AccountId: 011433970860
ContactId: c667296a-9adc-4028-8429-a2f625c2b4a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 738919 ms
Total Talk Time (AGENT): 271332 ms
Total Talk Time (CUSTOMER): 303072 ms
Interruptions: 8
Overall Sentiment: AGENT=0.9, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/c667296a-9adc-4028-8429-a2f625c2b4a9_20250212T18:09_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider's office checking on the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, uh-huh, actually I have got two claims to check the status.
[AGENT][NEUTRAL] OK. Are the claims for the same patient or different patients?
[CUSTOMER][NEUTRAL] Those are for the different patients actually.
[AGENT][NEUTRAL] Yes, [PII], I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] My callback number would be [PII] [PII].
[AGENT][NEUTRAL] Thank you and [PII], uh, before we get started, um, a few things, pieces of information for you. So you will use my name that I gave you along with today's date as your call reference number.
[AGENT][NEUTRAL] Also, if we do have the claims on file for these patients and you need a copy of the explanation of benefits, you may print them from our portal and our website for that is [PII].
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] [PII] with the total charges of $1,763.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then lastly [PII] any information that I do provide for you will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] It will.
[CUSTOMER][NEUTRAL] No, I
[AGENT][NEUTRAL] So
[CUSTOMER][POSITIVE] Thank you so much for the information. And if you don't mind, could you please spell out your name for me?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Right, right, and your first initial and last name?
[AGENT][NEUTRAL] [PII] [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the patient first patient's policy number, please?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Sure. Uh, uh, it's 021-38757.
[AGENT][NEUTRAL] OK, thank you. Give me a moment to get the member's information pulled up.
[CUSTOMER][POSITIVE] Sure, take your time, not a problem.
[AGENT][POSITIVE] Mhm. Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] My pleasure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually.
[AGENT][NEUTRAL] OK, so what is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] 351.
[CUSTOMER][NEUTRAL] All right. And the patient's first name is [PII]. Last name is [PII], and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service and total bill amount for him please.
[CUSTOMER][NEUTRAL] Sure, and the date of service is [PII] and the total bill amount is $542 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was received. The received date was 7-15-2024.
[CUSTOMER][NEUTRAL] That that's.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3482399.
[CUSTOMER][NEUTRAL] for.
[AGENT][NEUTRAL] And the reason for the denial.
[CUSTOMER][NEUTRAL] Yep, 348-2399.
[AGENT][POSITIVE] Yes, sir. That's correct.
[CUSTOMER][NEUTRAL] OK, only 33482399 is the claim number, right? All right.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And this claim was denied for the reason office visits are not covered by the above numbered policy. The member's plan does not cover office visits, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what kind of plan does the patient is having?
[AGENT][NEUTRAL] This is a supplemental.
[AGENT][NEUTRAL] Plan. We are not a major medical insurance.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so do you suggest us to build the patient for this?
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] And you said we can use your call. I can use your name at it as a conference number, right?
[AGENT][NEUTRAL] Yes, that is correct. Uh-huh. And do you need any additional information on this number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, just let, uh, love me a quick moment. Let me check that previously have you received any payments from, uh, APL for the office visits.
[AGENT][NEUTRAL] On this member's policy, office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Hey, I thank you so much for the confirmation.
[CUSTOMER][NEUTRAL] And shall let we
[CUSTOMER][NEUTRAL] One for the next member?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It's $1500.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And the next patient's policy number?
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] And the next member's policy number is 01989438 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And your patient's name and date of birth on this policy?
[CUSTOMER][NEUTRAL] Mm the first name is [PII] and first last name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] Inte of services [PII], and the total bill amount is $4,103 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] We.
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][POSITIVE] [PII] I be strong.
[AGENT][NEUTRAL] And you said the total bill amount is $4,103 is that correct?
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Yes, it's 4103.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Just.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] Give me just a moment to look at a few claims. I've not located a claim for that bill amount for this number, so just a moment.
[CUSTOMER][POSITIVE] Oh, I take your time, not a problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Last name is [PII]. It's [PII]
[AGENT][NEUTRAL] And what is the provider facility name?
[AGENT][NEUTRAL] That you're calling on behalf of?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, Gastro Health, uh, do you require the NPI? Do you want to spell you out there, spell out the NPI, like, I mean, say the NPI.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] On then
[AGENT][NEUTRAL] What is the tax ID number?
[CUSTOMER][NEUTRAL] The tax ID is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] So, I do not have a claim on file for the billed amount that you are providing for me.
[AGENT][NEUTRAL] For this provider.
[CUSTOMER][NEUTRAL] OK, there is no claim on file.
[AGENT][NEGATIVE] Not for this billed amount, no, sir.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah thank you.
[AGENT][NEUTRAL] Give me just one more moment.
[AGENT][NEUTRAL] Uh, give me one second, just one moment.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] I may have found it.
[CUSTOMER][POSITIVE] Oh, I take it I'm not a problem.
[AGENT][NEUTRAL] OK, so this claim, I did locate it, we did receive it [PII] and it was processed the same date.
[CUSTOMER][NEUTRAL] OK, you have received.
[AGENT][NEUTRAL] Yes, it was processed the same date.
[AGENT][NEUTRAL] The claim number is 3541294.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this claim was denied and the reason for the denial states this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, uh, and this also means that office visits are not covered.
[AGENT][NEUTRAL] On this policy, it says the service.
[AGENT][NEUTRAL] Is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, this services were when, uh, not called when this are performed in a doctor's office or a clinic.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and the conference number is your
[AGENT][NEUTRAL] Yes, [PII], my name in today's, that is correct.
[CUSTOMER][NEUTRAL] Name it, right?
[CUSTOMER][POSITIVE] OK. Alright, [PII], thank you so much for the information. Have a wonderful day. Bye bye. Thank you.
[AGENT][POSITIVE] OK. Well, you're welcome. Yes, [PII]. Thank you for calling APL and I hope you have a nice afternoon also if that's all I can help you with today.
[CUSTOMER][NEUTRAL] OK, uh, is there any chance you can fax us the copy of EOB?
[AGENT][NEUTRAL] Uh, you can print it, yes, you can print it directly from the portal now that you have the claim number.
[CUSTOMER][NEUTRAL] Or do we need to take it from there?
[CUSTOMER][NEUTRAL] Yes, I think I don't have an access for the portal. That's why I was asking.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You would just create, yes, you can create your own, it's a self registering portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'll just send it myself to the portal. Thank you so much and uh I'm so sorry I just missed out the provider, uh, portal link. Could you, uh, spell out the link?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Again, the website is [PII].
[AGENT][NEUTRAL] Dot AM.
[AGENT][NEUTRAL] PUB
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, what I've got is [PII]
[AGENT][POSITIVE] That is correct, [PII].
[CUSTOMER][POSITIVE] All right, [PII]. Thank you so much. I really appreciate your patience. Have a wonderful day. Bye-bye. Take care.
[AGENT][POSITIVE] Well, you are very welcome. Absolutely. All right. You too, [PII]. Yes, you too. Thank you again for calling.
[CUSTOMER][POSITIVE] Oh, thank you so much. Bye-bye.
[AGENT][NEUTRAL] Bye bye.