AccountId: 011433970860
ContactId: 785ed684-14af-454d-bcc0-ae3f55305b87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257869 ms
Total Talk Time (AGENT): 100457 ms
Total Talk Time (CUSTOMER): 95094 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/785ed684-14af-454d-bcc0-ae3f55305b87_20250204T14:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII], calling you from provider's office to check up on claim status. May I know your initial and the last name?
[AGENT][NEUTRAL] Yes, it is [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] You're welcome, [PII], and what is your callback number if we are disconnected please?
[CUSTOMER][NEUTRAL] Yeah, sure. The callback number [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, thank you, [PII]. What is that policy number please for the patient?
[CUSTOMER][NEUTRAL] Yes, it is 019-41775. M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] OK, thank you very much, [PII], one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Thank you. And let me just repeat that to you just to confirm I have that correct. I have it as 01941775 ML8.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient name, [PII], on the date of birth, [PII].
[AGENT][POSITIVE] OK, thank you very much for the verification process of the member and again you call for claim status I can assist you. And [PII], what is the date of service and the total charge amount please?
[CUSTOMER][NEUTRAL] Yes, date of service. [PII], total charge amount $194 even.
[AGENT][POSITIVE] OK, thank you so much. One moment, please.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Look at you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, thank you for your patience and as always you can check claim status by visiting our secure portal at [PII]. There you'll be able to obtain an EOB if you need one as well. Now it shows that we did receive the claim and it denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sorry, when did you receive the claim?
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][NEUTRAL] Uh, denied on.
[AGENT][NEUTRAL] The night on [PII].
[CUSTOMER][NEUTRAL] [PII]. Is it right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] It is denied for office visit not covered by policy. Is it right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK. May, so what we need to do to get the claim processed and paid?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] APL does not determine patients responsibility, and this is a service that is not covered by the patient's policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Services not covered by patient policy.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] May I know the patient plan?
[AGENT][NEUTRAL] This is a supplemental medical policy.
[CUSTOMER][NEUTRAL] Supplemental medical policy.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So, it is the patient responsibility, is it right?
[AGENT][NEUTRAL] APL does not determine patients' responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So service is not covered by patient policy plan. Is it, is it right?
[AGENT][NEUTRAL] That is correct, and again, APL does not determine patient's responsibility.
[CUSTOMER][NEUTRAL] OK. So what we need to do to get the claim processed and pay?
[AGENT][NEUTRAL] This is a service that is not covered by the patient's policy.
[CUSTOMER][NEUTRAL] To to send the claim or the character claim time limit.
[AGENT][NEUTRAL] There's no timely filing limit to submit a claim.
[CUSTOMER][NEUTRAL] OK. Can I get the call reference number?
[AGENT][NEUTRAL] We do not provide call reference numbers. You can use my name and today's date. [PII], anything else I can assist you with, please?
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][POSITIVE] [PII] estate. OK, thank you so much for the patient assistance. Have a great day.
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Mm thank you for calling APL. Have a good day. bye.
[CUSTOMER][NEUTRAL] Bye.