AccountId: 011433970860
ContactId: a9caa0c8-906e-4945-a6c4-cbb00c067fb7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 680750 ms
Total Talk Time (AGENT): 129317 ms
Total Talk Time (CUSTOMER): 158132 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/a9caa0c8-906e-4945-a6c4-cbb00c067fb7_20250217T16:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi there, [PII]. How are you today?
[AGENT][POSITIVE] I'm doing well how are you doing today, sir?
[CUSTOMER][POSITIVE] I'm doing good. Thank you for asking, [PII]. Um, actually, um, I'm a, I need assistance related uh lastly submitted claim.
[CUSTOMER][NEUTRAL] Through fax, uh, I wanna know that, um, I wanna know that, uh, do you receive that claim or not?
[AGENT][NEUTRAL] OK, I
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can check a claim for you. And can I get your name and your callback number, please?
[CUSTOMER][NEUTRAL] Sure. Uh, myself, [PII], last initial [PII] as well.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Callback number is [PII] and it's a direct line.
[CUSTOMER][NEUTRAL] Like.
[AGENT][NEUTRAL] OK and then is this claim for yourself or is it for a patient?
[CUSTOMER][NEUTRAL] It's for a patient because I'm calling from the provider's office dermatology PLLC.
[AGENT][NEUTRAL] OK. And then what is the patient's name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, uh, the patient's name is uh [PII].
[AGENT][NEUTRAL] OK. And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Sure. It's [PII], uh spelled [PII].
[AGENT][NEUTRAL] Oh, what is [PII]?
[CUSTOMER][NEUTRAL] OK. And their date of birth, date of birth is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And then what is the insured's policy number?
[CUSTOMER][NEUTRAL] Sure. Uh, policy number is uh gonna be
[CUSTOMER][NEUTRAL] 02164248.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][POSITIVE] Sure. Take your time.
[AGENT][POSITIVE] Thank you, sir.
[AGENT][NEUTRAL] Oh, [PII]. OK, I see.
[AGENT][NEUTRAL] And then what is the date of service?
[CUSTOMER][NEUTRAL] Sure, uh, the date of service of the claim is, uh.
[CUSTOMER][NEUTRAL] [PII]. And their total charges are $210 even.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Alright, and can you get the name of the facility? I just got the dermatology. I didn't get the first name of the dermatology.
[CUSTOMER][NEUTRAL] Strager, Schrager Dermatology, PLLC.
[AGENT][POSITIVE] OK thank you I appreciate it. I'm gonna put you on a brief hold, [PII], and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me. I do find the claim.
[AGENT][NEUTRAL] The claim number is 3541843.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied because office visits are not covered under the patient's policy.
[AGENT][NEUTRAL] We received the claim.
[CUSTOMER][NEUTRAL] And when it was processed?
[AGENT][NEUTRAL] We received the claim on [PII] and processed the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm. The claim was denied.
[CUSTOMER][NEUTRAL] D2 services billed are non-covered under the patient plan?
[AGENT][NEUTRAL] Right. Office visits are not covered by the patient's plan.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] It's not an office visit. The CPT code filled in this claim was 88305, which is a level 4 pathology service. It's a service that uh rendered before uh providing the surgery or other kind of treatment. It's only for the purpose of checking the patient's.
[CUSTOMER][NEUTRAL] The skin issue or skin type. This is the only the way we check that one before providing services to the patient. I wanna know that why it's not covered because uh it's only examination service.
[AGENT][NEUTRAL] OK, um, I can take your name and number and put in a request for somebody from the claims department to call you.
[AGENT][NEUTRAL] Because I can only verify how the claim was processed, um, what is your, is this phone number the [PII], is that a good number to call you back on?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, it's, and it's a direct line.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I.
[CUSTOMER][NEGATIVE] And there is no extension.
[AGENT][NEUTRAL] Thank you. I'm gonna put you on a brief hold while I get that request sent in. I'll, I'll be right back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK [PII], I I have that request in for you now. You should be getting a phone call back within 24 hours.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Can I get the reference number for this call?
[AGENT][NEUTRAL] OK, well
[AGENT][NEUTRAL] Yes, you can use my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] [PII] and the initial of your last name, [PII], right?
[AGENT][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you. Thank you. Thank you for your assistance. It's a pleasure to talk with you. Have a nice day. Bye for now.
[AGENT][POSITIVE] You're very welcome.
[AGENT][POSITIVE] You have a good day too, and thank you for calling APL. Bye-bye.