AccountId: 011433970860
ContactId: a6a613cd-2756-4183-8363-d38da0d152db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 278660 ms
Total Talk Time (AGENT): 95337 ms
Total Talk Time (CUSTOMER): 77209 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/a6a613cd-2756-4183-8363-d38da0d152db_20250218T13:48_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] Hello, [PII]. My name is [PII] and I'm calling from Boston Medical Center to check on the claim status. Could you please help me with that?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status, and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one, no, no.
[AGENT][NEUTRAL] OK. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII]. And the member ID is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [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 for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Rate of service is [PII] and the tax amount is $507.
[AGENT][NEUTRAL] Thank you hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm showing that the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3561457.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Office visits is not.
[CUSTOMER][NEUTRAL] Covered by
[AGENT][NEUTRAL] Covered by the.
[CUSTOMER][NEUTRAL] This policy.
[CUSTOMER][NEUTRAL] OK, uh, in this, in this policy there is no office office visits benefits, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, uh, is that a patient responsibility?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility because we're not the major medical insurance company. Um, if there is an outstanding balance, that would just be whatever your company's policies are on outstanding or remaining balances, write off, bill, it will be up to you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so, uh.
[CUSTOMER][NEUTRAL] Uh, one moment please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, could you please, uh, be on hold for one moment? I'll verify that, uh, what is that, uh.
[CUSTOMER][POSITIVE] Excellent.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] Yeah, I do see that.
[CUSTOMER][NEUTRAL] Uh, I do see that that, uh, this is not covered under patient plan, right? Uh what you're telling us?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Uh, so, yeah, we can, uh, bill the patient, right?
[AGENT][NEUTRAL] That's the same as asking about patient responsibility. So we don't determine patient responsibility. Billing to the patient would be determining their responsibility. So whatever your procedures are for outstanding balances is what would need to be followed. Unfortunately, I don't have that information.
[CUSTOMER][NEUTRAL] Yeah, uh, uh.
[CUSTOMER][NEUTRAL] OK. Uh, could you, are you seeing any, uh, Medicaid policy for the patient? Is there any Medicaid?
[AGENT][NEUTRAL] Um, no, we don't work with Medicaid or Medicare.
[CUSTOMER][NEUTRAL] OK. Could you please tell me the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Mhm. OK, thank you so much. Have a great day. Bye-bye for now.
[AGENT][POSITIVE] You also, [PII], thanks for calling APL. Bye-bye.