AccountId: 011433970860
ContactId: a6785567-16f2-4a07-85f4-d36aa913805a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604830 ms
Total Talk Time (AGENT): 153179 ms
Total Talk Time (CUSTOMER): 191609 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/a6785567-16f2-4a07-85f4-d36aa913805a_20250411T14:01_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm [PII] calling from our provider office to check on a claim status. And please be informed that this call will be recorded and monitored for quality and training purposes.
[AGENT][POSITIVE] OK. Well, 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 and the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh.
[CUSTOMER][NEUTRAL] It's [PII]. And the extension to my callback number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Just a moment.
[CUSTOMER][NEUTRAL] It's 02491567 M as in Mike, L as in Lima.
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, sure. It's [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Sure. It's uh [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 bill for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Sure. It's
[CUSTOMER][NEUTRAL] [PII] and the total charge amount $1331 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] It's Coral Springs Physician Services LLC.
[AGENT][NEUTRAL] Alright, so shall we receive the claim on [PII]?
[AGENT][NEUTRAL] The claim number is 3506078.
[AGENT][NEUTRAL] And on [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was denied?
[AGENT][NEUTRAL] And the denial reason, hold on one moment.
[AGENT][NEUTRAL] This is not a covered loss under the plan. Therefore, no amount payable, there is no, sorry, there is no amount payable for this expense, so it's not a covered charge.
[CUSTOMER][NEUTRAL] OK, let me verify that. Uh, the claim was received on [PII]. Am I right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. So was received on [PII] and it was
[CUSTOMER][NEUTRAL] Denied on [PII]. Am I right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII]. Could you please uh repeat the claim number?
[AGENT][NEUTRAL] The claim number is 3506078.
[CUSTOMER][POSITIVE] OK. Thank you for that.
[CUSTOMER][NEUTRAL] OK. According to the patient plan, uh, the services are not covered. Am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh, so, for this, uh, bill amount, we can bill the patient.
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility because we're not the major medical insurance. It would just be whatever your procedures or policies are on outstanding balances.
[CUSTOMER][NEUTRAL] Am I right?
[CUSTOMER][NEUTRAL] OK. It's not covered services under the patient plan.
[CUSTOMER][NEUTRAL] OK. Uh, could you please help me with the
[CUSTOMER][NEUTRAL] Uh, patient plan type.
[AGENT][NEUTRAL] This is the Medin supplemental gap insurance policy. We
[AGENT][NEUTRAL] We apply towards the copay, deductible and co-insurance after primary.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK. OK. Uh, could you please repeat the
[CUSTOMER][NEUTRAL] Uh, the plan type, it's medical supplemental.
[AGENT][NEUTRAL] Med Link, M E D L I N K.
[AGENT][NEUTRAL] Is the name of the policy, it's a Medlink policy.
[AGENT][NEUTRAL] A Metlink policy is a supplemental gap insurance policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, OK. Sure. OK.
[CUSTOMER][NEUTRAL] OK. Uh, just be on hold for a moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, could you please verify that we have rendered the service. It's not covered under the patient policy, am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, let me verify the
[CUSTOMER][NEUTRAL] The service is not covered under the patient policy or provider contract.
[AGENT][NEUTRAL] This is not a covered service under the member's policy.
[CUSTOMER][NEUTRAL] OK, thank you for that. Uh, could you please help me with uh call reference for this claim?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, and that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, thanks for that. I do have another claim for the same patient. Could you please help me with that?
[AGENT][NEUTRAL] OK, what's the next uh data service?
[CUSTOMER][NEUTRAL] OK, just a moment. Just pulling up the account. For it's
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $474 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Alright, so I'm showing that the claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number is 350.
[AGENT][NEUTRAL] 6080.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Could you please help me with the denied reason?
[AGENT][NEUTRAL] And it's the same denial reason is not covered on the member's policy.
[CUSTOMER][NEUTRAL] OK. For this, we can build the patient, right?
[AGENT][NEUTRAL] Again, we don't determine patient responsibility here, so it will be up to you as the provider.
[CUSTOMER][POSITIVE] OK. Thank you for that. Uh.
[CUSTOMER][NEUTRAL] OK, thank you, [PII], for this also the call reference is uh your name and uh today's date. Am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, thank you for that, [PII]. Have a great day.
[AGENT][POSITIVE] You're very welcome, [PII]. Was it [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, that's it for today.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] OK, have a great weekend. Bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.