AccountId: 011433970860
ContactId: 9e610c8e-d02b-4d68-b909-9416ebf33a2d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1402609 ms
Total Talk Time (AGENT): 329298 ms
Total Talk Time (CUSTOMER): 371573 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/9e610c8e-d02b-4d68-b909-9416ebf33a2d_20250404T16:25_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, [PII]. Good morning. This is [PII] calling from doctor office. I'm looking for a claim status.
[AGENT][POSITIVE] It would be my pleasure to assist you with claim status. I'll be. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] All right. It's 01678901, M like Mary, L like Lima, number 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's full name is uh [PII]. [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][POSITIVE] My pleasure to help you with that claim status. Do you have a claim number or date of service?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] December 7, 2024.
[AGENT][NEUTRAL] And the bill amount, please, sir?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah, bill amount is $410.28.
[AGENT][NEUTRAL] Thank you, [PII], and what is the facility name, please?
[CUSTOMER][NEUTRAL] M E H E M E O N C call Heon call.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] [PII], I am showing that we received that claim on [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim was denied as office visits are not covered per the patient's plan.
[AGENT][NEUTRAL] I can provide that claim number if you'd like.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Yeah, please go ahead.
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 67 I'm sorry, 3556729.
[CUSTOMER][NEUTRAL] OK, ma'am. And uh you mentioned that office was not covered by the patient plan not only office visit, right? Not covered?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Um, services are not covered in a doctor's office as well, so any procedures or treatments or office visit is not covered in a doctor's office.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said your good name is [PII], right? I, sorry, [PII]
[AGENT][NEUTRAL] It's [PII].
[AGENT][POSITIVE] And [PII], it was a pleasure to assist you with that payment information. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh, maybe I have, uh, more clients to check the status. Can I move to the next one?
[AGENT][NEUTRAL] Yeah, give me just one second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] I, I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Sorry, sorry, uh, same patient, uh, let me check if the office is the same patient, sorry, just check the CPT code.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Yeah, same patient next to this is 11-9-2024, [PII].
[AGENT][NEUTRAL] Will this be for the same facility?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And that claim we did receive on
[AGENT][NEUTRAL] 12925 processed on [PII].
[AGENT][NEUTRAL] And this claim was denied as services are not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] Uh, sorry, tell me the denial listen again.
[AGENT][NEUTRAL] Services are not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] O OK, service is not covered when performing device.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Same number.
[AGENT][NEUTRAL] That claim number is 355.
[AGENT][NEUTRAL] 8461.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's mean like uh.
[CUSTOMER][NEUTRAL] Any kind of medical uh services not going uh by the patient plan, right? In the patient plan, there is no like uh benefits related to medical.
[CUSTOMER][NEUTRAL] Uh 70 courses we charge.
[AGENT][NEGATIVE] It's the place of service. It's not covered when it's performed in a doctor's office.
[AGENT][NEUTRAL] So the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Has benefits for inpatient hospitalization.
[AGENT][NEUTRAL] And outpatient hospital facilities.
[AGENT][NEGATIVE] And there's no benefits for any services in a doctor's office.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] For this claim,
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. For both these patient claims, I need the reference number.
[AGENT][NEUTRAL] It's gonna be my name in today's date.
[CUSTOMER][NEUTRAL] All right. Uh, you said, uh, service is performed in office not good. I need to discuss with, with my supers. Please hold for one minute, OK?
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Just stay on the line.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, ma'am. Uh, sorry for the long hold and thank you for patiently waiting. Can I, uh, move to next, uh, can I move to next patient? Uh, I'll provide the member ID the next patient.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] So it's a different policy.
[CUSTOMER][NEUTRAL] The patient policy number, yeah.
[AGENT][NEUTRAL] OK, bear with me just one second.
[AGENT][NEUTRAL] Habi, I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah, next ID is 02312570 M.
[CUSTOMER][NEUTRAL] L. like Lion, 8.
[AGENT][NEUTRAL] And that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient full name is uh [PII].
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[CUSTOMER][NEUTRAL] Last name and date of birth is [PII].
[AGENT][NEUTRAL] And what is that data service?
[CUSTOMER][NEUTRAL] Mm, [PII].
[AGENT][NEUTRAL] I'm checking for data service [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], I'm checking for that data service. We do not have a claim on file for that data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 9628.
[CUSTOMER][NEUTRAL] All right. Same patient, please check next to the service.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] No claim on file for [PII].
[CUSTOMER][NEUTRAL] And number
[CUSTOMER][NEUTRAL] 20
[AGENT][NEUTRAL] And no claim for [PII].
