AccountId: 011433970860
ContactId: 761f42e2-31b2-44a4-ac4e-08124c42fbfc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335790 ms
Total Talk Time (AGENT): 137898 ms
Total Talk Time (CUSTOMER): 94783 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/761f42e2-31b2-44a4-ac4e-08124c42fbfc_20250206T18:52_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of provider's office regarding claims.
[AGENT][POSITIVE] OK, I'll be more than happy to assist you with the claim, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEGATIVE] Two claims for the same member with different date of service.
[AGENT][NEUTRAL] All right, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] with an extension of [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02319989
[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] Yeah, sure.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [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 dates of service and the total bill for the claims you like me to check on?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, can you repeat the date, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] $311 even.
[AGENT][NEUTRAL] And the next day the service?
[CUSTOMER][NEUTRAL] The next date of service is [PII] for $137 even.
[AGENT][NEUTRAL] [PII] $137.
[CUSTOMER][NEUTRAL] Yes, 137.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claims?
[CUSTOMER][NEUTRAL] Individual provider?
[AGENT][NEUTRAL] The facility.
[CUSTOMER][NEUTRAL] Saint Thomas Medical Partners.
[AGENT][NEUTRAL] Thank you for that. And just again for the call, the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the first claim for you.
[CUSTOMER][NEUTRAL] And your name is spelled as [PII]. Am I right?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] So the first claim um we received on [PII].
[AGENT][NEUTRAL] And that claim number is 354.
[AGENT][NEUTRAL] 673 0.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As this is not a covered loss under the um under the plan, therefore, no amount is payable for this expense.
[CUSTOMER][NEUTRAL] This is not a covered benefit under the patient's plan, am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] May I know why it is not a covered benefit?
[AGENT][NEGATIVE] Why it's not because it's not a service that's listed on the, on the list of covered services. It's just not a covered service.
[CUSTOMER][NEUTRAL] It is excluded under the patient's plan, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK. This will be the patient responsibility. Am I right?
[AGENT][NEUTRAL] We don't determine patient responsibility because we're not the major medical, we're the secondary.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But this is not a cover benefit under the patient's plan. It is an excluded benefit. Am I right?
[AGENT][NEUTRAL] Yes, correct. It's not covered on the patient's policy.
[CUSTOMER][NEUTRAL] Office visit co-pay is not covered or what?
[AGENT][NEUTRAL] Are you asking what was done for your claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you, do you need the procedure code? Like, I don't understand.
[CUSTOMER][NEUTRAL] No, I have the procedure code. Initially it was billed to primary and it has processed a co-pay amount of $40.
[CUSTOMER][NEGATIVE] So this was billed to American Public Life Insurance Company and has been denied.
[CUSTOMER][NEUTRAL] What is not a cover benefit because this is generally an office visit, right?
[AGENT][NEUTRAL] OK. So the primary insurance and the secondary insurance has their own benefits. So just because it's covered and paid under primary does not mean that it's covered and paid for secondary. For the secondary policy, procedure code 99204 is not a covered code.
[AGENT][NEUTRAL] It's not a covered service.
[CUSTOMER][NEUTRAL] OK, fine.
[CUSTOMER][NEUTRAL] OK, and same applies for the date of birth.
[AGENT][NEUTRAL] That's also the same.
[AGENT][NEUTRAL] That's correct. Did you need that claim information?
[CUSTOMER][NEUTRAL] That's OK. Can I get the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, which again is [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you. It was nice talking to you. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thanks for calling APL. Bye-bye.