AccountId: 011433970860
ContactId: 9bbb9617-3858-48f7-8071-34e154b553d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352890 ms
Total Talk Time (AGENT): 123171 ms
Total Talk Time (CUSTOMER): 143654 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/9bbb9617-3858-48f7-8071-34e154b553d6_20250501T16:30_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from providers office looking on a claim status and my initial is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If you don't mind, can you please spell out your name, please? Mhm.
[AGENT][NEUTRAL] Sure, it's [PII] [PII]. And I'm sorry, you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah, that's [PII] and my initial is [PII].
[AGENT][NEUTRAL] OK, thank you. And [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] The policy number that's gonna be.
[CUSTOMER][NEUTRAL] 008234.
[CUSTOMER][NEUTRAL] Sorry, uh
[CUSTOMER][NEUTRAL] Uh yeah, sorry for the inconvenience, uh, the member ID that's gonna be 02230085.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And do you have a call, a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, sure. The callback number that's gonna be [PII] and the extension will be [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] The patient's first name that's gonna be [PII] and the last name that's gonna be [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And you're calling for claim status. uh, what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The date of service it's gonna be [PII] with the total bill amount of $1,729 even.
[AGENT][NEUTRAL] OK. Thank you. And [PII], do you have the balance after Primary Insurance has processed the claim?
[CUSTOMER][NEUTRAL] Mhm, yeah, actually the primary has processed and uh built to secondary which is of uh.
[CUSTOMER][NEUTRAL] American public life and I can see here the balance amount is $24.61.
[AGENT][NEUTRAL] 2461.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] Edwards Sparrow Hospital.
[AGENT][NEUTRAL] OK, and while I'm looking at claim information just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and I show the claim process as physiology, speech or occupational therapy is not covered under the policy.
[CUSTOMER][NEUTRAL] Can you please repeat it again if you don't mind? Uh, I just showed that uh occupational.
[AGENT][NEUTRAL] Sure, uh, the claim.
[AGENT][NEUTRAL] I'm sorry. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, I'm ready for it.
[AGENT][NEUTRAL] OK. Uh, the claim process as physiology, speech, and occupational therapy is not covered for the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I this is this of patient responsibility or is uh we need to add just standard contraction this.
[AGENT][NEUTRAL] Uh, we can't give patient responsibility. We can only verify how the claim was processed, but for the patient's policy, those services are not covered under the plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, may I know when the claim was received on and denied on?
[AGENT][NEUTRAL] Uh, sure, claim received [PII] process on [PII].
[CUSTOMER][POSITIVE] Thank you so much, sir. Thank you so much for that.
[AGENT][POSITIVE] Alright, you're welcome.
[CUSTOMER][NEUTRAL] And uh actually, upon check upon checking here, I got the
[CUSTOMER][NEGATIVE] I, we do have an EOB but there is no proper information here.
[AGENT][NEUTRAL] If you turn it over, the ELB, it will show how the claim is processed, sorry.
[CUSTOMER][NEGATIVE] As it is showing, uh, denied as your ring.
[CUSTOMER][NEUTRAL] Yeah, but, uh, yeah, upon checking here I can see here there is no uh denied amount and uh.
[CUSTOMER][NEUTRAL] I can see only the claim was denied as PR 96 which is non-covered charges.
[AGENT][NEUTRAL] Yes sir, that's where our EOBs are set up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm yeah.
[CUSTOMER][NEUTRAL] Uh, so the total, uh, the total amount which is uh $224.61 is denied for the non-cover charges, right, the total amount.
[AGENT][NEUTRAL] Correct, it was processed, is not covered.
[CUSTOMER][NEUTRAL] OK, can I have the claim number?
[AGENT][NEUTRAL] Sure, 347-460-6.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much for the valuable information. And can I have the call reference number?
[AGENT][NEUTRAL] Uh, you may use my name and today's date, and is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] No, I got the sufficient information. Thank you so much for that.
[AGENT][POSITIVE] Oh, you're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Bye bye.