AccountId: 011433970860
ContactId: c33e3e39-95d3-44f6-a4bd-ed5d0445a009
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 498859 ms
Total Talk Time (AGENT): 198599 ms
Total Talk Time (CUSTOMER): 111209 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/c33e3e39-95d3-44f6-a4bd-ed5d0445a009_20250410T13:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling from a provider's office regarding claims.
[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I'm calling from our provider's office regarding claims.
[AGENT][NEUTRAL] OK, you're needing to check a claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, just like, and who am I speaking with?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And [PII] and what is your callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you and how many clients carry and do you have?
[CUSTOMER][NEUTRAL] One.
[AGENT][NEUTRAL] To check status
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Yes, ma'am, I can help you with that. And what's the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 01994047 M as in Mary L 8.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII] and any information that I do provide for you today will be a verification of benefits and not a guarantee of payment so.
[AGENT][NEUTRAL] First off, if you could please verify your patient date of birth.
[CUSTOMER][NEUTRAL] You said the name and date of birth?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Can you repeat that?
[CUSTOMER][NEUTRAL] Oh yes, it's [PII] 111,680.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] Data services [PII] for 991.
[AGENT][NEUTRAL] You said the year was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes, mhm.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK
[AGENT][NEGATIVE] Hey, [PII]. So I can see that the Carrian that this claim has been raised, um, more than once. It's been denied. The most recent one was denied is a d.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Look at, are you needing the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, this claim that was received information.
[CUSTOMER][NEUTRAL] Original mhm.
[CUSTOMER][NEUTRAL] Yes mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me locate that.
[AGENT][NEUTRAL] OK, so this claim was received on multiple claims. The initial claim was only for 766.
[CUSTOMER][NEUTRAL] OK, let me just check.
[AGENT][NEUTRAL] And that was, mhm, yeah.
[CUSTOMER][NEUTRAL] Yeah, it is for 766 yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so 766.
[AGENT][NEUTRAL] OK, and
[AGENT][NEGATIVE] It was received on [PII]. It's been denied on 3-30-2023.
[AGENT][NEUTRAL] The claim number was 327.
[AGENT][NEUTRAL] 8874.
[AGENT][NEUTRAL] And the reason for the denial on that claim, states insured primary provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And did you guys have the primary EOB on file?
[AGENT][NEUTRAL] Yes ma'am, we can't process claims without those.
[CUSTOMER][NEUTRAL] OK, because it shows a $50 copay on it, so I'm not sure why it would have denied for that reasoning.
[AGENT][NEUTRAL] On what code does it show for the?
[CUSTOMER][NEUTRAL] $50 for the 31231.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let me look at that information that was received.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Actually it was for the 99214.
[AGENT][NEUTRAL] OK, so that was that's denied separately on the, because the next claim that was submitted and we denied the 31231 is a duplicate.
[CUSTOMER][NEUTRAL] It might have been, let me just double check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The 99214 was denied as office visits are not covered, and that's under a different claim number.
[CUSTOMER][NEUTRAL] OK, so offices it's not covered.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what's that claim number for that one?
[AGENT][NEUTRAL] OK, that claim number is
[AGENT][NEUTRAL] 356 842-5
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got you. I just wanna make sure that it applies to that one.
[CUSTOMER][POSITIVE] Wow
[CUSTOMER][NEUTRAL] I believe it did.
[CUSTOMER][NEUTRAL] Apply to the office visits, so you guys, even though it's secondary, you guys don't cover office visits. It's not on their plan.
[AGENT][NEUTRAL] That is correct. The this the right particular plan that she has, or he has, I'm sorry, does not cover office visits. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you, um, alright then I am all set. Can I take a reference number?
[AGENT][NEUTRAL] OK, sure, you would use my name along with today's date and then one last thing, uh, carrying in the future if you need a copy of these explanation of benefits for these two claim numbers, we have a portal that you should be able to print them from.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Um, and that portal website is.
[AGENT][NEUTRAL] The keyword
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do you mind repeating that one more time?
[AGENT][POSITIVE] Yeah, sure, [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, let me just make sure that it pops up, yep, got it.
[AGENT][POSITIVE] OK. Well, is, well, you are certainly very welcome. And again, is there anything else that I could help you with today?
[CUSTOMER][POSITIVE] That's perfect thank you so much.
[CUSTOMER][NEUTRAL] No, that was all.
[AGENT][POSITIVE] OK. Well, thank you so much for calling APO and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[AGENT][NEUTRAL] You