AccountId: 011433970860
ContactId: 8e844717-ef47-4026-941f-68ea1139240f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1327449 ms
Total Talk Time (AGENT): 360626 ms
Total Talk Time (CUSTOMER): 455090 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/8e844717-ef47-4026-941f-68ea1139240f_20250603T19:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[AGENT][POSITIVE] Thank you for calling. This is. How can I help you?
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Skin and Cancer Associates. How are you doing today?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] I'm also good, doing good. Thank you for asking.
[CUSTOMER][NEUTRAL] And I'm calling to check the claim status.
[AGENT][NEUTRAL] Um, yes, sir. I can assist you with claim status. Could I get a good callback number just in case we're disconnected?
[CUSTOMER][POSITIVE] Yes, my good callback number is [PII] and it is a direct line.
[AGENT][NEUTRAL] Thank you. And now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Yes, before I proceed with that, please be informed that this call has been recorded for quality and training purpose. Would you like us to continue the recording?
[AGENT][POSITIVE] Yes, we can continue.
[CUSTOMER][NEUTRAL] Yeah. Uh, and, uh,
[CUSTOMER][NEUTRAL] Member's policy number is 01252688 M as in Mary, L as in Lima and number 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes. Uh, the member's first name is?
[CUSTOMER][NEUTRAL] [PII], and the last name is [PII]. and the date of birth is [PII].
[AGENT][NEUTRAL] OK. Please repeat that policy number.
[CUSTOMER][NEUTRAL] Yeah. It is 01252688 M as in Mary, L as in Lima, and number 8.
[AGENT][NEUTRAL] OK, different member is coming up under that policy number.
[AGENT][NEUTRAL] Um, do you have the member's social?
[CUSTOMER][NEUTRAL] Different members
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, no, as per our records, we don't have the
[CUSTOMER][NEUTRAL] Medical.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] I could try to look her up by name and date of birth. Um, what's the last name?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Uh, can you once again verify that it is, uh, you may see that it is [PII]. Is that right?
[AGENT][NEUTRAL] OK. Let me get the policy number one more time.
[CUSTOMER][NEUTRAL] Yeah. It is 02152688 M as in Mary, L as in Lima, and number 8.
[AGENT][NEUTRAL] OK, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Member's first name is [PII]. It is spelled as [PII] and the last name is [PII]. It is [PII], again, [PII], I, sorry, [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] OK. Thank you. I found her in our system. Um, and what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] Also
[CUSTOMER][NEUTRAL] Yes. And the date of service is [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $277 even.
[AGENT][NEUTRAL] OK, yes, we received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] And I'm showing that this claim denied because co-pays for office visits is not covered under the policy.
[CUSTOMER][NEUTRAL] Sorry, give me one second, repeat the process date. It is [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] That's correct. Uh, it was denied because the office visits are not covered under the patient's plan.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] So, as we don't have any response on our records, can you please send out, send us the UB through our fax number?
[AGENT][NEUTRAL] Yes, I can fax you the ELB. What's your fax number, please?
[CUSTOMER][NEUTRAL] Yes, the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And to whose attention?
[CUSTOMER][NEUTRAL] Yeah, the attention would be my name, [PII], and my last name, first initial is [PII].
[AGENT][NEUTRAL] OK, so that's [PII] attentions.
[CUSTOMER][POSITIVE] Yes, that is right.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. You should receive the ELB in about 10 minutes. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Within 10 minutes.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah. OK. Thank you, E. Thank you for that. And I do also have another claims to check the status. Can you please help me out with that?
[AGENT][NEUTRAL] Um, is it for the same number?
[CUSTOMER][NEUTRAL] No, for the different member?
[AGENT][NEUTRAL] OK, yes. One moment, please. I'm waiting on my system.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thanks for your patience. I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It is 01655031, M as in Mary, L as in Lima, and number 8.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes. Member's first name is [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] and the total bill amount is $683 even.
[AGENT][NEUTRAL] OK, one moment, please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. We received this claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3,577,520.
[AGENT][NEGATIVE] And I'm showing that this claim um denied because the benefit maximum was reached.
[AGENT][NEUTRAL] Um, that's why, that's why lines number 2 and 3 denied because the policy's benefit maximum was reached on a previous claim and line 1 denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Uh, but we don't see any payments for the, the both CBTs.
[AGENT][NEUTRAL] Right. There's no payment because under this policy, let's see, we cover up to.
[AGENT][NEUTRAL] We cover up to $500 per calendar year, and the $500 maximum was reached on a previous claim, so that's why um the charges on this claim denied.
[CUSTOMER][NEUTRAL] Uh, may I get the previous date of service on which this, uh, claim got paid?
[AGENT][NEUTRAL] Um, yes, it got paid for [PII].
[CUSTOMER][NEUTRAL] It is what to
[CUSTOMER][NEUTRAL] Yes well.
[CUSTOMER][NEGATIVE] Oh, yes, it was paid on [PII]. Uh, then if the, this, this date of service is first in [PII], the, this claim must be paid now. Why that was paid on [PII]?
[AGENT][NEUTRAL] Because we received this claim, um.
[AGENT][NEUTRAL] First, we received this claim on [PII].
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Where the benefit, the claim, where the benefit maximum was reached, we received that claim on [PII].
[CUSTOMER][NEUTRAL] This claim, OK.
[AGENT][NEUTRAL] And the claim that you're calling about, um, we didn't receive that claim until.
