[AGENT][NEUTRAL] You're welcome, [PII].
[AGENT][NEUTRAL] Was there anything else I can help with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, that's all for today. Thank you for asking.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great weekend and [PII].
[CUSTOMER][POSITIVE] Yeah, you too as well. Thank you. [PII].
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.