AccountId: 011433970860
ContactId: 89b3f0e3-a3a7-497d-89e2-d0e5b0dae6e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356290 ms
Total Talk Time (AGENT): 93199 ms
Total Talk Time (CUSTOMER): 146674 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/89b3f0e3-a3a7-497d-89e2-d0e5b0dae6e1_20250402T19:43_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling on a recorded point security. I have a question of a claim.
[AGENT][POSITIVE] I'd be happy to assist with the claim today [PII] if I can get a good call back number for you.
[CUSTOMER][POSITIVE] Yes, of course. Give me just one second.
[CUSTOMER][NEUTRAL] The callback number is going to be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number, give me just one second.
[CUSTOMER][NEUTRAL] Hello, this is [PII]. How are you doing today? It's going to be 02137793.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's going to be [PII] and the date of birth it's going to be [PII].
[AGENT][NEUTRAL] And what's the um data service for the claim?
[CUSTOMER][NEUTRAL] The service of the claim is going to be 12-5-2024.
[AGENT][NEUTRAL] OK, what's your tax ID?
[CUSTOMER][NEUTRAL] The tax ID is going to be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, now I do show we received two different claims from that tax ID for that data service. What's the CPT code you're looking at for?
[CUSTOMER][NEUTRAL] Oh yeah, give me just one second. So the specific code that I have here is going to be [PII].
[AGENT][NEUTRAL] OK, I'm showing that claim denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK. Give me just one moment.
[CUSTOMER][NEUTRAL] Because the thing that happened is that at this moment we have like no response of the American public life but you're mentioning that it's not covering, right?
[AGENT][NEUTRAL] Um, that's correct. I'm showing that um, the claim was denied on [PII].
[CUSTOMER][NEUTRAL] OK, I see. Well, in this case, um.
[CUSTOMER][NEUTRAL] If it was denied but we do not have received the information, do you think that the best should be like either um defer the claim until we receive the denial or bill the patient directly?
[AGENT][NEUTRAL] Well, it's not covered so you're gonna have to end up billing them anyway.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, wonderful. I'm, uh, let me ask you something real quick. I also have other claims by the same reason that is just denying like the copay and there's no response. So would you think that it's also because of the same reason?
[AGENT][NEUTRAL] I would need to see each claim.
[AGENT][NEUTRAL] Pull up each claim.
[CUSTOMER][NEUTRAL] Mm OK. OK, I see.
[CUSTOMER][NEUTRAL] Mhm. OK. Well, if you like, uh, can you assist me with another one?
[AGENT][NEUTRAL] Sure, one moment.
[AGENT][NEUTRAL] Is it for the same person or a different person?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, it's going to be for a different person.
[AGENT][NEUTRAL] Alright, and what's that policy number?
[CUSTOMER][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] This one is going to be 02042414.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's going to be [PII], and the date of birth is going to be [PII].
[AGENT][NEUTRAL] And what's the date of service for the claim?
[CUSTOMER][NEUTRAL] The date of service for this claim, it's going to be, give me just one second.
[CUSTOMER][NEUTRAL] It's going to be 12-9-2024.
[AGENT][NEUTRAL] And the tax ID?
[CUSTOMER][NEUTRAL] The tax ID is going to be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's the CPT code because we have.
[AGENT][NEUTRAL] Two different
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh no, it's the same. I'm sorry so I'm showing the claim denied um.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][POSITIVE] Mhm. Don't worry.
[AGENT][NEUTRAL] The claim denied for uh.
[AGENT][NEGATIVE] Not, um, there was no active coverage at the time of service. It looks like this policy lapsed [PII].
[CUSTOMER][NEUTRAL] Oh OK, OK. So let me just confirm this real quick. So,
[CUSTOMER][NEUTRAL] The service for this was current until June, right?
[AGENT][NEUTRAL] Their coverage ended [PII]. The date of service is [PII]. We denied the claim because there was no active coverage at the time of service, and then when you sent the claim the second time we denied it as a duplicate, so you'll need to bill the patient. They didn't have coverage with us on [PII].
[CUSTOMER][NEUTRAL] Of [PII] you mentioned?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, I understand. OK, wonderful. That's all the information I need for the moment. Uh, do you have a reference number for me perhaps?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call.
[CUSTOMER][POSITIVE] OK, well, thank you very much for all this information. Hope you have an excellent day. Goodbye.
[AGENT][POSITIVE] Thank you for calling APL have a good day.