AccountId: 011433970860
ContactId: 782fd1c4-a6ba-44e5-afb0-a511acdeb818
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515440 ms
Total Talk Time (AGENT): 204619 ms
Total Talk Time (CUSTOMER): 262541 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/782fd1c4-a6ba-44e5-afb0-a511acdeb818_20250306T19:43_UTC.wav
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[CUSTOMER][NEGATIVE] But according to this it's, it's not.
[AGENT][NEUTRAL] Calling A. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Hey [PII], good morning. My name is [PII]. I'm an agent with you. How are you today?
[AGENT][POSITIVE] I'm good this afternoon. How are you doing?
[CUSTOMER][POSITIVE] I'm, I'm gonna be doing better after we get done talking here, so I'm going crazy with this plane.
[AGENT][POSITIVE] All right. Well, how can I help you? Yes, sir, how can I help you?
[CUSTOMER][NEUTRAL] Uh, I'm wondering if you, if I'm wondering if you could pull a claim number up for me.
[AGENT][NEUTRAL] OK, first off, so you have a question regarding a claim that you filed for an insured?
[CUSTOMER][NEUTRAL] Yeah, he's sitting here with me.
[AGENT][NEUTRAL] OK, yes, sir. And what is your callback number, please, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number that you're calling about?
[CUSTOMER][NEUTRAL] 02.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 3373
[CUSTOMER][NEUTRAL] 07.
[AGENT][NEUTRAL] OK, thank you. So give me a moment please to get that policy information pulled up and then I will have to verify.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I do have a claim number for you.
[AGENT][NEUTRAL] Yes, sir. I'll have to verify.
[CUSTOMER][NEUTRAL] I do have a claim number for you if that.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Yes sir, it will in just a moment, but first I'll have to verify some other information first and then I can get that from you. So any information that I do provide today would be a verification of benefits and not a guarantee of payment. So first off, what is the insured's name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], date of birth, uh [PII].
[AGENT][NEUTRAL] OK, thank you, and then the group name?
[CUSTOMER][NEUTRAL] Uh, specialty host.
[AGENT][NEUTRAL] That he's with
[AGENT][NEUTRAL] OK, thank you. And then your email address please, [PII].
[CUSTOMER][NEUTRAL] Mine [PII] my name with a period between my first and last.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and what is the specific date of service and total bill amount?
[AGENT][NEUTRAL] For decline.
[CUSTOMER][NEUTRAL] That I don't know, but I, but I can give you a that's what that's where our problems at we have a denial of a claim and all I have is a claim number.
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] Will that help you?
[AGENT][NEUTRAL] OK, so first off, you said that Mr. um
[AGENT][NEUTRAL] That the insured is there with you, is that correct?
[CUSTOMER][NEUTRAL] He's sitting right here, yes, I'm, you're on speaker with him.
[AGENT][NEUTRAL] OK, perfect. Hi, [PII]. This is [PII] with APL. How are you today?
[CUSTOMER][POSITIVE] Good how about yourself?
[AGENT][NEUTRAL] I'm doing fine, thank you. So, did you file this claim? It appears that you filed this claim with us. Is that correct?
[CUSTOMER][POSITIVE] He filed it with me and I'm the one that send it in, yes.
[AGENT][NEUTRAL] OK, so do you, uh, yes, sir. I understand, but I'm just trying to verify uh as far as who submitted this information.
[CUSTOMER][NEUTRAL] I'm [PII]. I'm the agent.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK, so do you authorize me to speak to [PII] regarding this [PII] for this one phone call?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you very much. OK, so there's only one claim on file if you want to go ahead and give me that claim number you can to make sure that we are looking at this correct information.
[CUSTOMER][NEUTRAL] 355
[CUSTOMER][NEUTRAL] 572 5.
[AGENT][NEUTRAL] OK, thank you. So it appears that this is for 2 different dates of service.
[CUSTOMER][NEUTRAL] OK, then it is the same claim, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, 1010 10 318.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Uh-huh, that's it.
[CUSTOMER][NEUTRAL] 1031 8.
[AGENT][NEUTRAL] Those are the
[AGENT][NEUTRAL] Those are the only two dates of service that I see.
