AccountId: 011433970860
ContactId: 9119d22b-9b40-4403-8d2f-7180b58d944c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 974460 ms
Total Talk Time (AGENT): 300487 ms
Total Talk Time (CUSTOMER): 189763 ms
Interruptions: 3
Overall Sentiment: AGENT=-0.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/9119d22b-9b40-4403-8d2f-7180b58d944c_20250505T18:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on our claim status. Could you please spell your name?
[AGENT][NEUTRAL] [PII], and can you spell yours?
[CUSTOMER][NEUTRAL] Yeah, that is [PII]
[AGENT][NEUTRAL] Thank you [PII] and what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you, and you have one claim to check status on, is that correct?
[CUSTOMER][NEGATIVE] Yes, sorry, I didn't get you.
[AGENT][NEUTRAL] Did you say that you have one claim to check status on?
[CUSTOMER][NEUTRAL] Two claims.
[AGENT][NEUTRAL] For the same patient or different patients?
[CUSTOMER][NEUTRAL] Uh, let me check that one whether it is the same or different.
[CUSTOMER][NEUTRAL] Yeah, it's the same patient.
[AGENT][NEUTRAL] OK. And what is that patient's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the policy number is
[CUSTOMER][NEUTRAL] Oh my God.
[CUSTOMER][NEUTRAL] 001851923 M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] Thank you. One moment please while I get the member's information pulled up.
[AGENT][NEUTRAL] And any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name was [PII] and the date of [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the first date of service and total bill amount please?
[CUSTOMER][NEUTRAL] The first date of service is [PII] with the total charge $424 even.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] Give me just one second, [PII]. I've got to reload some information. One moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this claim has been received more than once. The most recently received claim was denied as a duplicate. Do you need that information or the original claims information?
[CUSTOMER][NEUTRAL] Yeah, have we seen here, like the original claim was denied as so it's not covered under the patient plan, right?
[AGENT][NEUTRAL] I can, that's what I'm asking, do you need the original denial information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So yes, this service is not covered when performed in a doctor's office or clinic. That is correct.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Let me check just a moment.
[AGENT][NEUTRAL] The supplement, the members, the members supplemental plan.
[AGENT][NEGATIVE] Does not cover this.
[CUSTOMER][NEUTRAL] Member supplementary plan.
[AGENT][NEUTRAL] Yes, ma'am. I read you the remark though. The specific remark states this service.
[AGENT][NEGATIVE] Is not covered.
[AGENT][NEUTRAL] When performed in a doctor's office or clinic.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, [PII] with that remark on it now, do you have the claim number?
[AGENT][NEUTRAL] Once I give you the claim number, you can print that yourself.
[CUSTOMER][NEUTRAL] Yeah, he
[CUSTOMER][NEUTRAL] Here, I have the claim number 349-7396.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So, just for confirmation, it was denied as services not covered under the patient plan. Can I know the patient plan?
[AGENT][NEUTRAL] This is a supplemental policy called Medlink.
[CUSTOMER][NEUTRAL] Like patient plan type.
[CUSTOMER][NEUTRAL] Can you spell that?
[AGENT][NEUTRAL] Supplemental
[AGENT][NEUTRAL] And the type of policy is Medlink, M E D L I N K.
[CUSTOMER][NEGATIVE] So the CPT was billed with $424 and it was totally denied or any allowed amount for this.
[AGENT][NEUTRAL] We are not a major medical insurance company.
[CUSTOMER][NEGATIVE] No, I'm asking the line voice denial.
[AGENT][NEUTRAL] Yes, ma'am. I, I'm, yes, ma'am. I gave you, I've read you the denial remark multiple times, [PII]. Under this patient's supplemental policy, this service is not covered when performed in a doctor's office or clinic.
[AGENT][NEUTRAL] That's what I'm saying. OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. I understand that, but I'm
[CUSTOMER][NEUTRAL] Yeah, I'm sorry to interrupt. Like I was asking you about.
[CUSTOMER][NEGATIVE] Any allowed amount like line one is allowed for this and it was denied.
[AGENT][NEGATIVE] No, ma'am. It is not covered. No ma'am. No, ma'am. It is not covered when performed in the doctor's office or clinic. The claim was denied.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I have the, uh, can you send the copy of AOP to the provider mailing address or to the fax?
