AccountId: 011433970860
ContactId: 75fd443c-8479-4a82-a78e-20cabf7dc1d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1131079 ms
Total Talk Time (AGENT): 232710 ms
Total Talk Time (CUSTOMER): 187596 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/75fd443c-8479-4a82-a78e-20cabf7dc1d9_20250226T15:17_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office. This call is regarding clients. Could you be able to assist me?
[AGENT][NEUTRAL] OK, sure. I can assist you with claims, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] One moment, I got a new number. I'll give you that.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And could you please spell your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[AGENT][NEUTRAL] May I have the patient's policy number?
[CUSTOMER][NEUTRAL] That's going to be 016.
[CUSTOMER][NEUTRAL] 44021.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] So here the patient name is going to be [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, the date of service is actually [PII] for $993.18.
[AGENT][NEUTRAL] OK, and that's [PII].
[AGENT][NEUTRAL] One moment
[AGENT][NEUTRAL] OK, let me put this EP.
[AGENT][NEUTRAL] And for the future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] I'm waiting on the EOB to pull up one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We process the claim on [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is that the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] And services are provided in doctor's office.
[AGENT][NEUTRAL] not covered, not covered in the doctor's office or clinic.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Is, is this because of the patient's plan or may I know what is the reason for the non-COVID? I can understand that.
[AGENT][NEUTRAL] Yes, it's basically
[CUSTOMER][NEUTRAL] But it's, it is, what is the cost so.
[AGENT][NEUTRAL] It is based on the member's plans.
[AGENT][NEUTRAL] So it's not covered under the member's plan.
[CUSTOMER][NEUTRAL] OK, members plan.
[CUSTOMER][NEUTRAL] All right, one moment please.
[AGENT][NEUTRAL] Yeah sure.
[CUSTOMER][NEUTRAL] May I know the plan type and plan name?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Major medical.
[AGENT][NEUTRAL] No, this is a secondary, secondary supplemental plan to the major medical, so it's a secondary policy.
[CUSTOMER][NEUTRAL] Which means
[CUSTOMER][NEUTRAL] OK. It is, oh I forgot to type the secondary, uh, that's the problem. Secondary supplement plan to the major medical.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, um, are we allowed to bill patient for this one?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement on the remaining of the claim, and it's not payable under this policy.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK, um, before I move on to the next one, do you have any call reference number for this one?
[AGENT][NEUTRAL] No, we don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] All right, sir. So shall move on to the next one?
[AGENT][NEUTRAL] One moment, let me make a note on this one and you don't need any other information on this one.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And what's the next
[CUSTOMER][NEUTRAL] Yeah, uh, one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the next policy number.
[CUSTOMER][NEUTRAL] Um, I'll give you that in a moment.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's going to be
[CUSTOMER][NEUTRAL] 1356244
[CUSTOMER][NEUTRAL] You want me to repeat?
[AGENT][POSITIVE] it's fine thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][POSITIVE] Yep, I'll give you that.
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] What's stuck with the system. It's [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yup. Um, the date of service is [PII], [PII]. And the total charge is $2830.06.
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] Let me pull this up.
[AGENT][NEUTRAL] Alright, so this one was processed on, on [PII] and it was denied um stating that the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEGATIVE] It is also denied for the same reason.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, and, uh, if you don't mind, I have a claim number here. It is 3555122. And that one actually got denied as a duplicate claim. May I know the claim process the return for the one that was duplicate?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, for the original one, you mean?
[CUSTOMER][NEUTRAL] Uh, the duplicate one.
[AGENT][NEUTRAL] Oh, the duplicate 11 moment, let me pull this.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] The duplicate one was processed on [PII].
[AGENT][NEUTRAL] Under that claim number you just provided the 355122.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know the claim number for the original one?
[AGENT][NEUTRAL] Sure. That's um 353-313-3.
[CUSTOMER][NEUTRAL] OK. Uh, let's go to the last time that I have.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] You make a note
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's the last policy?
[CUSTOMER][NEUTRAL] 982
[CUSTOMER][NEUTRAL] 078.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So here the patient name is going to be [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] What's the date of service and the amount on the claim.
[CUSTOMER][NEUTRAL] So the date of service is actually [PII] and the total charge is $443.48.
[CUSTOMER][NEUTRAL] Give me one moment please.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it looks like we processed this one twice as well.
[AGENT][NEUTRAL] Um, one was denied as a duplicate, the other one is denied as office visits are not covered by the policy.
[AGENT][NEUTRAL] Which one do you need?
[CUSTOMER][NEUTRAL] That's the institution.
[CUSTOMER][NEUTRAL] So, first of all, I would like to know the
[CUSTOMER][NEUTRAL] Mm, uh, original claim process date and the claim number.
[AGENT][NEUTRAL] The original one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Are you not feeling well?
[AGENT][NEGATIVE] Yes, I'm not feeling well.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Take some hot water.
[AGENT][NEUTRAL] Yeah, probably need to put some honey or ginger or something.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 78.
[AGENT][POSITIVE] Thank you.
[AGENT][NEGATIVE] The original one was passed on.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me go back again. I don't think I got that.
[AGENT][NEUTRAL] 3578.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Here. OK, here we go.
[AGENT][NEUTRAL] Alright, the original claim was processed [PII].
[CUSTOMER][NEUTRAL] Claim number, please?
[AGENT][NEUTRAL] That is 353-357-8.
[CUSTOMER][NEUTRAL] 353-3578. All right.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][POSITIVE] All right, so that's all for today. Thank you so much for your kind assistance and I wish you have a great day and stay healthy. Bye-bye. Take care.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you as well and thank you for calling APL. Bye bye.