AccountId: 011433970860
ContactId: a7f8caa3-b9a4-4ede-ac2d-85ae5c0fc74d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286339 ms
Total Talk Time (AGENT): 108911 ms
Total Talk Time (CUSTOMER): 71252 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/a7f8caa3-b9a4-4ede-ac2d-85ae5c0fc74d_20250521T18:32_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling from provider office and I'm looking for the
[CUSTOMER][NEUTRAL] Claim status?
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status. May I have a callback number just in case we get disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] is the last two.
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. And may I have the name of the facility, yes, my name is Soul. That's S as in Sam, O as in Oscar, L as in Lima. Last initial M as in Mary.
[CUSTOMER][NEUTRAL] Can you repeat your name?
[CUSTOMER][NEUTRAL] Got it. And the facility name is West Road Dermatology Associates.
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02478686 MLA
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and the bill amount is.
[CUSTOMER][NEUTRAL] $239 even.
[AGENT][NEUTRAL] OK, [PII] for 239. Let me see if I can find this claim. For future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Um, let's see. OK, I think is this one.
[AGENT][NEUTRAL] Let me get this information pull up for you.
[AGENT][NEUTRAL] OK, so we received the claim on [PII], processed [PII].
[AGENT][NEUTRAL] And um the claim was denied. The reason for the denial is that service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You said service is not covered because?
[AGENT][NEUTRAL] Yes, Service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Clinic. But as I'm checking here, this is the Medicare supplement plan and primary like the primary insurance already processed and paid the same services. So why you guys have denied the claim?
[AGENT][NEUTRAL] Because offices are not covered under this plan.
[CUSTOMER][NEUTRAL] May I have the patient's plan name?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical for outpatient facilities.
[AGENT][NEUTRAL] In hospitals.
[CUSTOMER][NEUTRAL] Sorry, patient plan name is?
[AGENT][NEUTRAL] Secondary supplemental plan.
[CUSTOMER][NEUTRAL] So patient is liable for this one or?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement on the remaining of the claim.
[CUSTOMER][NEUTRAL] OK, got it. Call reference number and the claim number I think.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, we don't have reference numbers. You can use my name in today's date if you will. The claim number is 359-9364.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, thank you for calling APO. Have a good day.