[AGENT][POSITIVE] Yes ma'am, you can actually print it. They can print it by going to [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] because one was already mailed.
[CUSTOMER][POSITIVE] Secure.
[AGENT][NEUTRAL] When the
[AGENT][NEUTRAL] Uh-huh. A
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Can I know when did you send the uh mailing uh EOP to the provider mailing address?
[AGENT][NEUTRAL] Yes, it would have been sent the day after the processing date and this claim was processed in [PII], so it would have gone out on [PII].
[CUSTOMER][NEUTRAL] Uh, can you send me the copy, like, it is possible to send through fax?
[AGENT][NEUTRAL] Can you not print it?
[CUSTOMER][NEUTRAL] I didn't get you. I'm sorry for that.
[AGENT][NEUTRAL] Can you not print it yourself by using that claim number?
[CUSTOMER][NEUTRAL] Yeah, actually, here it was showing the glitch first. So could you please send to the fax number?
[AGENT][NEUTRAL] Just a moment. And let me get that pulled up for you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] It's still loading.
[AGENT][NEUTRAL] Does it need to be put to your attention, [PII], or is that not necessary?
[CUSTOMER][NEUTRAL] The attention will be my name, [PII]
[AGENT][NEUTRAL] OK, just a moment. It's still.
[AGENT][NEUTRAL] And what is your fax number please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can I have the received date? When did you receive the claim?
[AGENT][NEUTRAL] Once I fax this to you, I'll get you that information.
[AGENT][NEUTRAL] I gave you the process date, and I'll get you the receipt date.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And again, the fax number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, that has been faxed.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the receipt date for this one moment.
[AGENT][NEUTRAL] This claim was received [PII].
[CUSTOMER][NEUTRAL] And Dong?
[AGENT][NEUTRAL] Tonight on [PII].
[CUSTOMER][NEUTRAL] Uh, can I get the check number?
[AGENT][NEGATIVE] It was denied.
[AGENT][NEGATIVE] There's no check number. There was no benefit. I read you the denial remark, [PII]. Did you say you had another data service for this member?
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[AGENT][NEUTRAL] OK, that's the same data service we did and what's the bill amount?
[CUSTOMER][NEUTRAL] 296.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And do you already have the claim number on this one?
[CUSTOMER][NEUTRAL] Yeah, 349-7465. It is also for the same denial.
[AGENT][NEUTRAL] No. No, no, no, no, it's not 65. It's 349-7475.
[CUSTOMER][NEUTRAL] 3497475, right?
[AGENT][NEUTRAL] It's
[AGENT][NEGATIVE] Yes, and it's the same denial.
[CUSTOMER][NEUTRAL] Can I know the receipt date?
[AGENT][NEUTRAL] The same, everything is the same as the other one. Also received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Can you fax a copy of ERP for the same fax number?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And if for any reason you all don't receive the the ones that have been faxed since they have also been mailed, then the next course of action, [PII] would be to print them yourself by going to the portal and using the claim number.
[AGENT][NEUTRAL] To print them out.
[CUSTOMER][NEUTRAL] So there is no chance to send through fax, right? It was already sent. Correct?
[AGENT][NEUTRAL] I've
[AGENT][NEUTRAL] I just explained to you that I'm going to fax these to you, but if for any reason you don't receive them, then yes, ma'am, you would just need to print them from the portal.
[CUSTOMER][NEUTRAL] OK. Yeah, sure.
[AGENT][NEUTRAL] So just a moment while this information is still loading.
[AGENT][NEUTRAL] OK, [PII], so I've also sent you the separate fax.
[AGENT][NEUTRAL] With this explanation of benefits.
[CUSTOMER][NEUTRAL] Can I have the
[CUSTOMER][NEUTRAL] Thank you. Can I have the call reference?
[AGENT][NEUTRAL] My name and today's date, excuse me, my name and today's date.
[AGENT][NEUTRAL] And is there anything else that I could help you with today?
[CUSTOMER][POSITIVE] No, thank you so much for the information about it and have a nice day. Thank you.
[AGENT][POSITIVE] Well, you're very welcome, [PII], and thank you for calling APL. I hope you have a nice rest of your day as well.