AccountId: 011433970860
ContactId: 9fe9ee4a-fca7-4474-a916-4bb375f3cd9c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515109 ms
Total Talk Time (AGENT): 175325 ms
Total Talk Time (CUSTOMER): 164415 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/9fe9ee4a-fca7-4474-a916-4bb375f3cd9c_20250217T21:20_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], uh, calling from, this is uh [PII] calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes. And uh may I know initial of your last name?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes and yours?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Yours is [PII], is that correct, [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, thank you. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you did say [PII], is that correct?
[CUSTOMER][POSITIVE] Yes, yes, correct.
[AGENT][NEUTRAL] OK. OK, now, yes, I can help you with claim status. And what is your patient's policy number?
[CUSTOMER][NEUTRAL] 02415249.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] And to mail any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] First name is uh [PII] and the last name is [PII] and date of birth is uh [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] One moment, [PII]. I'm having trouble with one of my screens.
[CUSTOMER][POSITIVE] Yes, yes. Take your time, no issue.
[AGENT][POSITIVE] Yeah, thank you.
[AGENT][NEUTRAL] OK, and I'm so sorry, would you please verify her date of birth one more time for me?
[CUSTOMER][NEUTRAL] Yes. [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for her, please.
[CUSTOMER][NEUTRAL] [PII]. And total service is $459 even. 4 $59.
[AGENT][NEUTRAL] 459. OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so the most recently received claim was denied as a duplicate. [PII], do you need that information or the original claims information?
[CUSTOMER][NEUTRAL] Uh, no, I, I have one, like specific question regarding about this claim. I, upon checking, uh, like we do receive that you will be getting that non-covered charges. I can provide you the claim number as well. So we just want to know whether it's uh facing uh under the PO.
[CUSTOMER][NEUTRAL] I mean under patient responsibility or?
[AGENT][NEUTRAL] What is?
[AGENT][NEUTRAL] OK, what is your claim number? I wanna verify that you have the correct claim number.
[CUSTOMER][NEUTRAL] What's the deny for that?
[AGENT][NEUTRAL] What is the claim number you have [PII]?
[CUSTOMER][NEUTRAL] OK. Uh, so claim number is
[CUSTOMER][NEUTRAL] 353-976-8
[AGENT][NEUTRAL] OK, yeah, so that is the claim that I am looking at now we do not determine patient responsibility, [PII], that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. So, OK.
[CUSTOMER][NEUTRAL] So, uh, this means that, uh, it's uh non-coverters, right? CO 96 or PR PR 96.
[AGENT][NEGATIVE] This was denied as office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, may I know the claim received that?
[AGENT][NEUTRAL] I'm sorry, ask your question again, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] A claim received that.
[AGENT][NEUTRAL] You need the claim receipt date?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] His claim was received on [PII] and processed and denied on [PII].
[CUSTOMER][NEUTRAL] So, uh, deny as no cover and this providers plan, not patient plan, right?
[AGENT][NEUTRAL] Patient's plan, not the provider.
[AGENT][NEUTRAL] This is not covered by the patient's policy with APL.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Not covered by patients? OK.
[CUSTOMER][NEUTRAL] So, may I know what type of uh plan that member patient has?
[AGENT][NEUTRAL] This is a, we are not a major medical carrier. This is a supplemental medical plan only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, hel hello, [PII].
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] So, uh, may I know is this, uh, PR denial or uh uh CO denial?
[CUSTOMER][NEUTRAL] Once more.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm sorry, what is your question?
[CUSTOMER][NEUTRAL] Uh, I mean, is this, uh, PR denial or CO denial?
[AGENT][NEGATIVE] I don't understand the question. I'm sorry, [PII]. This is denied, this was denied because it is not covered.
[CUSTOMER][NEUTRAL] I mean, the
[AGENT][NEUTRAL] Under this policy that the patient has with APL.
[AGENT][NEUTRAL] The supplemental policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you
[CUSTOMER][NEUTRAL] So, uh,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it it is members responsibility, right?
[AGENT][NEUTRAL] Again, we do not determine I explained to you that we do not determine patient responsibility. The provider would make that determination.
[CUSTOMER][NEUTRAL] OK. Uh, just for clarification, it's not covered by a patient plan. Patient has supplement the medical plan, right? which does not cover office visit.
[AGENT][NEUTRAL] This is a sup this is a supplemental medical plan and no, sir, it does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, [PII], you can print that from our portal and our portal website is secured. [PII].
[CUSTOMER][NEUTRAL] OK. Uh, just, can you please hold for a second, please?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, can you please hold for a second, please?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK. Uh, thank you so much, [PII], for your time and information. Uh, yeah, can I get the call reference number?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Well, if that's all that I can help you with, thank you again for calling APL and I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You too. Thank you so much. Have a wonderful day. Thank you.
[AGENT][POSITIVE] Uh, you're, you're very welcome and thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.