AccountId: 011433970860
ContactId: 9ad10e2f-f48d-4731-8891-768522733cc8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290029 ms
Total Talk Time (AGENT): 115625 ms
Total Talk Time (CUSTOMER): 82611 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/9ad10e2f-f48d-4731-8891-768522733cc8_20250411T14:53_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm calling to check on uh the status of a claim.
[AGENT][NEUTRAL] OK, I can help you with the claim status. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's um my my name is [PII] and my phone number is [PII].
[AGENT][NEUTRAL] Thank you for that, and [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] It's 02132468.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Um, I got [PII].
[CUSTOMER][NEUTRAL] And date of birth is.
[CUSTOMER][NEUTRAL] Sorry, one second, this was in front of it, uh, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Uh, 24.
[CUSTOMER][NEUTRAL] And the total bill is 224.
[AGENT][NEUTRAL] OK, hold on
[CUSTOMER][NEUTRAL] But we're only billing you guys 25 for her because you're her secondary.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Caring Hands Healthcare Centers and it's [PII].
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so we have a claim here. It is from your provider.
[AGENT][NEUTRAL] It's a different same date of service, but the total bill is 179 versus the 224. Would this be the same thing?
[CUSTOMER][NEUTRAL] Oh yes, because um.
[CUSTOMER][NEUTRAL] It was billed the Medicare first so it has the G code on it.
[AGENT][NEUTRAL] OK, um, so we received this claim on May, oh sorry, OK.
[CUSTOMER][NEUTRAL] Oh wait, wait, wait, wait, wait.
[CUSTOMER][NEUTRAL] Sorry, it, it looks like it wasn't a Medicare. It was.
[CUSTOMER][NEUTRAL] Um, the patient had also got, uh, injections, but the.
[CUSTOMER][NEUTRAL] Primary insurance paid for those in full, so you, you were only billed the office is it which is the co-pay.
[AGENT][NEUTRAL] 99213. OK. So, um,
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So we received this claim on [PII].
[AGENT][NEUTRAL] And the claim number is 344.
[AGENT][NEUTRAL] 1016.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And now is that for um.
[CUSTOMER][NEUTRAL] Like all of your claims.
[CUSTOMER][NEUTRAL] Like as a whole, do you not cover or is it just her plan?
[AGENT][NEUTRAL] No, no, it's our policy. Some of the policies have um office visit coverage, um.
[AGENT][NEUTRAL] In terms of like
[AGENT][NEUTRAL] So she has the office treatment rider, so the treatment in the office can be covered. This is not covered because it was billed for the facility, the 99213. So this secondary policy is broken down into like inpatient or outpatient.
[AGENT][NEUTRAL] And under the outpatient is where the um office treatment rider is, but there's no coverage for the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] facility charge on this policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, OK, and can I get a reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. Again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you very much [PII] you have a great day.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] All right, thanks for calling APR. Have a great weekend. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.