AccountId: 011433970860
ContactId: ab203f06-6b6d-456a-bae2-c12bd9a27e8e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 505880 ms
Total Talk Time (AGENT): 107976 ms
Total Talk Time (CUSTOMER): 143953 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/ab203f06-6b6d-456a-bae2-c12bd9a27e8e_20250425T19:59_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is uh [PII] and initial of her last name is [PII], and I'm calling for a claim status.
[AGENT][POSITIVE] I'll be happy to assist with claim status today if I can get a good callback number for you.
[CUSTOMER][NEUTRAL] Um, yes, ma'am. My callback number is [PII] with an extension number of [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Uh, sorry?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] The policy number?
[AGENT][NEUTRAL] The patient's policy number that you're calling about.
[CUSTOMER][NEUTRAL] Oh, the member ID right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, um, sorry, that's the first time someone said that, so that's why I was, uh, so the member ID is 01963575.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] What was the last two?
[CUSTOMER][NEUTRAL] 75.
[AGENT][NEUTRAL] 75? OK.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, so the patient's name is [PII], and uh the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And what is the date of service?
[CUSTOMER][NEUTRAL] Um, so the data services.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, sorry, uh it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And your tax ID?
[CUSTOMER][NEUTRAL] Um, the tax ID is [PII].
[AGENT][NEUTRAL] OK, I'm not showing we have that claim on file.
[AGENT][NEUTRAL] Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Um, so there is no claim on file?
[AGENT][NEGATIVE] Not for that data service from the tax ID that you gave me, no.
[CUSTOMER][NEGATIVE] Not on that data service again uh.
[CUSTOMER][NEUTRAL] OK. Just a moment, ma'am.
[CUSTOMER][NEUTRAL] Um, so, ma'am, we even have received the UB.
[CUSTOMER][NEUTRAL] Um, for that same data service.
[AGENT][NEUTRAL] And what's the claim number on that EOB?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, so the claim number is 3521531.
[AGENT][NEUTRAL] And if you look what is the tax ID?
[AGENT][NEUTRAL] On that
[CUSTOMER][NEUTRAL] Tax ID on that uh on the explanation of benefits.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK. Yeah, that was my mistake. So, the tax ID is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Right, so when you gave me the other tax ID, I stated to you we don't have the claim on file for that data service for the tax ID that you gave me. So since you already have the EOB, how can I help you with this claim?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, I just need to know about the original process claim.
[AGENT][NEUTRAL] Claim denied because the 99215 is not covered under the policy and the 80305, there was no patient responsibility because the primary insurance didn't apply any patient responsibility.
[AGENT][NEUTRAL] Um, do you not see that on the EOB that we sent?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Well, we do, but man.
[CUSTOMER][NEUTRAL] Uh, sometimes we have to confirm things.
[AGENT][NEUTRAL] 00, OK. I'm sorry.
[CUSTOMER][NEUTRAL] So that we could know more right yeah so we just need to know a better explanation for that. So that's why we sometimes make a call to confirm that so um so it's not covered, OK, right.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK. So, ma'am, the EOB we received was, uh, was from a duplicated uh um claim. So the first claim, the original claim was also denied because of the same reason.
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] The the second time you sent the claim is denied as a duplicate.
[CUSTOMER][NEUTRAL] So
[AGENT][NEGATIVE] The first time it denied because the 99215 was not covered and the other charge there was no patient responsibility.
[CUSTOMER][NEGATIVE] There was no responsibility.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, so, can you please provide me a reference number for this call, ma'am?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] No, ma'am. Thank you for your time.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] You