AccountId: 011433970860
ContactId: add3638f-c69b-4216-8fca-0546e12d68a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 232149 ms
Total Talk Time (AGENT): 104770 ms
Total Talk Time (CUSTOMER): 146211 ms
Interruptions: 9
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/add3638f-c69b-4216-8fca-0546e12d68a4_20250217T14:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] Yeah, good morning. Uh, hi, I'm [PII] calling from provider's office to look on our claims general explanation, and could you please, uh, spell your name for me?
[AGENT][NEUTRAL] Sure, it's [PII]. And [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Q as in Quebec
[CUSTOMER][NEUTRAL] Yeah, the policy number is 982-078.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure. The callback number is [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And verify that patient's name, date of birth, please.
[CUSTOMER][NEUTRAL] Yeah, the patient's name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of er I'm sorry, yes, what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Yeah, the data service is [PII] with the amount of $195 even.
[AGENT][NEUTRAL] OK, thank you. And do you have the balance after primary has processed the claim?
[CUSTOMER][NEUTRAL] Yes, uh, that is $122.39.
[AGENT][NEUTRAL] OK, thank you. And while I'm looking at claim information let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][POSITIVE] OK, thank you and.
[CUSTOMER][NEUTRAL] Claim information let you know we do have an online service center where providers can check claim status as well as they should be that's something that.
[CUSTOMER][NEUTRAL] Some in public.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] Yeah, that's, uh, specialty orthopedic Group.
[AGENT][NEUTRAL] OK, I'm showing that claim process as DME durable medical equipment is not covered under the policy.
[CUSTOMER][NEUTRAL] OK, I'm sure my claim processed.
[CUSTOMER][NEUTRAL] And the medical is not covered under the policy.
[CUSTOMER][NEUTRAL] OK. Uh, under the patient's policy, right?
[AGENT][NEUTRAL] Correct. Per the patient's policy, durable medical equipment is not covered.
[CUSTOMER][NEUTRAL] The medical equipment is not covered. OK, um, well, so, uh, so that you have, uh, not paid, right?
[AGENT][NEUTRAL] Correct. Since it's not covered, it was not paid by our office.
[CUSTOMER][NEUTRAL] Can we
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK. Can we build the version for this one OK?
[AGENT][NEUTRAL] Uh, we can't give patient responsibility. We can only verify how we process the claim.
[CUSTOMER][NEGATIVE] Can't responsibility.
[CUSTOMER][NEUTRAL] Uh, I didn't get it clearly. Uh, can we build a patient for this one, or, uh?
[AGENT][NEUTRAL] We cannot give patient responsibility or tell you to bill the patient. We can only verify how we process the claim.
[CUSTOMER][NEUTRAL] We can't give patient responsibility or tell you to build the patient. We can only verify how we process the client.
[CUSTOMER][NEUTRAL] Mhm. OK, uh, thank you so much. OK. Is there any other, uh, denial, uh, you know, any any information for this denial, or only this one? OK.
[AGENT][NEUTRAL] I'm sorry, say that again.
[CUSTOMER][NEUTRAL] Uh, is there any other information for this detail, or the only reason is not covered under the patient's policy?
[AGENT][NEUTRAL] Well, I can give you the claim number and the date it was processed if you need that. And like I said, we do have the online service center to where you can check claim status and pull out that EOB if you like.
[CUSTOMER][NEUTRAL] Or we can give you the claim number and the date was processed if you need that and like I said we do have the online service centers where you can check claim status and pull out that if you like. OK, and may I know the uh claim number?
[AGENT][NEUTRAL] Uh, yes, sir. It is 3551764.
[CUSTOMER][NEUTRAL] It is 3551764. Mhm. Understood. Uh, may I know the call reference number please?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but you may use my name in today's date.
[CUSTOMER][NEUTRAL] We don't give reference numbers but you may use my name is.
[CUSTOMER][POSITIVE] Yeah, sure. Thank you so much, uh, OK, and have a wonderful day ahead. Thank you.
[AGENT][POSITIVE] Oh, you too. Thank you for calling APL. Bye.
[CUSTOMER][POSITIVE] You too, thanks for calling ATL.