AccountId: 011433970860
ContactId: a0ef5e46-70f9-4384-8b91-f9dd0d6f0291
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1451939 ms
Total Talk Time (AGENT): 309861 ms
Total Talk Time (CUSTOMER): 448766 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/a0ef5e46-70f9-4384-8b91-f9dd0d6f0291_20250109T18:31_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. We are calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] Hi [PII], I can help you with the claim status. What is your callback number please?
[CUSTOMER][NEUTRAL] That is [PII] [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The patient's name?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK. And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] OK, and then what is [PII]'s?
[AGENT][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] Yeah, uh, just a minute.
[CUSTOMER][NEUTRAL] It's 021022 um just a minute. I'm sorry for that. It's uh um let me repeat it again. So it's uh 02120049 M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you. I appreciate you giving me that policy. Let me pull that in real quick.
[CUSTOMER][NEUTRAL] OK. Uh, am I right? Your name is [PII]?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] OK, can I have your last name initial [PII]?
[AGENT][NEUTRAL] It's, it is [PII]
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're very welcome. Can you give me the date of service for [PII], please?
[CUSTOMER][NEUTRAL] Yeah, sure. Um, the date of service is going to [PII] with the billed amount of $197.45.
[AGENT][NEUTRAL] OK, and then can you give me the charge amount after primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, that is.
[CUSTOMER][NEUTRAL] Let me check for that.
[CUSTOMER][NEUTRAL] It's uh $56.69.
[AGENT][NEUTRAL] OK thank you and then [PII] what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] It's for Cyberstein dermatology.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Miss [PII]. I'm gonna pull for you and I will be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you.
[AGENT][NEUTRAL] So I did find the claim for you, uh, the claim number is 352-735-6.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] And the claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was denied because office visits are not covered for the insured's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Office.
[CUSTOMER][NEUTRAL] All right, not cover.
[CUSTOMER][NEUTRAL] Under the patient's policy, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. May I know the patients or policy type?
[AGENT][NEUTRAL] It's a Medlink
[CUSTOMER][NEUTRAL] It's a me.
[CUSTOMER][NEUTRAL] Massling.
[CUSTOMER][NEUTRAL] It's like uh PPO HML like that?
[AGENT][NEUTRAL] No, it's a gap insurance.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Oh, all right.
[CUSTOMER][NEUTRAL] May I know what are the um
[CUSTOMER][NEUTRAL] Uh, services are not covered under this patient's, uh, benefit plan.
[AGENT][NEUTRAL] OK, and this is just to verify coverage. It's not a guarantee of payment. The insured has a supplemental gap insurance policy that helps with deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] Uh, I'm not sure of this. Uh, could you please repeat that for me?
[AGENT][NEUTRAL] It is a supplemental insurance policy that is billed secondary to the primary.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][POSITIVE] It helps with deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The patient has an outpatient calendar year deduct benefit amount of $1500 under that outpatient calendar year benefit amount office visits are not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, OK. Uh, is there any possibility to repeat this one, for the documentation purpose, a little bit slow for me.
[AGENT][NEUTRAL] Yes, it is a secondary insurance.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That helps with deductible?
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Co-pay
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEGATIVE] Go away.
[AGENT][NEUTRAL] Or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Under the patient's plan, office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Yeah, thank you for that one for me and.
[CUSTOMER][NEUTRAL] OK. And can you please uh repeat the claim number for me?
[AGENT][NEUTRAL] Yes, the claim number is 352.
[AGENT][NEUTRAL] 7356.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7356.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] Um, can I have the EOB?
[AGENT][NEUTRAL] Yes, if you give me your fax number.
[CUSTOMER][NEUTRAL] Through fax?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, [PII], I'm gonna put you on hold while I send that fax to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII] for holding for me that fax is on its way to you now.
[CUSTOMER][NEUTRAL] Yeah. Thank you, [PII]. And uh I just have uh one more claim. Could you please help me with that one, sir?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, what is the patient's name?
[CUSTOMER][NEUTRAL] Yes, uh, before that, uh, may I know the reference number for this, uh, in or the individual claims.
[AGENT][NEUTRAL] Yes, the reference number is my name [PII] in today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes, um, shall we move on to the next one?
[AGENT][NEUTRAL] Yes, ma'am. What is the patient's name?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh, the patient's name would be, would be [PII].
[AGENT][NEUTRAL] OK, and what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK, and then what is [PII]'s policy number?
