AccountId: 011433970860
ContactId: a9a224dd-6ab8-4a6b-b194-df02fcbb218f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275739 ms
Total Talk Time (AGENT): 119928 ms
Total Talk Time (CUSTOMER): 97814 ms
Interruptions: 2
Overall Sentiment: AGENT=2.3, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/a9a224dd-6ab8-4a6b-b194-df02fcbb218f_20250213T16:24_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]. My name is [PII]. I'm calling from Genesis Care USA Florida LLC. I'm just calling to verify a denial on a claim.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] OK [PII], you're needing to verify a denial for on a claim that we processed, is that correct?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And what is a good call back number for you please, [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII] and that is my direct line.
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] It is 17387.
[AGENT][NEUTRAL] OK, that's a group number. There should be another number.
[CUSTOMER][NEUTRAL] OK, let me, I see the policy number is 01545864.
[AGENT][POSITIVE] OK, thank you. So give me a couple of moments to get the member's information pulled up please.
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][POSITIVE] Mhm, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you for your patience while it's loading up.
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Data service is [PII]. The billed amount is $1,629.82 on the patient's primary applied.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, $521.43 to the patient responsibility for deductible and yours just says on your EOB here it says it's not, this is not covered when performed in a doctor's office or clinic. Um, this was just an
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, this was, um, you know, um, a vasectomy that was performed in the patient's office.
[AGENT][NEUTRAL] That is correct, and on this member's plan, that is not a covered service.
[CUSTOMER][POSITIVE] Perfect. And do you cover deductible as well? Like does the, do you cover the primary deductible?
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] This policy is designed to help them with their co-pays, deductibles, and co-insurance amounts of covered services, but this is not covered on this policy. Correct, yes ma'am. Mhm, yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A covered service.
[CUSTOMER][POSITIVE] I got you. Perfect. Can I get a reference number, [PII]? Thank you.
[AGENT][NEUTRAL] Sure, you're very welcome. I, you would use my name along with today's date, and I don't know um if you've already been given this information before [PII], but for future reference if you should need a copy of one of our explanation of benefits, we do have a portal that you can register in. It's a self registering portal and it's located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] And so you should be able to check claim status or very least once you have the claim number, be able to print, you know, pull up the EOB.
[CUSTOMER][POSITIVE] Thank you so much. I appreciate it. Have a wonderful day.
[AGENT][NEUTRAL] You, you.
[AGENT][POSITIVE] I hope you do too, [PII] and that's all I can help you with, thank you again for calling APL yes ma'am.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you, honey. Bye-bye.
[AGENT][NEUTRAL] Mhm.