[CUSTOMER][NEUTRAL] Well, I have one here for 88124. You don't have that?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] That's gonna be filed and we can get that.
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] 182 15 3 21 and 4.
[CUSTOMER][NEUTRAL] 44 of 24.
[AGENT][NEUTRAL] The only two dates of service on this claim that we have received information on was for [PII] and [PII].
[CUSTOMER][NEUTRAL] But none of these have been filed. I know I I know I send them in. We did we fill them out on all of these? Yeah, well, I thought so. That's what I thought. Well, apparently we gotta do it again. OK, OK, alright, so.
[AGENT][NEGATIVE] Now, on the [PII] data service that was denied because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and we understand that.
[AGENT][NEUTRAL] And they, oh, OK.
[CUSTOMER][NEUTRAL] Go go ahead.
[AGENT][NEUTRAL] And then the [PII] data service, it was also denied because the service is not covered when performed in a doctor's office or clinic, but as of now, yes, so that's the only two dates of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On file for you, [PII].
[CUSTOMER][NEUTRAL] That was this claim here. Hold on a minute. What did you have done on these two dates? There services on the [PII].
[CUSTOMER][NEUTRAL] And how much does he owe on those?
[CUSTOMER][NEUTRAL] That's like 19 at the doctor charge.
[CUSTOMER][NEUTRAL] So 08 is gonna be 109. That one is gonna be the 30, I think. So we only, we only have 10809 that we gotta worry about with, with it being done, is that correct? I see that one.
[CUSTOMER][NEUTRAL] Yeah, this is 81. So, OK, so what you've got to do, bear, bear with me, [PII] here just a minute please. Yeah, I didn't know.
[CUSTOMER][NEUTRAL] OK, then you're gonna have to go back and you're gonna have to go back and tell the doctor.
[AGENT][NEUTRAL] Sure, yes. Mhm.
[CUSTOMER][NEUTRAL] Why did.
[CUSTOMER][NEGATIVE] Don't question him as to why he did it in the office and you start getting everybody pissed off and everybody defensive.
[CUSTOMER][NEGATIVE] Just tell them that your insurance company is not gonna pay it because it was done in an office. It's uh [PII], can you tell me why this procedure is not covered in the doctor's office?
[AGENT][NEUTRAL] Let's see, let me look at the benefits on this policy because on this policy, it does not have, yes, it does not have benefits for office treatment or office visits.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] But this was a procedure when correct I think what was done in the in the office that you're building being built 108.
[CUSTOMER][NEUTRAL] Uh, therapy, therapeutic, yeah, therapeutic services done in the office. Would that not be that should be covered under the office co-pay, shouldn't it?
[AGENT][NEUTRAL] Correct. And that, no.
[AGENT][NEUTRAL] No, sir, not under this supplemental policy.
[CUSTOMER][NEUTRAL] No, under the medical policy that should be covered under the office copay if it's done in the doctor's office, am I not correct?
[AGENT][NEUTRAL] Now that I'm not sure of. You would actually have to just speak to the primary insurance, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But on the supplemental policy, office visits and treatments done in the office are not covered.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm aware of that.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] That these have not been filed.
[CUSTOMER][NEUTRAL] You, you, you have another dates correct? What, what do you have with that that was 81.
[CUSTOMER][NEUTRAL] [PII], where is the 81?
[CUSTOMER][NEUTRAL] That's he he owes how much on that 109. They're all 109 minus the 30.
[CUSTOMER][NEUTRAL] And we don't have anything else then they do have they do have all the claims that I filed is what you're saying alright, [PII], I don't think there's anything else we can do. I think we, we, uh, he's gotta go back to his doctor on this. I just needed to make sure of what why the denials were coming in.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes, sure. I totally understand. So is there anything else that I could help you with this afternoon?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][POSITIVE] No [PII], I appreciate your time and uh you have a great rest of the day.
[AGENT][POSITIVE] Oh, I hope you all do too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] OK, [PII], bye bye.
[AGENT][POSITIVE] Um, bye-bye. Thank you.
[CUSTOMER][NEUTRAL] But this is