AccountId: 011433970860
ContactId: adfd4995-742e-44db-b2c8-72dd1bf94e97
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285179 ms
Total Talk Time (AGENT): 130517 ms
Total Talk Time (CUSTOMER): 118736 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/adfd4995-742e-44db-b2c8-72dd1bf94e97_20250227T16:47_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII]. And what is the policy number, please?
[CUSTOMER][NEUTRAL] Sure, uh, the policy number is uh
[CUSTOMER][NEUTRAL] 02512377
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] OK, and this is for medical, correct?
[CUSTOMER][NEUTRAL] I like
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Uh, [PII] and the bill amount is $28 even.
[AGENT][NEUTRAL] OK, thank you. Give me one moment and while I'm looking up claim information and 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][NEUTRAL] you
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] Community Medical Associates.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But I'll be there.
[AGENT][NEUTRAL] OK, and I'm showing that claim process is any puncture is not covered by this policy.
[CUSTOMER][NEUTRAL] I can imagine.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The claim processed as any puncture is not covered per the policy.
[CUSTOMER][NEUTRAL] May I know the received date and receive date and processed date?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Sure. Claim was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Under the claim number?
[AGENT][NEUTRAL] 356-051-0
[CUSTOMER][NEGATIVE] So it has been denied as a non-covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I know for what reason it has been delayed for non-covered?
[AGENT][NEGATIVE] Cause the puncture is not covered for the patient's policy.
[CUSTOMER][NEUTRAL] So venous blood vein puncture is not covered under the patient's policy.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So it has been processed towards uh members responsible.
[AGENT][NEGATIVE] Uh, we don't give patient responsibility. It would just process is not covered.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEGATIVE] So it is not patient responsibility.
[AGENT][NEUTRAL] We don't give patient responsibility. We can only verify how the claim was processed, which was not covered.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, and [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, may I know the spell out your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you, OK, and may I have the call reference number?
[AGENT][NEUTRAL] We don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] You're welcome. Thanks for calling APL [PII]. Have a great day.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] I didn't receive any UOB regarding this uh claim number under this denial. Uh, could you please fax me the EOP?
[AGENT][NEUTRAL] As I stated, we do have an online service center where providers can check claim status as well as print out the EOB and that site is at [PII].
[CUSTOMER][NEUTRAL] It's an open portal or uh need to create a credential?
[AGENT][NEUTRAL] Uh, you would need to create an account, you need the payer ID and the patient not pay ID I'm sorry, the tax ID number and the patient account number, and from there you'll be able to set up a username and password and then you'll be able to verify claim status.
[CUSTOMER][POSITIVE] OK, thank you, thank you for assisting. Have a great day.
[AGENT][POSITIVE] Oh, you too. Thank you for calling APL. Bye.