AccountId: 011433970860
ContactId: bf79b1c1-4840-4811-abd3-3bd77821861b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446679 ms
Total Talk Time (AGENT): 131906 ms
Total Talk Time (CUSTOMER): 138917 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/bf79b1c1-4840-4811-abd3-3bd77821861b_20250508T18:15_UTC.wav
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[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is An[PII]How may I help you?
[CUSTOMER][NEUTRAL] Hello, An[PII]My name is Je[PII]nd I'm calling from provider office. I want to know the status of the claim.
[AGENT][NEUTRAL] OK, well, I can help you with the claim status, and Je[PII]may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, yeah, sure. The contact number is 86[PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The policy number is 60801.
[AGENT][NEUTRAL] So that's our payer ID. Do you have a copy of the member's ID card there with you?
[CUSTOMER][NEUTRAL] Uh, let me check if I have that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, that's first uh Per ID which I'll provide you.
[AGENT][NEUTRAL] Yes, that's APL payer ID.
[CUSTOMER][NEUTRAL] OK. Sorry, we do not have the member's policy card. Could you please check uh the number?
[AGENT][NEUTRAL] OK. I can also
[CUSTOMER][NEUTRAL] Could you please check with the name and the date of birth?
[AGENT][NEUTRAL] Yes, I can check with the member's first and last name. I can't search with the date of birth until I get into the policy.
[CUSTOMER][NEUTRAL] Uh, thank you so much, An[PII]Yeah, the number of first name spelled as P [PII]and the last name spelled as S [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And I'm just waiting for the policies to populate here. Hold on one moment.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And this is for the medical policy?
[CUSTOMER][NEUTRAL] Yeah, that is for the medical policy.
[AGENT][NEUTRAL] OK, I believe I just located it. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] The date of birth is De[PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number is 240.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] 636 8.
[AGENT][NEUTRAL] And may I have the date of service and the total bill for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yeah, sure. The data service is Ma[PII]nd the charge.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Just the charge amount is $94.95.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And can you verify the name of the provider?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Office on the claim?
[CUSTOMER][NEUTRAL] Yeah, yeah, sure. The provider name is AdventHealth Respir and Equipment.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, I'm trying to received the claim on Ma[PII].
[CUSTOMER][NEUTRAL] On Ma[PII]OK.
[AGENT][NEUTRAL] The claim number is 358-032-7.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And on Ma[PII]the claim was denied because durable medical equipment is not covered on this policy.
[CUSTOMER][NEUTRAL] OK. But uh,
[CUSTOMER][NEUTRAL] As for the Medicare guideline that was covered.
[CUSTOMER][NEUTRAL] And the primary already pay for that.
[AGENT][NEUTRAL] OK, so this policy is not affiliated with Medicare and the insured's primary insurance has their own benefits as their secondary does, and the secondary policy does not cover durable medical equipment.
[CUSTOMER][NEUTRAL] Uh, OK. So, what we, uh, do on that, this type of denar?
[CUSTOMER][NEUTRAL] Are we eligible for the appeal?
[AGENT][NEUTRAL] Um, that would be
[CUSTOMER][NEUTRAL] Or not.
[AGENT][NEUTRAL] I mean, you can appeal at any time, but if the policy doesn't cover something, it just doesn't cover it. Um, for the remaining balance, it would be up to you as the provider and we don't determine patient responsibility because we're not the major medical, we're the second.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, just give me a moment. Let me check, uh, because that was, uh, 3 rental. Let me check what happened in the previous rental. Just give me a moment.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is the provider was uh in network or the out of network?
[AGENT][NEUTRAL] There's no in or out of network for the secondary insurance?
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK, please provide me the call reference number.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, and again, that's An[PII].
[CUSTOMER][POSITIVE] Thank you, An[PII]And thank you so much, An[PII].
[AGENT][POSITIVE] You're very welcome, Je[PII]Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Alright, thanks for calling AP[PII]Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.