AccountId: 011433970860
ContactId: 778209b2-07b4-44e3-b92c-c7cd35137642
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 535289 ms
Total Talk Time (AGENT): 210121 ms
Total Talk Time (CUSTOMER): 183460 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/778209b2-07b4-44e3-b92c-c7cd35137642_20250224T13:26_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] My name is [PII]. Last name is [PII].
[AGENT][NEUTRAL] What is your first name again? I'm sorry, I did not understand you.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Hi [PII], and how can I help you today?
[CUSTOMER][NEUTRAL] I need help regarding a claim which got denied for non-covered charges.
[AGENT][NEUTRAL] OK, so you have a question regarding a denial on a claim, is that correct?
[CUSTOMER][POSITIVE] And that is right.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And what is your callback number please, [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] With extension [PII].
[CUSTOMER][NEUTRAL] I um.
[AGENT][NEUTRAL] Thank you, and the patient's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Oh, OK. The patient policy number is 024.
[CUSTOMER][NEUTRAL] 96908.
[CUSTOMER][NEUTRAL] You go
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] What's the
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] The patient first name is spelled as in [PII] and the last name is spelled as in [PII] and the middle name is spelled as in [PII] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And the date of service and total bill amount that you're calling in regards to today, [PII]?
[CUSTOMER][NEUTRAL] OK. The date of service is [PII] with the bill amount of, just give me a moment, please.
[AGENT][NEUTRAL] I'm sorry. You said
[CUSTOMER][NEUTRAL] 500, uh uh 500, sir.
[CUSTOMER][NEUTRAL] [PII] with the bill amount of $570.89.
[AGENT][NEUTRAL] And again data services 1024-2024.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] No, it's uh [PII].
[CUSTOMER][NEUTRAL] 4 only.
[AGENT][NEUTRAL] 1004.
[CUSTOMER][NEUTRAL] 044.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, let's do that again. What is the month?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 04
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] For $570.89.
[CUSTOMER][NEUTRAL] No, the bill amount is $570 570 and 89 cents.
[AGENT][NEUTRAL] That is what I said, yes, ma'am. And what is the claim number you have?
[CUSTOMER][NEUTRAL] Uh, previously, the claim is not submitted, uh, that's why we don't have the claim number with me.
[AGENT][NEUTRAL] OK, are you checking to see if it was received or the reason for the denial?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Uh, the first, uh, of all, uh, the claim is, uh, there's no claim on file. That's why we submitted claim by our mailing address.
[CUSTOMER][NEUTRAL] And after that, we get the denial of non-covered charges.
[AGENT][NEUTRAL] OK, so yes ma'am. What is the claim number that you received stating it was non cover charges?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just give me a moment. Let me check the UV from your side.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just hold for a while.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], I have the claim number. I thought that you had that meeting clarification on the denial.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I don't have the claim number.
[AGENT][NEUTRAL] The claim was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there was a benefit paid in the amount of $481.11.
[CUSTOMER][NEUTRAL] my
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for procedure code 8703.
[AGENT][NEUTRAL] OK, what's the rest of the code 8703 and what's the last number?
[CUSTOMER][NEUTRAL] 8.
[AGENT][NEUTRAL] Mhm. OK. So that claim was denied.
[AGENT][NEGATIVE] And it states this item it does not meet the definition of durable medical equipment under the policy contract. Therefore, we are unable to provide benefits for this charge.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Durable medical equipment is medical equipment that can withstand repeated use and is not disposable and is used to serve a medical purpose with respect to treatment of an inpatient.
[AGENT][NEUTRAL] Cover charge or outpatient cover charge if applicable, and is not useful to a person in place of a sickness or injury and it's appropriate for use and then is primarily reused within the home and is not implantable within the body and is covered under the other medical plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Is that other provider is willing uh this vehicle?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Like, uh, for 87038. Is, is there a different uh providers willing this procedure code for this patient?
[AGENT][NEUTRAL] That is not covered under this patient's policy, this supplemental policy with APL.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] This was airport?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The code is not a covered procedure or covered under this supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, can we, uh, submit an
[AGENT][NEUTRAL] And you need a copy of this explanation of it. If you need a copy of this, you may print that.
[CUSTOMER][NEUTRAL] I, we have the, we
[AGENT][NEUTRAL] Can I please uh [PII], can I please finish giving you my information?
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] I'm extremely sorry, your voice is breaking in between.
[AGENT][NEUTRAL] You said that you
[AGENT][NEUTRAL] OK, you said that you did not have the explanation of benefits with the remarks.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] If you need a copy of that, [PII], you may print it by going to our portal at [PII]. Now that you have the claim number and you should be able to print a copy of that explanation of benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for your information. Can I have the call reference for this one?
[AGENT][NEUTRAL] Yes ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] And your good name, please?
[AGENT][NEUTRAL] Again, my name is [PII], spelled [PII]
[CUSTOMER][POSITIVE] OK. Thank you so much for your precious time and information. Hope you have a wonderful day.
[AGENT][NEUTRAL] You're welcome, [PII].
[AGENT][POSITIVE] Yes, ma'am. I hope you have a very nice day too, and thank you again for calling APL.