AccountId: 011433970860
ContactId: cc30145b-5cf6-4c80-9d16-ecf14f3af1db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343989 ms
Total Talk Time (AGENT): 141659 ms
Total Talk Time (CUSTOMER): 144368 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/cc30145b-5cf6-4c80-9d16-ecf14f3af1db_20250603T16:10_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Skin and Cancer Associates. How are you doing today?
[AGENT][POSITIVE] I'm great, thanks for asking. How are you?
[CUSTOMER][POSITIVE] I'm also doing good. Thank you for asking. And I'm calling to check the claim status.
[AGENT][NEUTRAL] Sure, I can assist you with that. Could you provide me with the spelling of your name and a callback number?
[CUSTOMER][NEUTRAL] Yes. My name is [PII], and my last name, first initial is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Could I have a callback number?
[CUSTOMER][NEUTRAL] And my good callback number is?
[CUSTOMER][NEUTRAL] Yes, before I proceed with that, please be informed that this call has been recorded for quality and training purpose. Would you like us to continue the recording?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah. And my good callback number is [PII] and it is a direct line.
[AGENT][NEUTRAL] What is the policy number of the member that you're calling to verify claim status for?
[CUSTOMER][NEUTRAL] Yeah. The patient's member ID is, it is 20681.
[AGENT][NEUTRAL] It's not long enough to be a policy number.
[CUSTOMER][NEUTRAL] OK. Please wait for a moment. It is 01802550. M as in Mike, L as in Lima, and number 7.
[AGENT][NEUTRAL] 01825?
[AGENT][NEUTRAL] Could you repeat the policy number?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Yeah, 01802550.
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, and number 7.
[AGENT][NEUTRAL] Thank you, could you verify the patient's name and date of birth that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] Yes, the patient's name is, first name is [PII], and the last name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service that you're calling to check the status of a claim for and I'll be able to assist you.
[CUSTOMER][NEUTRAL] It is for [PII].
[AGENT][NEUTRAL] What is your bill amount?
[CUSTOMER][NEUTRAL] The total bill amount is $241.
[AGENT][NEUTRAL] I do apologize, your phone is breaking up. Could you verify the date of service again?
[CUSTOMER][NEUTRAL] Yes. It is [PII].
[AGENT][NEUTRAL] And what is the procedure code?
[CUSTOMER][NEUTRAL] The procedure code is 99203.
[AGENT][NEUTRAL] There was no payment made on this claim and the reason why there was no payment is because office visits are not covered under the member's policy, so the member's policy does not cover office visits.
[CUSTOMER][NEUTRAL] members
[CUSTOMER][NEUTRAL] Uh, policy does not cover office visits.
[AGENT][NEUTRAL] Yes, this claim was received [PII] and it was processed, I'm sorry, [PII] and it was processed [PII]. So per the policy, the policy does not cover office.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] It does not cover office visits. So, can we charge this amount from the patient?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So being that we're not a primary insurance company, I can't tell you that all I can verify is that we didn't make a payment because office visits are not covered under the policy, no.
[CUSTOMER][NEUTRAL] Uh, yes, uh, actually, we received payments for, from the primary insurance and it was applied towards patient responsibility and so that is the reason we have built to bill it to APL for the patient responsibility of primary insurance. So we received denial stating CO20 for non-covered charges.
[AGENT][NEUTRAL] Right, and so that balance is still owed to you guys, so unfortunately I can't tell you that you can charge bill the patient because this is not a primary insurance company. I can only verify that we didn't make a payment and your balance is still due, so I'm not sure what decisions you will have to make. however, I can only verify what's in the system here at American Public Life and tell you the outcome of it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, I just want to confirm that with her, so then we, we, this, uh, we can bill this to patients. That is the reason we are calling. So we are having.
[CUSTOMER][NEUTRAL] Uh, so many claims with the same reason, uh, as this office visits are not.
[AGENT][NEUTRAL] Right, but we, we're not a primary insurance company to tell you that you can.
[AGENT][NEUTRAL] Bill the patient we can only verify that there was no payment made on the on the claim that you submitted so your balance is still due, but I can't tell you that because we're not, I can't tell you that you can build the patient because we're not a primary insurance company. So I'm not, I don't have jurisdiction to tell you that. I just know that there is no network to this policy, there is no allowed amount, the benefits are not covered under the policy, therefore your balance is still due.
[CUSTOMER][NEUTRAL] OK. Uh, so, can I get the call reference for this number?
[AGENT][NEUTRAL] We don't provide those, however, you can use my name and today's date as a reference is [PII], and today's date is a reference.
[CUSTOMER][POSITIVE] Uh thank you, [PII]. Thank you for your information. Have a nice day. Bye for now.
[AGENT][POSITIVE] Thanks for calling APO you have a great day as well. Goodbye.