[AGENT][NEUTRAL] What was the date of service again?
[CUSTOMER][NEUTRAL] OK. Our denied claim date of service was [PII].
[AGENT][NEUTRAL] OK. Yeah, we didn't receive that claim until [PII]. Well, [PII] is when we received it.
[CUSTOMER][NEUTRAL] OK. That's OK. I got that. Uh,
[CUSTOMER][NEGATIVE] So this was denied under the dollars, uh sorry. This was denied because of max benefits exhausted under the dollars, right? Or dollars or the units?
[AGENT][NEUTRAL] Dollars.
[CUSTOMER][NEUTRAL] Dollar. Uh, can you please once again repeat the dollar amount for which this claim was paid?
[AGENT][NEUTRAL] 500 per calendar year. Mhm. 500 per calendar year.
[CUSTOMER][NEUTRAL] CPTs were paid.
[CUSTOMER][NEUTRAL] 500, yes.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thank you for your information.
[AGENT][POSITIVE] Yeah, thank you too for calling APL. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Uh, I do also, I also have more claims to check the status. Can you please help me with that?
[AGENT][NEUTRAL] Um, I can help you with one more, one moment.
[CUSTOMER][NEUTRAL] More than one claim? OK.
[AGENT][POSITIVE] OK, I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Yeah. The next policy number is
[CUSTOMER][NEUTRAL] 944,160.
[AGENT][NEUTRAL] OK. And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, uh.
[CUSTOMER][NEUTRAL] Member's first name is Ms. [PII] and the last name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] OK. Please repeat the policy number.
[CUSTOMER][NEUTRAL] It is 944,160.
[AGENT][NEUTRAL] OK. That's 944,160.
[CUSTOMER][POSITIVE] Yes, that is right.
[AGENT][NEUTRAL] OK. A different members coming up under that policy number.
[CUSTOMER][NEUTRAL] I think it may be [PII], right?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Someone else is coming up, right?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Um, what's the last, what's the last name again? I could try to look them up by name and date of birth. Please repeat the last name.
[CUSTOMER][NEUTRAL] But they
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, it is [PII]. It is spelled as [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK. What's the first name?
[CUSTOMER][NEUTRAL] First name is, it is [PII], it is [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and please verify the date of birth.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, I found her in our system. And what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] OK, yes, we received that claim on [PII].
[AGENT][NEUTRAL] And the claim processed on [PII].
[CUSTOMER][NEUTRAL] Sorry, can you please once again repeat the process date?
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Let me get back to that screen.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And I'm showing that this claim denied because under this policy, we cover up to 4 office visits per calendar year.
[AGENT][NEUTRAL] And the benefit maximum was reached on a previous claim.
[CUSTOMER][NEUTRAL] 4 digits for the calendar year, right?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh, but we
[CUSTOMER][NEGATIVE] Uh, but we see there was no payment received for this patient.
[CUSTOMER][NEUTRAL] On our records.
[AGENT][NEUTRAL] Yeah, those office visits, uh, payments went to different providers. That's why.
[CUSTOMER][NEUTRAL] So 3, so all the 4 office visits are for the different providers?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, can I get those provider details?
[CUSTOMER][NEUTRAL] Or date of services?
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, actually, these dates of services were for other um members under the policy.
[AGENT][NEUTRAL] We only cover up to 8 office visits for the entire family, and the office visits were applied to different family members. And since it was for other members, I can't give you that information.
[AGENT][NEUTRAL] So she actually didn't have any office visits. Um, the office visits, um, were taken up by her other family members for the calendar year.
[CUSTOMER][NEUTRAL] OK. So this was, uh, this was paid for the another members under the same policy, right? The family members.
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so, uh, can I don't get this provider details for which this was paid? Can I get the details?
[AGENT][NEUTRAL] No, because that information is under different um family members. It's under different policy members.
[CUSTOMER][NEGATIVE] When it was cover paid under a different policy, then why it cannot be paid for this policy number?
[AGENT][NEUTRAL] Because you're asking for information for [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] This [PII], uh, yes.
[AGENT][NEGATIVE] Just know that we cover up to 8 office visits per family, and those visits were taken up by other family members, all 8 of them, and that's why this one denied for [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, yes, I got that point. That, uh, it, uh, which are covered under this, the same policy number or the different policy number?
[AGENT][NEUTRAL] It was the same policy number.
[CUSTOMER][NEUTRAL] Under the same policy number.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. Thank you. Yes, thank you, thank you for your information. And as we don't have any information on our records, can you please send us the UV through our fax number?
[AGENT][NEUTRAL] Um, yes, I can send you the EOB. What's your fax number?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello. Hello.
[AGENT][NEUTRAL] Yes, I'm still here. I'm waiting on my system. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, what would be the type to receive the fax?
[AGENT][NEUTRAL] You should receive it in about 10 minutes.
[CUSTOMER][NEUTRAL] Uh, thank you, Avi. Thank you for your information. And can I get this call reference for these members?
[AGENT][NEUTRAL] Um, yes, for the reference number, you can use my name and today's date.
[CUSTOMER][NEUTRAL] Yes. And your name is spelled as [PII]. It is [PII], right?
[AGENT][NEUTRAL] Yes, [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Yes. Thank you, [PII] Thank you for your information.
[AGENT][POSITIVE] OK, thank you so for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Thank you. Bye for now and have a nice day.
[AGENT][POSITIVE] Thank you.