[CUSTOMER][NEUTRAL] 927 [PII].
[AGENT][NEUTRAL] And what is the facility name and the bill amount?
[CUSTOMER][NEUTRAL] That is uh hemi ONC call.
[AGENT][NEUTRAL] OK, same one.
[CUSTOMER][NEUTRAL] And bill amount is.
[CUSTOMER][NEUTRAL] 4 $10.28.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4 1028.
[AGENT][NEUTRAL] Amount was 4 1028.
[CUSTOMER][NEUTRAL] 10.28.
[CUSTOMER][NEUTRAL] Bye
[AGENT][NEUTRAL] I don't have that claim on file either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, what is the payer ID, uh, electronic payer ID, correct?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And, can I, for this, [PII], you said there is no claim on file, right?
[AGENT][NEUTRAL] that
[AGENT][NEUTRAL] That is correct, and that can also be faxed directly to our claims department.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, please tell me fax number and attention to.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm, fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK pay attention to.
[AGENT][NEUTRAL] Claims
[CUSTOMER][NEUTRAL] Can I provide you the next patient ID?
[AGENT][NEUTRAL] Mhm. Let me get there.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Next one is [PII] like Mary, [PII] Lima, number 8.
[AGENT][NEUTRAL] And that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient first name is uh [PII] and last name is uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and that date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that bill amount, please.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Bill amount is 410.28.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] [PII], that claim we received on [PII].
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] That claim was denied as office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that claim number?
[CUSTOMER][NEUTRAL] Same, uh, reason, right? Uh.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK. Your claim number?
[AGENT][NEUTRAL] The claim number is 137.
[AGENT][NEUTRAL] 2039
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm going to the next question.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Ready?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Next ID is 01829134 ML 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient full name is uh [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And build them out. This is the same build out.
[CUSTOMER][NEUTRAL] Yes, 12.28.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] That claim we received on [PII].
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] And that is the same reason, offices it's not covered.
[CUSTOMER][NEUTRAL] Same number.
[AGENT][NEUTRAL] Oh yeah, I'm so sorry. The claim number is 356.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 77
[AGENT][NEUTRAL] 78
[CUSTOMER][NEUTRAL] I'm gonna move to the next patient.
[AGENT][NEUTRAL] Sure, I'm ready. What's that next policy number?
[CUSTOMER][NEUTRAL] And just the last one.
[CUSTOMER][NEUTRAL] Or claims showing for this special.
[CUSTOMER][NEUTRAL] Next ID is 01673442 ML 8.
[AGENT][NEUTRAL] Name and date of birth.
[CUSTOMER][NEUTRAL] Patient. First name is uh [PII], and last name is uh [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth.
[AGENT][NEUTRAL] Thank you. Did you say you had 4 claims for [PII]?
[AGENT][NEUTRAL] Did I hear that? Is it just one claim or multiple claims for [PII]?
[CUSTOMER][NEUTRAL] Uh, next one is, uh, also 4 11224 different CPT different charge amount, same data service.
[AGENT][NEUTRAL] For 11 2024.
[CUSTOMER][NEUTRAL] November [PII] same patient, same data service different charge amount.
[AGENT][NEUTRAL] Oh, November [PII].
[CUSTOMER][NEUTRAL] No, no, November [PII]. Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, [PII], the date of service is [PII].
[CUSTOMER][NEUTRAL] Be me.
[CUSTOMER][NEUTRAL] One with office visit code and next one is with a different CPD code, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't have those claims on file. I have no claims for 114 2024.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Check the next 1, 1111 224, same patient, so again.
[AGENT][NEUTRAL] 1111 2024.
[AGENT][NEUTRAL] What is that bill amount?
[CUSTOMER][NEUTRAL] this time
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Charge amount is the same uh 410.28.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] We don't have that claim on file.
[CUSTOMER][NEUTRAL] Next 1 11:30 presentation 2024 11:13 2024.
[AGENT][NEUTRAL] OK, that one we do have.
[AGENT][NEUTRAL] And that one we received on [PII].
[AGENT][NEGATIVE] And processed on 13125 and denied his offices is not covered.
[CUSTOMER][NEUTRAL] OK, this is not covered, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] And tell me claim number, please.
[AGENT][NEUTRAL] The claim number 3558413.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, ma'am. Yeah. Uh thank you for beautiful cooperation. Have a blessed day. Take care.
[AGENT][POSITIVE] And my pleasure to assist you with those claim status. Avi, anything else I can help you with before you go?
[CUSTOMER][POSITIVE] Enjoy the rest of the day.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Well, thank you, thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. Same to you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.