AccountId: 011433970860
ContactId: a60d93ea-c245-4c5d-b854-26623f012c55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 470019 ms
Total Talk Time (AGENT): 143434 ms
Total Talk Time (CUSTOMER): 179459 ms
Interruptions: 6
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/a60d93ea-c245-4c5d-b854-26623f012c55_20250131T15:29_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling for the provider Tampa General Medical Group Inc. Please be informed that this call is being recorded and monitored for quality and training purpose. I'm calling to check on the claim status.
[AGENT][NEUTRAL] OK. You're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Yes, ma'am. I can help you with that. And what did you say your name was?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And you, you said that you do have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am, I can help you. So what is the member's policy number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Member ID is.
[CUSTOMER][NEUTRAL] 224-455-6
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 6430.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure. Patient's first name is [PII] and the last name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Sure. Date of services.
[CUSTOMER][NEUTRAL] [PII] and the total charges is $679 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, just a moment, please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, take your time.
[AGENT][NEUTRAL] And what is the provider group name?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] It's Tamba General Medical Group INC.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so I do show Adly that this claim was received. The received date was 11-21-2024. It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK, may I know the reason?
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 5293.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] God
[AGENT][NEUTRAL] OK, one of the reasons on this code on this state office visits are not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Of this policy?
[CUSTOMER][NEUTRAL] So, can you please repeat me the denied reason?
[AGENT][NEUTRAL] One of them is office visits are not covered by the above number policy. The member's plan does not cover office visits.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So it is not covered service as for the patients benefits plan, am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, may I know the, whether the CPT or diagnosis is not covered?
[AGENT][NEUTRAL] One
[AGENT][NEGATIVE] Office visits are not covered.
[CUSTOMER][NEGATIVE] Office visits, it's not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the other denial remarks states policy provides no benefits for the treatments of conditions other than a sickness or injury as defined by the policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the last remark states this policy does not provide a benefit for which in for services in which no charges were incurred.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The policy does not provide a benefits for uh no charges are incurred.
[AGENT][NEUTRAL] Services in which no charges were incurred.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits with the remarks on it, [PII], you can print that directly from our portal at [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] And that's.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, ma'am, that is correct, [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So, may I know the call reference number?
[AGENT][NEUTRAL] It would be my name along with today's date. Again, my name is [PII].
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] Yes ma'am, you're very welcome and thank you again, [PII] if that's all I can help you with for calling APL and I hope you have a nice weekend.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Oh