AccountId: 011433970860
ContactId: aafa7d9e-9ec1-47a4-af62-1a555f8f530e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331220 ms
Total Talk Time (AGENT): 151853 ms
Total Talk Time (CUSTOMER): 115488 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/aafa7d9e-9ec1-47a4-af62-1a555f8f530e_20241230T14:11_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] Uh, hey, hi, [PII]. This is [PII]. I'm calling from provider's office.
[AGENT][NEUTRAL] Good morning. Do you mind spelling your name for documentation?
[CUSTOMER][NEUTRAL] Uh, it's gonna be [PII].
[CUSTOMER][NEUTRAL] And mine is still gonna be [PII].
[AGENT][POSITIVE] Thank you, ma'am. And what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, it's gonna be [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] And how can I help you this morning?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, actually I do have a dinner on the plane, so could you please ask this for me?
[AGENT][POSITIVE] It would be my pleasure to assist you with that claim information. Ma'am, do you have that that claim number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, yeah, I do have a claim number.
[AGENT][NEUTRAL] And that claim number is?
[CUSTOMER][NEUTRAL] Ma?
[CUSTOMER][NEUTRAL] Uh yeah, sure, it's gonna be 353-684-3.
[AGENT][NEUTRAL] And what is the data service?
[CUSTOMER][NEUTRAL] Uh, it's [PII] and then the total charge amount which is gonna be $146.76.
[AGENT][NEUTRAL] Thank you. And can you verify the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Sure, it's gonna be [PII] and the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And I am checking on that claim for you now. It is a nonco it was denied due to a non-covered diagnostic test.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is a limited indemnity policy.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And the diagnostic tests that are covered is an MRI CAT scan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A thyroid uptake, CT scan, PET scan, angiogram, baro enema, lower GI series, myelogram, nuclear stress test, arteriogram, barium swallow swallow upper GI series, sleep study, and transesophageal echocardiogram. So it is a non-covered diagnostic test.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so you're stating that that CPT which we have been billed, uh, which is not covered with the diagnosis code, am I right?
[AGENT][NEUTRAL] The diagnostic test is a non-covered diagnostic test.
[CUSTOMER][NEUTRAL] OK. So it's another patient's policy.
[AGENT][NEUTRAL] That's correct, and that's for the patient's plan.
[CUSTOMER][NEUTRAL] OK. Uh, and the type of plan is limited integrity policy, am I right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Thank you so much. Do the member is having any other insurance?
[AGENT][NEUTRAL] And not with APL.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So can we build this uh specific amount for the member?
[AGENT][NEUTRAL] And that would be determined by the provider. We're not major medical, so therefore we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Uh, sorry, I didn't get that.
[AGENT][NEUTRAL] Oh, we're not major medical. We don't determine patient responsibilities, so any billing would be determined by the provider.
[CUSTOMER][NEUTRAL] So you are stating that the specific uh 9993306 have been denied because it was a non-covered under the patient policy. And we can't bill it for the number, am I right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That would be determined by the provider. We can't, um, we don't determine whether you can bill the patient or not, so there's no contractual involvement in the processing of our claim. So if you bill the patient that would be determined by the provider.
[CUSTOMER][NEUTRAL] Uh, so what can be the resolution for this?
[AGENT][NEUTRAL] You would, you can either bill the patient or contact the patient. It's.
[AGENT][NEUTRAL] APL has no determining factor whether you bill the patient or not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that information. May I have the claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's the claim number you gave me 353-6843.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I have the call reference number and your name?
[AGENT][NEUTRAL] The call reference number would be my name and today's date, and I spell my name [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Have a great day bye.
[AGENT][POSITIVE] It was my pleasure to help you with that claim [PII]. Thank you for calling APL and I hope you have a great day as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank