AccountId: 011433970860
ContactId: c3954808-bb79-4767-9206-e875d5bc6417
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1417800 ms
Total Talk Time (AGENT): 301500 ms
Total Talk Time (CUSTOMER): 415204 ms
Interruptions: 14
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/c3954808-bb79-4767-9206-e875d5bc6417_20250121T20:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] For how may I help you? Hi, this is [PII] calling the provider's office to check on the claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing well. How are you doing today?
[CUSTOMER][POSITIVE] Yeah, I'm doing great as well. Uh, uh, can I know your name? Can you please spell it out for me?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you spell yours for me too, please?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] OK, thank you [PII] and what is your callback number just in case our call gets disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Disconnected. Yeah, sure. Uh, callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the um patient's name?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure. Give me a moment. Uh, you want patient's names?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] And what is [PII]'s?
[AGENT][NEUTRAL] Yes, thank you, ma'am. And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] A date of birth, yeah. It's [PII].
[AGENT][NEUTRAL] Thank you and then what is the policy number for [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's 1479338.
[AGENT][NEUTRAL] OK, and then so I can look up the claim for you. What is the date of service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And then the charge amount?
[CUSTOMER][NEUTRAL] Uh, give me a moment.
[CUSTOMER][NEUTRAL] The total charge amount is $675.04.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, to, or, uh, uh, voice is not that clear. Could you please check the line for me?
[AGENT][NEUTRAL] Yes, what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] It's $89.08.
[AGENT][NEUTRAL] OK, and what's the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Sorry, 0
[CUSTOMER][POSITIVE] Sure. Give me a moment. It's uh convenient care clinic.
[AGENT][NEUTRAL] OK, I'm going to put you on hold and look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Put you on
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. So looking for data service of [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I do not find a claim on file.
[CUSTOMER][NEUTRAL] I do find the claim
[CUSTOMER][NEUTRAL] So claim is not on file, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can I get the pay ID?
[AGENT][NEUTRAL] Yes, it's 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the mailing address?
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] C
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][POSITIVE] That's great, uh.
[CUSTOMER][NEUTRAL] Can you see whether the patient is active or not?
[AGENT][NEUTRAL] The policy lapsed on [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The patient is not active. OK.
[AGENT][NEUTRAL] Oh wait a minute, I see an active policy. I see an active policy. Let me check that one for you.
[CUSTOMER][NEUTRAL] checked out
[CUSTOMER][NEUTRAL] OK, sure. I need the effective date and termination date, OK?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'll give that to you in just a sec.
[CUSTOMER][NEUTRAL] I'll get that to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I did find the claim and the claim number is
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] and
[AGENT][NEUTRAL] 349-709-1.
[CUSTOMER][NEUTRAL] 3477.
[AGENT][NEGATIVE] And it was denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The office or
[CUSTOMER][NEUTRAL] So service is not covered as the provider, right?
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Services not covered for the patient's policy.
[CUSTOMER][NEUTRAL] type.
[CUSTOMER][NEUTRAL] For patient, OK.
[AGENT][NEUTRAL] And the effective date?
[CUSTOMER][POSITIVE] effective
[AGENT][NEUTRAL] Is [PII] and it policy is active.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] these back yeah.
[CUSTOMER][NEUTRAL] What is the term date?
[AGENT][NEUTRAL] There isn't one, the policy is active?
[CUSTOMER][NEUTRAL] OK, so now you find the claim, right?
[AGENT][NEUTRAL] Yes, I did.
[CUSTOMER][NEUTRAL] So it is uh not covered as per patients plan. So should I, should I be the patient.
[AGENT][NEUTRAL] I can't give patient responsibility that's determined by the provider.
[CUSTOMER][NEUTRAL] I can't responsibility.
[CUSTOMER][NEUTRAL] That's determined by
[CUSTOMER][NEUTRAL] OK. Uh, so can I get the business of this claim?
[AGENT][NEUTRAL] Can you what?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] EOB explanation of benefits.
[AGENT][POSITIVE] EOB, yes, can I get um your fax number and I'll get that right to you.
[CUSTOMER][NEUTRAL] Yeah yeah I get.
[CUSTOMER][NEUTRAL] Get that right to you. Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 3671.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold and send that fax.
[CUSTOMER][NEUTRAL] OK, but you
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you, [PII]. I've got that fax on its way to you.
[CUSTOMER][NEUTRAL] On this
[CUSTOMER][NEUTRAL] Yeah, uh, but still I have a few more questions to ask on this claim. Can you please clarify it for me?
[AGENT][NEUTRAL] A few more patients on the same claim.
[CUSTOMER][NEUTRAL] A few more on the no, no, a few more questions over the same claim.
[AGENT][NEUTRAL] OK, what are your questions?
[CUSTOMER][NEUTRAL] OK, I need to know receive date and denied date.
[AGENT][POSITIVE] Yes, ma'am. I can give that to you.
[CUSTOMER][POSITIVE] Yes ma'am, I can get that to you. OK.
[AGENT][NEUTRAL] The received date was [PII].
[CUSTOMER][NEUTRAL] Received it was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was processed on [PII].
[CUSTOMER][NEUTRAL] And the claim was processed on [PII]. That is the date, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, uh, then I need to know why it is not covered as per patients plan.
[AGENT][NEUTRAL] Because under the policy contract.
[CUSTOMER][NEUTRAL] Because I'm the policy contract.
[AGENT][NEUTRAL] It's not covered service, yes, it's not a covered service um in a doctor's office or a clinic.
[CUSTOMER][NEUTRAL] Because of the contract, yeah, not the covered service.
[CUSTOMER][NEUTRAL] Uh, in doctor's office or clinic.
[CUSTOMER][NEUTRAL] Because the provider is not contacted, right?
[AGENT][NEUTRAL] No, because under the policy contract this procedure is not covered in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] No, because under the the this procedure is not covered in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Policy contract procedure is not covered, OK.
[AGENT][NEUTRAL] Under the doc in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Under the doctor the doctor's office for clinic.
[CUSTOMER][NEUTRAL] OK. Uh, can I know the patient's plan type?
[AGENT][NEUTRAL] The patient has Medlink.
[CUSTOMER][NEUTRAL] The patient has Medli Medlink.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Uh, please, uh, could you wait for a moment?
[AGENT][NEUTRAL] I'm sorry, what did you say, ma'am? Can you repeat that?
[CUSTOMER][NEUTRAL] Can you wait for a moment? I'm putting you on hold for a few seconds.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thanks for your patience, story. Uh, may I know, can I be the patient for this claim?
[AGENT][NEUTRAL] I can't give that information that's determined by the provider.
[CUSTOMER][NEGATIVE] I can't get that information.
[CUSTOMER][NEUTRAL] Can we change the procedure code and uh resend the claim?
[AGENT][NEGATIVE] Uh, I don't think that's legal.
[CUSTOMER][NEGATIVE] Uh, I don't think that's legal.
[CUSTOMER][NEUTRAL] Uh, no, I, I couldn't hear you.
[AGENT][NEGATIVE] I don't believe that is legal.
[CUSTOMER][NEGATIVE] I don't believe that is legal.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII], you have said that uh it is not covered as per patients plan, right? That is the policy contract procedure is not covered in doctor's office, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So that's what I'm asking. Uh, can I change the procedure code and, uh, resend the claim, or, uh, can I build the patient for it?
[AGENT][NEUTRAL] I can't advise you on.
[AGENT][NEUTRAL] I can't advise you whether you should bill the patient. I can't advise you on what how you should file the claim.
[CUSTOMER][NEUTRAL] Uh, I need to know this.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] That's determined by the provider.
[CUSTOMER][NEUTRAL] That's determined by the provider.
[CUSTOMER][POSITIVE] Uh, that's great. OK.
[CUSTOMER][NEUTRAL] So you send me the uh EUB, right?
[AGENT][NEUTRAL] Yes, ma'am, I did.
[CUSTOMER][NEUTRAL] OK, uh, shall we move on to the next clean?
[AGENT][POSITIVE] Yes ma'am, we can.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what is the next patient's name?
[CUSTOMER][NEUTRAL] OK,
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] The next patient's name is uh [PII].
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then what's [PII]'s policy number?
[CUSTOMER][POSITIVE] Thank you and
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure. Uh, the policy number is 025496005.
[AGENT][NEUTRAL] OK, let me pull up that policy.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] Charge total charge amount is $597.32.
[AGENT][NEUTRAL] OK, and then what is the charges after primary paid their part?
[CUSTOMER][NEUTRAL] Uh, uh, no, I could see this is a primary payer.
[AGENT][NEUTRAL] OK, thank you and then what is the name of the facility that you're calling for?
[CUSTOMER][NEUTRAL] That you're calling for. Uh, the facility is Crossroad urgent care.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I look this claim up for you. I'll be right back.
[CUSTOMER][NEUTRAL] Put you on hold while let's just for you. Yeah, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, [PII], this is [PII]. So I have the claim for [PII], um, the
[CUSTOMER][NEUTRAL] Name for [PII].
[AGENT][NEUTRAL] The claim number is 351.
[CUSTOMER][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 6804.
[CUSTOMER][NEUTRAL] 6804.
[AGENT][NEUTRAL] It was reported on [PII].
[CUSTOMER][NEUTRAL] It was reported on [PII]. OK.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] It was processed on [PII].
[AGENT][NEGATIVE] And denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] May I know who is the primary, the primary carrier?
[AGENT][NEUTRAL] I don't have that information.
[CUSTOMER][NEUTRAL] I don't have that information.
[CUSTOMER][NEUTRAL] OK, can I get uh the UV of the screen?
[AGENT][NEUTRAL] I'm sorry, I can't hear you.
[CUSTOMER][NEUTRAL] I'm sorry I can't hear you.
[CUSTOMER][NEUTRAL] Can I get the EUP of this claim?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am. Yeah, to the same fax number which you provided previously, yeah.
[AGENT][NEUTRAL] Hold on real
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I get that for you. I'll be right back.
[CUSTOMER][NEUTRAL] Yeah, I'll put you on hold while I get that for you. I'll be right back. Yes, sure. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, [PII], this is [PII]. I've got that fax on the way to you.
[CUSTOMER][POSITIVE] Yes, sure, thank you so much. Uh, could you please, uh, be on hold for some time?
[AGENT][NEUTRAL] Yes, I can hold for a moment.
[CUSTOMER][NEUTRAL] Yes, I can hold for a moment. OK.
[CUSTOMER][NEUTRAL] Uh, yes, [PII]. I need to know the information, uh.
[CUSTOMER][NEUTRAL] When from when onwards the American public uh
[CUSTOMER][NEUTRAL] L is on, uh, is a secondary?
[AGENT][NEUTRAL] Yes, we are secondary.
[CUSTOMER][NEUTRAL] Yes, wait for second. Yeah, from when I need to know the date.
[AGENT][NEUTRAL] From the date that the policy became effective, which is [PII].
[CUSTOMER][NEUTRAL] From the day that the policy became effective, which
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, what is the timely filing limit for the rash?
[AGENT][NEUTRAL] There is not one.
[CUSTOMER][NEGATIVE] No timely filing limit.
[AGENT][NEUTRAL] No, we don't have one.
[CUSTOMER][NEUTRAL] No, we don't have one
[CUSTOMER][NEUTRAL] OK. Uh, can I get the mailing address?
[AGENT][NEUTRAL] Yes, ma'am. It's the same address, APL claims.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The city
[CUSTOMER][POSITIVE] OK, that's great. OK, thank you so much, [PII]. Thank you for the information you have provided.
[AGENT][POSITIVE] You're very welcome. You have a great day and thank you for calling APL.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] You do have a great day thank you bye bye.
[AGENT][NEUTRAL] You too, [PII]. Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Yeah