[CUSTOMER][NEUTRAL] OK, it's 01893571 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you and then what is the date of service, please?
[CUSTOMER][NEUTRAL] For this one, the rate of service is going to, OK, [PII] with a bill amount of $313.72.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] It's uh $38.84.
[AGENT][NEUTRAL] OK, and is it for the same facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright Miss [PII], I'm gonna put you on a hold again just so I can look that claim up for you. I'll be right back.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi there Miss [PII], so looking on Andrea's policy for data service [PII], I do not find a claim on file for that charge amount.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, but I do have received the, uh, denial of remittance here. Can you please check with the claim number that I have?
[AGENT][POSITIVE] Yes, yes, that would be helpful. Thank you.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah, it's 354-028-9.
[AGENT][NEUTRAL] 354-028-9
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me see if I can find that.
[AGENT][NEUTRAL] OK, I'm fine in the claim, but it's not for the amount that you have given.
[CUSTOMER][NEUTRAL] Is this for $313.72?
[CUSTOMER][NEUTRAL] The whole amount?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Um, let me check in uh remittance here, just a minute.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] 13.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $317313.72.
[CUSTOMER][NEUTRAL] Yes, it is, uh, the bill amount.
[AGENT][NEUTRAL] OK, I'm not seeing the claim for that bill amount.
[CUSTOMER][NEUTRAL] Do you have the uh co-pay amount of $38.84?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mm let me check it for this one.
[CUSTOMER][NEUTRAL] 38 and 84.
[CUSTOMER][NEUTRAL] Deductible
[CUSTOMER][NEUTRAL] Maybe just a minute.
[AGENT][NEUTRAL] OK, and I'm looking at the claim number that you gave me.
[CUSTOMER][NEUTRAL] Uh, is this for $97.18?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Am I right?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I have the remittance in this one.
[CUSTOMER][NEUTRAL] Uh, the ICN this one, right?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, do you receive, I mean, uh, is there any check number of 2018153?
[AGENT][NEUTRAL] No ma'am, no, yes, 2018153, yes.
[AGENT][NEUTRAL] And we paid $58.34.
[CUSTOMER][NEUTRAL] Oh, OK. You actually, you paid uh the patient's deductible amount.
[AGENT][NEUTRAL] Right, that's what this policy covers.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, what is the thing is, um, actually, uh, the pay, I mean.
[CUSTOMER][NEUTRAL] American Public Life Insurance denied denied the $36 and um
[CUSTOMER][NEUTRAL] $38.84. They paid $58.34.
[CUSTOMER][NEUTRAL] Am I right?
[AGENT][NEGATIVE] No, ma'am, we paid $58.34 and we denied $140.03.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because that's an office visit.
[CUSTOMER][NEUTRAL] $140.
[CUSTOMER][NEUTRAL] Oh, that's a whole, uh, I mean, that's the bill amount, uh, for the procedure code 99213.
[CUSTOMER][NEUTRAL] Uh, it's paid by, uh, United Healthcare.
[CUSTOMER][NEUTRAL] And they allowed $38.84.
[AGENT][NEUTRAL] OK, so we paid with that check we paid $58.34.
[CUSTOMER][NEUTRAL] OK, so, um, the procedure code 99213 was denied, right?
[AGENT][NEUTRAL] Yes, that's an office visit. It's non-covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK. Is this also the same uh as the previous member policy or the different one?
[AGENT][NEUTRAL] Yes, it's, yes, it's the same situation. Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, all right. Thank you. And um can I have the paid uh details for the um procedure code 17,110?
[AGENT][NEUTRAL] OK, just one moment, let me finish putting my note in real quick and we'll go back to that EOB.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] OK, so the procedure code that you asked about the 17,110?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That was paid $58.34.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me check this have in my file. Oh, OK, they posted this one. thank you for that, uh, the denial reason because, um, that one in, um, in my file like the the denier.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Uh, outstanding amount. Thanks for this one.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's um, can I have the receipt date and the process date for this one?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Let me look it up.
[AGENT][NEUTRAL] 289. We received it on [PII].
[AGENT][NEUTRAL] And we processed it on [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, is there anything else?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] All right, that's all for this one. Thank you, [PII]. Thank you for your assistance for this one.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome, [PII]. You're very welcome. I hope you have a wonderful rest of your day and we thank you for calling APL today.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, have a great day. Bye bye.
[AGENT][NEUTRAL] You too bye bye [PII].
[CUSTOMER][NEUTRAL] Yeah