AccountId: 011433970860
ContactId: ce8e99a5-de4e-4627-9cc1-bedd150f8c61
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 580479 ms
Total Talk Time (AGENT): 141832 ms
Total Talk Time (CUSTOMER): 102024 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/ce8e99a5-de4e-4627-9cc1-bedd150f8c61_20250221T18:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling on APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi, myself, [PII]. I'm calling on behalf of provider's office to check claim status.
[AGENT][NEUTRAL] OK [PII], I can help you with the claim status sir. What is your callback number?
[CUSTOMER][NEUTRAL] [PII] with the extension [PII].
[AGENT][NEUTRAL] Thank you sir and then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient name is [PII], and date of birth, [PII].
[AGENT][NEUTRAL] Thank you. And then what is the policy number?
[CUSTOMER][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] 19284
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] OK, and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] D of service, [PII]. And the bill amount is
[CUSTOMER][NEUTRAL] 2500 $2,547 even.
[AGENT][NEUTRAL] OK, and what's the name of the facility you're calling for like?
[CUSTOMER][NEUTRAL] It's Min and Brooks Radiology.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you and I will be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 352 1
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. I did find the claim. The claim number is 3521045.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] And processed it on [PII].
[AGENT][NEUTRAL] And the claim was denied as noncovered for the patient's policy.
[CUSTOMER][NEUTRAL] May I know the reason why it was non court charges?
[AGENT][NEUTRAL] Per the patient's policy.
[CUSTOMER][NEUTRAL] Uh, I mean, like, uh,
[CUSTOMER][NEUTRAL] But the patient policy means?
[AGENT][NEUTRAL] It's non-covered under the patient's policy.
[CUSTOMER][NEUTRAL] Can you please, yeah.
[CUSTOMER][NEUTRAL] Yeah, can you please evaluate about this, you know, under the patient policy means like uh patient has any other policy uh these services will not covered under this.
[CUSTOMER][NEUTRAL] Patient
[AGENT][NEGATIVE] Does not, does not have another policy and it's not covered under this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please verify the patient policy details?
[AGENT][NEUTRAL] The patient has a limited.
[AGENT][NEUTRAL] Hospital indemnity plan?
[CUSTOMER][NEUTRAL] Patient has a limited hospital in, yeah, go ahead, sorry.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Diagnostic testing is non-covered?
[AGENT][NEUTRAL] And also uh.
[CUSTOMER][NEUTRAL] May I know the diagnosis
[AGENT][NEUTRAL] No, uh, hold on real quick diagnostic testing is non-covered.
[AGENT][NEUTRAL] And also,
[AGENT][NEUTRAL] The policy does not provide benefits for outpatient hospital facility charges or an outpatient surgical facility.
[CUSTOMER][NEUTRAL] You mean this policy will not cover outpatient services, right?
[AGENT][NEUTRAL] Not for outpatient hospital facility or surgical facility or for diagnostic testing.
[CUSTOMER][NEGATIVE] I see this services is emergency.
[AGENT][NEUTRAL] Uh, let me look at the claim actually, the, um, EOB.
[AGENT][NEUTRAL] The procedures that are on the claim is 74176.
[AGENT][NEUTRAL] 939976.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And 76,870.
[AGENT][NEGATIVE] And they're non covered.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, may I know the reason why the procedure of course has been denied as a non-covered charges?
[AGENT][NEUTRAL] I gave you those reasons.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I gave you those reasons.
[CUSTOMER][NEUTRAL] You mean patient current benefit plan will not provide services for this procedures, right?
[AGENT][NEGATIVE] Correct, does not provide coverage this non-coverage service under the patient's policy.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] The claim number is 3521045, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] May I have the reference number for today's call?
[AGENT][NEUTRAL] Yes, you can use my name, it's [PII] and today's date.
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Great. Thank you so much for giving this information. Have a nice day.
[CUSTOMER][NEUTRAL] Mm
[AGENT][POSITIVE] You have a good day too, [PII], have a good weekend thanks for calling APL.
[CUSTOMER][POSITIVE] Happy weekend. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.