AccountId: 011433970860
ContactId: ae751c48-9b85-4797-8823-0df91dabdb43
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 237470 ms
Total Talk Time (AGENT): 96845 ms
Total Talk Time (CUSTOMER): 125721 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/ae751c48-9b85-4797-8823-0df91dabdb43_20250221T15:11_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, um, I just have a question on how a claim we sent in was processed.
[AGENT][NEUTRAL] OK, and may I ask who's calling?
[CUSTOMER][NEUTRAL] Uh, my name is [PII], and I'm calling from a provider's office.
[AGENT][NEUTRAL] OK, Ms. [PII], what's that policy number? Oh, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Wasn't sure which
[CUSTOMER][NEUTRAL] Uh, I was gonna say I don't know if I pressed the right number or not, it was, uh, but anyways, uh.
[AGENT][NEUTRAL] Oh, you're fine. Oh, I can assist you with that.
[CUSTOMER][NEUTRAL] OK, good. Uh, the policy number is 02107804.
[AGENT][POSITIVE] OK, thank you. Give me one moment please.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII]. I'm at [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Uh, the name is [PII], I don't know, uh, [PII].
[AGENT][NEUTRAL] You can.
[AGENT][NEUTRAL] I was gonna say you can spell it if you need to, but um.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] What was that data service and amount of the charge?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII] and the bill amount is.
[CUSTOMER][NEUTRAL] I do not see it on here. 0 $170.
[AGENT][NEUTRAL] OK, and do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Uh, let me look, hold one sec.
[AGENT][NEUTRAL] Oh, let's see.
[CUSTOMER][NEUTRAL] Uh, it would just be $40 the a copay.
[AGENT][NEUTRAL] OK. And, sure.
[CUSTOMER][NEUTRAL] So I, I just have a quick question. I had called back in September of last year. I've spoken with someone and they had said that only procedures were covered under this policy, like no office visits, uh, so, but I didn't ask about pathology and so this, that's what this is and so I'm just, I just wanna verify because on here it states that uh our providers not participating in the network. So I just wanna make sure, uh, I just wanna verify exactly why it's being um not processed.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, well, we don't have a network uh since it's a secondary policy and um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See, and you're calling from?
[CUSTOMER][NEUTRAL] Southeast dermatology.
[AGENT][NEUTRAL] OK, uh, Ms. [PII], I'm sure that claim processes the benefits, the outpatient benefits has maxed for the year. The insured has an outpatient benefit that pays up to $500 per calendar year, and they've already met that max.
[CUSTOMER][NEUTRAL] OK, so benefits max, um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, all right, um.
[CUSTOMER][NEUTRAL] I think, OK, can I, do you mind if I ask you, um, if the lady that I spoke with if she gave me the correct information if like past and stuff is not covered, just only procedures like an office visit wouldn't be covered. I just wanna make sure, um, I, because I'm sure the patient will call. I just wanna make sure that I have all the correct information.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, she was correct. They do have the patient has a rider that covers treatment or procedures in the office if it's for sickness or an injury, but just not the visit itself.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So any lab, diagnostic, surgery, um, performed in office is covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So this would have been covered if she wouldn't have been max.
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, alright, cool, alright, would you mind if I got a reference number please?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] Would you, would you mind spelling your name for me?
[AGENT][NEUTRAL] Sure, it's [PII], last initial [PII].
[CUSTOMER][POSITIVE] All right well thank you so much I appreciate your help.
[AGENT][POSITIVE] You are welcome, Ms. [PII], and thank you for calling APL. Have a great day and weekend.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][NEUTRAL] Bye.