AccountId: 011433970860
ContactId: af901665-cd17-4038-8245-256d01d7da13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 904080 ms
Total Talk Time (AGENT): 213702 ms
Total Talk Time (CUSTOMER): 260223 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/af901665-cd17-4038-8245-256d01d7da13_20250530T22:15_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII] speaking from provider's office regarding claim status. Can you help me with that?
[AGENT][NEUTRAL] Sure, I can verify claim status for you and your name is again?
[CUSTOMER][NEUTRAL] [PII]. Initial first name is [PII]. Can you spell out your name for me?
[AGENT][NEUTRAL] [PII] last initial [PII] And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] It is 02428173 M as in Mary, L as in Lima, 7.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it's [PII] with an extension [PII].
[AGENT][NEUTRAL] And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] [PII] for a total charge of $78 even.
[AGENT][NEUTRAL] You said $28?
[CUSTOMER][NEUTRAL] $78.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and the name of the provider's office?
[CUSTOMER][NEUTRAL] It is CCF Western Clinic.
[AGENT][NEUTRAL] Uh, show the claim process is service not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The claim processed as service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And the doctor's office.
[CUSTOMER][NEUTRAL] OK. So what can you do for the claim to be processed then?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] What can we do for the claim to be processed?
[AGENT][NEUTRAL] I'm not understand what you're asking. You need to contact the patient. Their policy with our company does not cover procedures in office, so it was denied. So if any status, you need to contact the patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was denied at the patient policy, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is it denied under patient policy?
[AGENT][NEUTRAL] Yes, per the patient's policy is not covered.
[CUSTOMER][NEUTRAL] OK. May I know that what would be the provider discount?
[AGENT][NEUTRAL] There is no discount, we don't discount claims.
[CUSTOMER][NEUTRAL] OK, what is the patient responsibility then?
[AGENT][NEGATIVE] We don't give patient responsibility.
[AGENT][NEUTRAL] We only verify how the claim was processed.
[CUSTOMER][NEUTRAL] OK. May I know the claim number?
[AGENT][NEUTRAL] 352-360-3
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. And the KK I do have a few more questions. Would you please like to help me with that?
[AGENT][NEUTRAL] What is the next, well, hold on one moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, what is the next policy number?
[CUSTOMER][NEUTRAL] 02344566.
[AGENT][NEUTRAL] Patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII] on [PII].
[AGENT][NEUTRAL] OK, data service amount of the charge.
[CUSTOMER][NEUTRAL] [PII] for a total charge of $444.
[AGENT][NEUTRAL] Uh, we have not received that claim.
[CUSTOMER][NEUTRAL] OK. May I know what will be the time you plan to resubmit the claim?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] May I know the time you're trying to resubmit the claim?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] OK. May I know when was the patient affected with the insurance?
[AGENT][NEUTRAL] [PII] and the policy is active.
[CUSTOMER][NEUTRAL] OK. May I know the mailing address and the payer ID?
[AGENT][NEUTRAL] Pay ID 60801, mail address [PII], [PII] [PII].
[CUSTOMER][NEUTRAL] Sorry, [PII].
[AGENT][NEUTRAL] [PII], OK, [PII].
[CUSTOMER][NEUTRAL] What is the zip code?
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. I got it.
[CUSTOMER][POSITIVE] Thank you for the information and uh let's go with another patient whenever you are ready.
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][NEUTRAL] It's 148427. M as in Mary, L as in Lima, 7.
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. Sounds like it's missing a number. Do you have a copy of the card in front of you?
[CUSTOMER][NEUTRAL] Uh, let me check.
[CUSTOMER][NEUTRAL] Sorry, I don't have it.
[AGENT][NEUTRAL] OK, well, you need to contact the patient for that one because that's not one of our policy numbers.
[CUSTOMER][POSITIVE] OK, not an issue.
[CUSTOMER][NEUTRAL] Let's go with another patient I had.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the next number ID is [PII].
[AGENT][NEUTRAL] Patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, data service amount of the charge.
[CUSTOMER][NEUTRAL] [PII] for a total charge of $336.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Uh, that claim has not been received.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. May I know that when was the patient affected with the insurance?
[AGENT][NEUTRAL] Effective date [PII], policy is active.
[CUSTOMER][NEUTRAL] OK, there's no time in flying, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. And the mailing address and the pay ID remains the same, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you for that. Let's go with another patient I had.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] They say
[AGENT][NEUTRAL] OK, what is next policy number?
[CUSTOMER][NEUTRAL] It's going to be 01988421, M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] Patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII]. [PII].
[AGENT][NEUTRAL] OK, data service amount of the charge.
[CUSTOMER][NEUTRAL] [PII] for a total charge of $969.
[AGENT][NEUTRAL] And as sure that claim processes office visits are not covered per the patient's policy.
[CUSTOMER][NEUTRAL] OK, per patient policy.
[CUSTOMER][NEUTRAL] OK. May I know the claim number?
[AGENT][NEUTRAL] 3572235
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] And let's go with another patient.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, what is the next policy number?
[CUSTOMER][NEUTRAL] 02462344. M as in Mary, L as in Lima, 7.
[AGENT][NEUTRAL] Patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Data service amount of the charge.
[CUSTOMER][NEUTRAL] [PII] for an amount of $937.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's uh not a covered loss under the plan, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] Not a covered benefit under patient plan?
[AGENT][NEUTRAL] Not a covered the loss per the patient's policy.
[CUSTOMER][NEUTRAL] Patient policy, what would be the patient responsibility in this?
[AGENT][NEUTRAL] We don't give patient responsibility. We can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] 3589543
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And let's go with another patient I had.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what is next policy number and how many more do you have?
[CUSTOMER][NEUTRAL] This is the last one.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] 2341084 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Data service amount of the charge.
[CUSTOMER][NEUTRAL] [PII] for an amount of $690.
[AGENT][NEUTRAL] I'm sorry, give me that data service again.
[CUSTOMER][NEUTRAL] [PII] for an amount of $690.
[AGENT][NEUTRAL] Uh, balance after primary.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is the balance after the primary?
[CUSTOMER][NEUTRAL] It's $123.15.
[AGENT][NEUTRAL] Uh, don't show that claim has been received.
[CUSTOMER][NEUTRAL] OK. May I know that, can we resubmit the claim?
[AGENT][NEUTRAL] Yes, you can. Same address, same payer ID.
[CUSTOMER][NEUTRAL] And when was the patient affected with the insurance?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And that you, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] May I have your best call reference number KK?
[AGENT][NEUTRAL] You may use my name in today's date.
[CUSTOMER][POSITIVE] OK. Thank you, [PII], for the information you've been provided. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Bye.
[CUSTOMER][NEUTRAL] Yeah, bye-bye.