AccountId: 011433970860
ContactId: cf7d39b4-ca23-4106-a3a3-02ff85fe0eeb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 754049 ms
Total Talk Time (AGENT): 309448 ms
Total Talk Time (CUSTOMER): 194823 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/cf7d39b4-ca23-4106-a3a3-02ff85fe0eeb_20250218T18:19_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] Yes. Did you say your name is [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you. Yes, my name is [PII] calling from Geisinger Clinic checking on claim status for 4 patients.
[AGENT][NEUTRAL] OK, [PII], so you have 4 patients. Do they each have 1 data service?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with a uh with the claim status for those numbers and what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. So [PII], you will use my name along with today's date as your call reference number for each one if you need a reference number. Also, any information that I provide for you on the claims will be a verification of benefits and not a guarantee of payment. And lastly, [PII], if we do have the claims on file and you need a copy of the explanation of benefits for APL, you can go to our portal to print those.
[CUSTOMER][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] And the website for our portal, it is secured.
[CUSTOMER][NEUTRAL] Oh, what is the portal?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]. Again, that's secured. [PII].
[CUSTOMER][NEUTRAL] And is there a registration?
[AGENT][NEUTRAL] You, it's a self registering portal and you would just select that I'm a medical or dental provider and then walk through the steps.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] Yes, and one thing on that Kelly, when it asks, there is a place where it's going to ask you for the patient account number.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And that is the number that you all have for the patient. It is not their APL policy number, it's the provider's patient account number. Mhm. It does state that but some people still get confused on it, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just for reference. OK, so what is your first patient's policy number?
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] 02441989
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then, OK. And what is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the data service and total bill amount for him?
[CUSTOMER][NEUTRAL] Um, it is 11:16 2024 for $420.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And we have you as the secondary payer.
[AGENT][NEUTRAL] That is correct. This is a supplemental policy to the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We may have only billed you 200 because it looks like.
[CUSTOMER][NEUTRAL] The office visit was paid by the primary.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] The one code would be 87,880.
[AGENT][NEUTRAL] OK one moment. So, um, so we did receive that that was received on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 354 excuse me 0291.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this claim was denied and the reason for the denial for the code you're asking about is the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] And
[AGENT][NEGATIVE] And we also did the office visit was on there as well and that was denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, alright, and patient responsibility?
[AGENT][NEUTRAL] We do not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how would I get an explanation of payment?
[AGENT][NEUTRAL] By going to the portal now that you have a claim number you should mhm.
[CUSTOMER][NEUTRAL] To the
[CUSTOMER][NEUTRAL] OK, alright, OK, next one.
[AGENT][NEUTRAL] And do you need any other information on this one before I finish my note?
[CUSTOMER][NEUTRAL] No. That was all.
[AGENT][NEUTRAL] OK. All right. Just one moment, please.
[CUSTOMER][NEUTRAL] And the 99213 that was denied for.
[AGENT][NEUTRAL] Because the office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Office office visits are not covered. OK, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and what is your patient's policy number?
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Uh, that would be.
[CUSTOMER][NEUTRAL] 02441989
[AGENT][NEUTRAL] That's the same policy we just did.
[CUSTOMER][NEUTRAL] I know it's the, the father, [PII].
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, so just one moment, let me pull it back up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And his date of birth, uh, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount for him please?
[CUSTOMER][NEUTRAL] 114 for 325.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, again 114 of 2024, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we did not have a claim on file for [PII] for that data service.
[CUSTOMER][NEUTRAL] OK, no claim on file, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Mhm, that is correct.
[CUSTOMER][NEUTRAL] OK, just checking alright.
[AGENT][NEUTRAL] Um, was there any other dates of service for another member on this policy? No?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No. Mm mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next policy number?
[CUSTOMER][NEUTRAL] 02222090
[AGENT][NEUTRAL] OK, and your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service and total bill amount for her.
[CUSTOMER][NEUTRAL] Uh, [PII] for $510.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Like literally like
[AGENT][NEUTRAL] And again you said 9-1220 24 for 510, is that correct?
[CUSTOMER][POSITIVE] That is correct, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was also received. It was received on [PII], processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 5396.
[AGENT][NEUTRAL] And the denial remark on here states benefits payable under this certificate are limited to those outlined in the schedule of benefits. This is not a covered loss under the plan. Therefore, no amount is payable for this expense.
[CUSTOMER][NEGATIVE] OK, so according to their benefits it's not covered.
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and I have one other one please.
[AGENT][NEUTRAL] Um, different policy?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] OK, all right, just one moment.
[AGENT][NEUTRAL] OK, and the next policy number?
[CUSTOMER][NEUTRAL] 02581811
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I have the date of service and total bill amount for him please?
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII] for 497.
[CUSTOMER][NEUTRAL] Dollars
[AGENT][NEUTRAL] OK, [PII]?
[CUSTOMER][POSITIVE] Yes, yes, please.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so we do not have any claims on file for him for that data service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'll bail them out.
[CUSTOMER][POSITIVE] Alright, alright, thank you.
[AGENT][NEUTRAL] And then if you will be submitting a claim, you're welcome if you will be submitting a claim to us on this, make sure to include the primary insurance company's explanation of benefits as well, [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Yes, sounds great.
[AGENT][NEUTRAL] OK. Well, is there anything else I can help you with?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Now this portal, you said the patient account number?
[AGENT][NEUTRAL] It's the account number that you all have mhm that you use when you submit a claim for a member, mhm.
[CUSTOMER][NEUTRAL] That is.
[CUSTOMER][NEUTRAL] It's ours.
[CUSTOMER][POSITIVE] OK. All right. OK, that's all I need. Thank you very much, [PII].
[AGENT][POSITIVE] Uh, OK. Well, you are certainly very welcome. It was my pleasure, and if that is all I can help you with at the moment, thank you again for calling APL and I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome bye bye.