AccountId: 011433970860
ContactId: bc09174c-7b08-452f-9e59-7a931bf42ec6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 307190 ms
Total Talk Time (AGENT): 117622 ms
Total Talk Time (CUSTOMER): 101027 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/bc09174c-7b08-452f-9e59-7a931bf42ec6_20250521T16:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] and. My initial is [PII] calling from provider's office to check on claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] One claim.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Uh, the good callback number is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] As for the member ID I have it starts with 02556914.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, for the member's name is uh [PII] [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] For this member's date of birth is uh [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and total bill for the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, for the date of service is [PII], this total bill amount is uh $320 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And I believe I just located the policy. Hold on one moment, or the claim, I'm sorry.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] For this provider's name is clinical radiologist TSC.
[AGENT][NEUTRAL] Alright, so I'm sure we received the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is 354-4755.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because it's not a covered, uh, or not a covered uh service. Covered diagnostic benefits for this policy are limited only to MRI, CT scans.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And colonoscopy.
[CUSTOMER][NEUTRAL] Like, um,
[CUSTOMER][NEUTRAL] It's uh uh it's not covered under the patient's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, what was the, like, uh, how much amount need to be patient?
[AGENT][NEUTRAL] We don't determine patient responsibility because we're not the major medical insurance company.
[CUSTOMER][NEUTRAL] Like for this whole amount, we need to be patient only?
[AGENT][NEUTRAL] Again, we do not determine patient responsibility. That will be up to you as the provider, whatever your policies are for um outstanding or remaining balances.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, how much we need to adjust the claim for this balance amount to provide us contractual adjustment?
[AGENT][NEUTRAL] The questions that you're asking, I can't answer because we do not determine patient responsibility. So it would be up to your provider's office to determine if you're going to bill the patient, write it off. We can't advise you of that because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK. Thank you so much, ma'am. Uh, what was the patient's plan have?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Plan
[AGENT][NEUTRAL] It's a hospital indemnity policy.
[CUSTOMER][NEUTRAL] What was the patient's plan name?
[CUSTOMER][NEUTRAL] Hospital.
[AGENT][NEUTRAL] Hospital indemnity.
[CUSTOMER][NEUTRAL] Diminutive policy.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Policy.
[CUSTOMER][POSITIVE] OK. Thank you so much, ma'am, for this info.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Call reference number?
[AGENT][NEUTRAL] So there's no call reference number?
[CUSTOMER][NEUTRAL] No, I don't have any address.
[AGENT][NEUTRAL] There's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, thank you so much, [PII], for this info. Have a great day. Bye for now.
[AGENT][POSITIVE] Thank you, [PII] also and thanks for calling APL. Bye-bye.