AccountId: 011433970860
ContactId: 9d264f4c-3c8c-46c2-abb4-3e8a7d7246b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 560359 ms
Total Talk Time (AGENT): 168429 ms
Total Talk Time (CUSTOMER): 310263 ms
Interruptions: 9
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/9d264f4c-3c8c-46c2-abb4-3e8a7d7246b7_20250501T21:11_UTC.wav
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[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Good afternoon. Thank you for calling APM. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII]. I'm calling from provider office. I need claim information, so can you help me with that, please?
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure, that is [PII].
[AGENT][NEUTRAL] Thank you and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Two claims.
[AGENT][NEUTRAL] And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, sure, why not give me a moment. The first policy number, OK. Sure. That is going to be 982-075.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure. That is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure, sure, why not? So that's going to be the claim data service like uh [PII] building on $140 even.
[AGENT][NEUTRAL] Thank you. And are both claims for the same member or it's a different member for the second claim?
[CUSTOMER][NEUTRAL] Different, different, ma'am, different member.
[AGENT][NEUTRAL] OK. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, sure. It's the name of the provider office.
[CUSTOMER][NEUTRAL] OK. That is going to be sent to medic Medical Associates.
[CUSTOMER][NEUTRAL] Uh, you know.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] Here we go.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, and I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3,567,720.
[AGENT][NEUTRAL] And also on [PII], the, the claim was denied.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] As office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Denied his office visit are not covered under the policy.
[CUSTOMER][NEUTRAL] May I have the U be offered?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Uh, that is [PII].
[AGENT][NEUTRAL] I'm sorry, can you repeat that slowly, please?
[CUSTOMER][NEUTRAL] Yeah, sure. That is [PII].
[AGENT][NEUTRAL] And does that need to be attention, [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] You're right. You can mention my name here.
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] Yeah, right, [PII]. That's correct number here, um, to.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mm yeah, sure, why not.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the next member's policy number?
[CUSTOMER][NEUTRAL] Sure, the next, uh, policy number that is, uh, give me a moment just.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To different policy over here.
[CUSTOMER][NEUTRAL] It's um uh give me a moment, just be on the line. Yeah, that is 2025555259.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 02 and then there's 45 and then 259.
[CUSTOMER][NEUTRAL] How do we
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No, no, there are 35 only.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] 352 5. Sure, sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][POSITIVE] I love it.
[CUSTOMER][NEUTRAL] Sure. First name [PII]. Last name [PII], and date of birth [PII].
[CUSTOMER][NEUTRAL] With date of [PII].
[AGENT][NEUTRAL] Um, hold on one second.
[CUSTOMER][NEUTRAL] $21 even.
[AGENT][NEUTRAL] I'm not there yet. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said [PII] for the member's date of date of birth, I'm sorry, the policy delayed.
[CUSTOMER][NEUTRAL] [PII]. Uh yeah, right. [PII], right.
[AGENT][NEUTRAL] Is that correct?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Thank you. And again for the call, all the information provided is a verification of benefits, not a guarantee of payment, and may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, sure, sure, that is [PII] with bill amount $21 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And would this be the same provider or a different provider on this claim?
[CUSTOMER][NEUTRAL] Oh, that is our lady like a physician.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, lady, like a physician, this is a different provider.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] this
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So I shall receive the claim on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3544536.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm. Mm.
[AGENT][NEUTRAL] And also on [PII].
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] And also on [PII], the claim was denied?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Because it is not a covered diagnostic test.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Covered under the diagnostic. So you want us to change the diagnostic code then need to bill, right?
[AGENT][NEUTRAL] No, it's not a covered diagnostic test. So, unless it's an MRI, CAT scan, thyroid uptake test, CT scan, PET scan.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Uh really.
[AGENT][NEUTRAL] Um, there's like a list of, there's a specific list of tests for this policy, and this test that was performed is not covered by this policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] This test was performed is not.
[CUSTOMER][NEUTRAL] Covered by this, so there's a like patient responsibility, right?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we're not the major medical insurance company.
[CUSTOMER][NEUTRAL] So let's see.
[CUSTOMER][NEUTRAL] OK then, no problem. Can you also fax me that you as well?
[AGENT][POSITIVE] Yes, of course.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And can I have the call reference number?
[AGENT][NEUTRAL] And so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Thank you and uh and can I have the timely final limit?
[AGENT][NEUTRAL] There's no timely filing limit as long as the policy is active, you can file the claim at any time.
[CUSTOMER][POSITIVE] OK, perfect. Thank you and have a nice day. Did you fax a UB to me?
[AGENT][NEUTRAL] It's on the way. I'm faxing it to you now.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] OK, perfect then.
[AGENT][NEUTRAL] Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. I hope you have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.