AccountId: 011433970860
ContactId: cd7d1eae-f0c0-4a57-aa6f-9e4e02ec2623
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325440 ms
Total Talk Time (AGENT): 131791 ms
Total Talk Time (CUSTOMER): 205478 ms
Interruptions: 9
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/cd7d1eae-f0c0-4a57-aa6f-9e4e02ec2623_20250131T20:25_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], how may I help you? Um, hi, this is [PII] calling from the provider's office to check on a claim status.
[AGENT][POSITIVE] [PII], it would be a pleasure to assist you with claim status this afternoon. What is the callback number?
[CUSTOMER][POSITIVE] I said it would be a pleasure to assist you with my status this afternoon. What's the callback number? [PII]
[AGENT][NEUTRAL] Thank you, [PII], and the policy number for the patient?
[CUSTOMER][NEUTRAL] Thank you [PII] and the policy number for the patient? It is.
[CUSTOMER][NEUTRAL] 02292666.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Please
[CUSTOMER][NEUTRAL] Uh, sure. The patient name is
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][POSITIVE] Alright, thank you, it would be my pleasure to assist you with that claim status. Do you have a claim number or date of service?
[CUSTOMER][POSITIVE] Thank you. It would be my pleasure to assist you with that claim status. Do you have a claim number or date of service? Data services [PII] for the amount of $191 even.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the facility name?
[CUSTOMER][NEUTRAL] Can we send you what's the facility.
[CUSTOMER][NEUTRAL] It's MARC physicians.
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] Now, I am showing that we received that claim on [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Received that claim.
[AGENT][NEUTRAL] The claim was processed on [PII].
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] 12 184.
[AGENT][NEGATIVE] And it was denied because office visits are not covered per the policy guidelines.
[CUSTOMER][NEGATIVE] And it was denied because office visits are not covered for the policy guidelines.
[AGENT][NEUTRAL] So it was tinn is uncovered.
[CUSTOMER][NEGATIVE] So that is not covered.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] And I can provide that claim number if you need that, [PII].
[CUSTOMER][NEUTRAL] Um, yes, may I know the claim number?
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] 354.
[AGENT][NEUTRAL] 2734
[CUSTOMER][NEUTRAL] 734. Thank you so much. And can you please confirm that it uh non-covered as per the patient's plan or the provider's contract?
[AGENT][NEUTRAL] It's for the patient's plan.
[CUSTOMER][NEUTRAL] For the patient's plan. Uh, could you please confirm the patient's plan type?
[AGENT][NEUTRAL] It is a secondary gap policy, Medli gap.
[CUSTOMER][NEUTRAL] Um, is it like a HMO PPO like that?
[AGENT][NEUTRAL] No, it's like a supplemental plan.
[CUSTOMER][NEUTRAL] Supplemental plan.
[CUSTOMER][POSITIVE] OK, thank you so much. And so, um.
[CUSTOMER][NEUTRAL] Is it possible to send a copy of EOB through my fax?
[AGENT][NEUTRAL] And we do have a provider portal it's quicker if you can get that EOP from the portal I can assist you with creating an account if you don't have an account listed.
[CUSTOMER][NEUTRAL] We do have a provider portal. It's quicker if you can get that EOB from the portal. I can assist you with creating an account if you don't have an account listed. Mhm. OK. So I will check that one.
[CUSTOMER][NEUTRAL] And I do have one more uh patient.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] All right, it would be.
[CUSTOMER][NEUTRAL] So for claims. Can you please assist me with that?
[AGENT][POSITIVE] It would be my pleasure to assist you with another claim, [PII]. What is that policy number?
[CUSTOMER][NEUTRAL] It would be my pleasure to assist you with another claim, [PII]. What is that policy number? It is 02265945.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Thank you, [PII]. What is that patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK and what is that patient's name and date of birth? Patient name is [PII].
[CUSTOMER][NEUTRAL] [PII], date of birth of [PII].
[AGENT][NEUTRAL] All right, thank you. And what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Alright thank you and what is the date of service security? So this is for [PII] and the bill amount is $375 even.
[AGENT][NEUTRAL] OK, thank you. Is it for the same facility?
[CUSTOMER][NEUTRAL] for the same facility. Yes.
[AGENT][NEUTRAL] What is the name of the facility?
[CUSTOMER][NEUTRAL] The name of the facility. It's MUS safe Associs.
[AGENT][NEUTRAL] You said total bill amount 135?
[CUSTOMER][NEUTRAL] You said total bill amount was 35. Uh, no, 375.
[AGENT][NEUTRAL] 37549424.
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] 24. Yes.
[AGENT][NEUTRAL] OK, so I don't have that claim on file.
[CUSTOMER][NEUTRAL] So I don't have that on file. Oh sure, may I know the patient's eligibility?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Mhm. Eligibility is the effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Eligibility is effective due is [PII].
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] Policy termed on 10-124.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] May I know the pay ID to submit the claim?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] Hey ID is
[CUSTOMER][NEUTRAL] 0801. And you said there's no timely filing limit to submit a claim, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] That is correct. So then that's it for the day. Thank you so much and may I know the reference number for our conversation?
[AGENT][NEUTRAL] Reference number is my name and today's date and I spell my name A L I C I A, first initial last name [PII].
[CUSTOMER][POSITIVE] I spell my name [PII]. Thank you so much for assisting me, [PII]. That's it. Thank you so much, and you may have a wonderful weekend. Bye bye.
[AGENT][NEUTRAL] Anything else I can help you with, [PII]?
[AGENT][POSITIVE] I hope you have a wonderful weekend as well, [PII]. Thank you for calling APL. Take care.
[CUSTOMER][POSITIVE] Have a wonderful weekend as well, so thank you for calling APL. Take care bye bye.
[AGENT][NEUTRAL] Bye bye.