AccountId: 011433970860
ContactId: 90e8395f-c5df-43dd-ab05-b7d1f80777e0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384040 ms
Total Talk Time (AGENT): 199679 ms
Total Talk Time (CUSTOMER): 95541 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/90e8395f-c5df-43dd-ab05-b7d1f80777e0_20250610T19:30_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], I'm calling about a claim that was denied.
[AGENT][NEUTRAL] OK. Are you needing the reason for the denial? I mean, how can I help you today? OK, you need to get the reason? Yes, ma'am, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII]. Last initial is [PII] calling with the Southeast Physicians Network for um physician [PII].
[AGENT][NEUTRAL] OK, thank you, [PII] and what is your call back number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] 02592674
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information that I do provide for you, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's for [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Did I say that name right?
[AGENT][NEUTRAL] I'm not sure. Sounds good to me.
[CUSTOMER][NEUTRAL] A pork.
[AGENT][POSITIVE] That sounds good to me. Close. We're gonna call it close.
[AGENT][NEUTRAL] [PII], probably [PII].
[AGENT][NEUTRAL] But I'm guessing I'm strictly.
[CUSTOMER][NEUTRAL] OK, cause I was thinking that and then left, yeah, OK, that's unique. I never seen that one before.
[AGENT][NEUTRAL] Yes. Um, no, me either.
[AGENT][NEUTRAL] OK, so any information again that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is the data service and total bill amount?
[CUSTOMER][NEUTRAL] [PII] and it was for $444 even.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I'm so sorry. Did you say 4:44 or 4:45?
[CUSTOMER][NEUTRAL] 0 44.
[AGENT][NEUTRAL] My hearing is going this afternoon. I'm sorry.
[CUSTOMER][NEGATIVE] Uh, my phone cutting in and out. I had several people that say that they couldn't understand what I was saying.
[AGENT][NEUTRAL] Oh, I don't think that was a you though. I think that was a me.
[AGENT][NEGATIVE] I think I just didn't hear it right.
[AGENT][NEUTRAL] We're gonna give your phone a break on this one.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Alright, this one's gonna take me just a couple of minutes to look at the documents to see what I'm looking at. Do you have a claim number? I was gonna ask you that as well.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] I'm not seeing one cause sometimes when they put the remit up, they don't post it. I don't know why they do it that way, but.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh Jesus.
[AGENT][NEUTRAL] Oh, you all right?
[CUSTOMER][NEUTRAL] Just dropping everything on my desk.
[AGENT][NEUTRAL] 00, OK. So I do see that this claim was received. Um, the claim number is 359-7395.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] And there was a benefit paid on this in the amount of $50.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that was paid on single check 204.
[AGENT][NEUTRAL] 2749.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are you gonna need the receive date and the process date or just the status?
[CUSTOMER][NEUTRAL] I have the check. I see where you all pay $50 and it was adjustment of $100 but um it's leaving the patient.
[AGENT][NEUTRAL] 00, OK, OK.
[AGENT][NEUTRAL] So the remarks I.
[AGENT][NEUTRAL] Yes, I can go over the claims remarks. So under the, for the payment with this check, the maximum benefit payable for this data service has been met.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The other line items were all denied is the same for the same reason, the maximum benefit payable for this data service has been met. This is not a major medical plan.
[AGENT][NEUTRAL] This is a condemnity limited benefit plan. It's not major medical insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So with that $50 payment, that was the maximum payment.
[CUSTOMER][NEUTRAL] OK, so it makes the balance the patient.
[AGENT][NEUTRAL] Oh, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] So it would make it the patient's responsibility for the remainder.
[AGENT][NEUTRAL] We do not determine patient responsibility here at APL. That would be up to the provider, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] And can I get a um a claim number?
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I mean, not a claim number, reference number, I'm sorry.
[AGENT][NEUTRAL] I was gonna say I can repeat that uh you're gonna use my name and today's date as your call reference number and then I'm gonna give you our website where we have a portal that you should be able to use that claim number to print the EOB if you need that and the website for the portal is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. All right. Well, is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, you have a wonderful day. Thank you.
[AGENT][POSITIVE] Well, well, you're certainly welcome and I hope you have.