AccountId: 011433970860
ContactId: ba26f8ed-bfca-48af-845a-36ecd9e485f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 496679 ms
Total Talk Time (AGENT): 114448 ms
Total Talk Time (CUSTOMER): 110277 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/ba26f8ed-bfca-48af-845a-36ecd9e485f1_20250218T17:10_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, can you hear me?
[AGENT][NEUTRAL] I can hear you now.
[CUSTOMER][NEUTRAL] Yeah. Hi, this is [PII] calling on behalf of provider offers regarding claim status. Um, could you spell your name for me, please?
[AGENT][NEUTRAL] Sure, that's [PII], and I need a callback number just in case we get disconnected, Mr. [PII].
[CUSTOMER][POSITIVE] Yeah. Yeah, thank you, thank you so much. And my callback number is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] and the extension is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] And the patient number ID number is going to be, just a moment. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. It's [PII].
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, sure. And the member name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service in the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure. And the date of service.
[CUSTOMER][NEUTRAL] [PII] and the total bill amount is $117.85.
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this claim for you and for the future, you can check claim status online through our website at [PII] and that's gonna be optional. And bear with me, let me pull this EOP. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for me. OK, so, um, we processed this claim several times, but the last time we processed and denied um was um received on [PII], processed [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it was denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, just a moment, please hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's denied for office visit is not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, may I know it's non-offs that is non-governed patient plan or providers contact?
[AGENT][NEUTRAL] Patience plan.
[CUSTOMER][NEGATIVE] And you send this claim back for the process many times but it's still denying same, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] And may I know what is for the procedure to process this claim?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um, may I know what is the further procedure to process this claim?
[AGENT][NEUTRAL] It's been denied, so, um, it looks like it's been processed 123456 times. 2 are denied as office visits are not covered, the rest are denied as a duplicate. So it is denied by this policy. It's not going to be covered by this policy. So it's up to the provider's discretion for the remaining of the claim. You can go back to the primary EOB and see what they apply that to towards.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, just a moment. I will check if there is any other plan I have.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, now, may I know the call reference for this one?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Oh, no, thank you and thank you for your assistance and have a great day.
[AGENT][POSITIVE] You as well. Thank you for calling ATM. Bye-bye.
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, bye bye. Take care.
[AGENT][NEUTRAL] You too. Bye-bye, Mr. [PII].
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yeah.