AccountId: 011433970860
ContactId: ba32a866-8bd5-4af0-8da1-1e54f5b160f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 800760 ms
Total Talk Time (AGENT): 204301 ms
Total Talk Time (CUSTOMER): 392405 ms
Interruptions: 15
Overall Sentiment: AGENT=0.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/ba32a866-8bd5-4af0-8da1-1e54f5b160f7_20250217T20:13_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hello, my name is [PII] and I'm calling from the provider's office. How are you today?
[AGENT][NEUTRAL] I'm fine, and I'm sorry, your name is again?
[CUSTOMER][POSITIVE] Glad [PII] last initial B [PII]. Can I know yours please?
[AGENT][NEUTRAL] Sure, it's [PII], last name, last initial [PII], and glad, um how may I assist you today?
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Could you please help me out with the claim status of for a member?
[AGENT][NEUTRAL] OK, what's that policy number, please?
[CUSTOMER][NEUTRAL] Uh, that is 01852040. M as in Mary, L as in Larry, number 8.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], [PII]. [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] The amount of the claim is going to be $72,920.40.
[AGENT][NEUTRAL] OK, thank you. And glad do you have the balance after primary is processed the claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Give me 1 2nd please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm. Just give me one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] My system got stuck here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much for waiting. I really appreciate your patience. Um, the primary left patient responsibility is going to be $402.90.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. I'm showing a claim initially process is diagnostic facility is not covered. And the second time it was processed, it's not a covered place of service for the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] one.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] A subservice.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] With this policy is secondary, uh, place, uh, outpatient is considered ER, urgent care, ambulatory surgery center, MRI or imaging center, and the place of service of this claim is not covered for the policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Hey, thank you so much for waiting. I really appreciate it.
[CUSTOMER][NEUTRAL] I've got a claim. I mean, I've got multiple claims which are being paid for this member with the same place of service that we billed. Um, do you want me to help you with the claim number?
[CUSTOMER][NEUTRAL] Which you have paid.
[AGENT][NEUTRAL] You can give me a claim number and I can review.
[CUSTOMER][NEUTRAL] Uh, I do not have an ERA with me one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I can give you the date of service.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, your claim number, one second, one second, I'm just searching for that.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much for waiting. Uh, I have a claim number that is 3508824.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said 3508824?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yeah, so we received that claim and that claim process is not a covered place of service for the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, it's also the same? OK.
[AGENT][NEUTRAL] Yes, that also process is not a covered place of service.
[CUSTOMER][NEUTRAL] Not a covered place of service. So, do you, uh, do you not cover the medic medical um services?
[AGENT][NEUTRAL] Services are not covered when performed in a dialysis uh facility. Like I said, for outpatient facility is outpatient hospital, ER, urgent care, ambulatory surgery center, MRI or imaging center. If outpatient services are not performed in one of those places of service, it's not covered per the patient's policy with us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, what kind of plan does the member have?
[AGENT][NEUTRAL] It is a secondary supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you do not follow the Medicare guidelines.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, I had more 22, well, I mean, I've got 12, yeah, 2 claims more. Just wanna verify the denial.
[AGENT][NEUTRAL] For the, for the same patient or a different patient?
[CUSTOMER][NEUTRAL] Same member. Can you help me with the claim number for this one?
[AGENT][NEUTRAL] From [PII] you ask initially?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it is 353-351-2.
[CUSTOMER][NEUTRAL] And when was this claim denied on?
[AGENT][NEUTRAL] Uh, this claim processed on [PII].
[CUSTOMER][NEUTRAL] They're not on the same date, right?
[AGENT][NEGATIVE] It denied on [PII], received on [PII].
[CUSTOMER][POSITIVE] OK, thank you. I'll pull out the next date of service. It's just right here. You're welcome, and that is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is going to be for [PII].
[CUSTOMER][NEUTRAL] know
[AGENT][NEUTRAL] Amount of the charge.
[CUSTOMER][NEUTRAL] Amount on the claim is $55,271.53.
[AGENT][NEUTRAL] OK, and so that claim has been processed, it's not a covered place of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it process out of network also?
[AGENT][NEUTRAL] We don't have a network.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And can I have the claim number for this one?
[AGENT][NEUTRAL] Sure. It is 354-467-1.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][POSITIVE] OK, thank you so much. Just one more left.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and this is for [PII].
[AGENT][NEUTRAL] Amount of the charge?
[CUSTOMER][NEUTRAL] $65,286.25.
[AGENT][NEUTRAL] OK, uh, so this claim also processed is not a covered place of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, this claim was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] we
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I'm so sorry, did, did we get the previous date of, uh, date of service process date? Yes, we did. No, we didn't. But can you help me with the claim number for this one, for the current [PII].
[AGENT][NEUTRAL] For December, uh, that claim number is 354467-1.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh no, I'm sorry, I gave you the wrong one. It's 356-099-8.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So and also the dialysis services are not covered under the member's plan, right?
[AGENT][NEUTRAL] Uh, and that facility is not covered.
[CUSTOMER][NEUTRAL] Under the providers plan, OK.
[AGENT][NEUTRAL] No, on the patient's policy with our company, uh, outpatient dialysis facility is not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, could you please repeat that line again? I'm so sorry. I'll just take a note of it.
[AGENT][NEUTRAL] The outpatient dialysis facility is not a covered place of service per the patient's policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Um, no, that's it. Thank you.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Can I, can I get a call reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. You may use my name in today's date.
[CUSTOMER][POSITIVE] OK perfect thank you so much [PII] you have a lovely day ahead.
[AGENT][POSITIVE] Alright, you too. Thanks for calling APL. Bye.
[CUSTOMER][NEUTRAL] Bye bye.