AccountId: 011433970860
ContactId: d214cdfb-d2a3-4e90-aff5-f0de39ab7320
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 672690 ms
Total Talk Time (AGENT): 233856 ms
Total Talk Time (CUSTOMER): 164663 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/2025/06/13/d214cdfb-d2a3-4e90-aff5-f0de39ab7320_20250613T12:34_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, [PII]. My name is [PII] and last name initial is [PII] I'm calling from provide office.
[CUSTOMER][NEUTRAL] And I need your help with the claim status.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status, and you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII]
[AGENT][NEUTRAL] OK, and how many clients do you have in total today?
[CUSTOMER][NEUTRAL] Only one claim for today.
[AGENT][NEUTRAL] Alright, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEGATIVE] My computer is not working with me. I apologize. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can you repeat the phone number for me please?
[CUSTOMER][NEUTRAL] Sorry? Phone number.
[AGENT][NEUTRAL] Can you repeat? Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] My policy number is uh.
[CUSTOMER][NEUTRAL] 019
[CUSTOMER][NEUTRAL] 093
[CUSTOMER][NEUTRAL] 2 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] And that was 0190932?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] There's a number missing. Can you repeat the number? You don't have to, hold on one second. You don't have to give the ML8. Can you just repeat the numbers?
[CUSTOMER][NEUTRAL] M as in Mike
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 0190932 ML 8.
[AGENT][NEUTRAL] OK, there's a number missing. What's the member's first and last name?
[CUSTOMER][NEUTRAL] And the first name is uh [PII].
[CUSTOMER][NEUTRAL] Last name is uh [PII].
[AGENT][NEUTRAL] Can you spell the first and last name for me, please?
[CUSTOMER][NEUTRAL] Yeah. First name, [PII].
[CUSTOMER][NEUTRAL] Last name is [PII].
[AGENT][NEUTRAL] I'm sorry, I'm sorry, I'm sorry. I'm sorry. Hold on one second. The last name, can you give the letters again, [PII].
[CUSTOMER][NEUTRAL] Yes. After that, [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policies to um populate here. Hold on one moment.
[AGENT][NEUTRAL] And you said first name is [PII]?
[CUSTOMER][POSITIVE] OK. Take your time.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Middle name is [PII].
[AGENT][NEUTRAL] All right. And this is for the medical policy? I see it here.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number um that you were trying to give is 195.
[AGENT][NEUTRAL] 0932, it was missing a 5?
[AGENT][NEUTRAL] But this policy is no longer active. It was a
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] It was effective from [PII].
[AGENT][NEUTRAL] There is an active policy on file.
[CUSTOMER][NEUTRAL] Wait one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please repeat the effective date [PII].
[AGENT][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] To [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] In the [PII].
[AGENT][NEUTRAL] The active policy number is 243.
[AGENT][NEUTRAL] 6106.
[AGENT][NEUTRAL] And it's been active since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the date of service and the total bill for your claim?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII], and total charge amount is $267.60.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][POSITIVE] Yes yes of course it's uh.
[CUSTOMER][NEUTRAL] South Florida Urology Institute, LLC.
[AGENT][NEUTRAL] Thank you. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, I'm just waiting for the claim to populate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 8741.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the service is not covered when when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Denied due to?
[CUSTOMER][NEUTRAL] So it is not covered?
[AGENT][NEUTRAL] When performed in a doctor's office.
[AGENT][NEUTRAL] Or clinic.
[CUSTOMER][NEUTRAL] And clinic.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The place of service is 11 and place of service is 11 is office.
[AGENT][NEUTRAL] Correct, and the service is not covered when it's in a doctor's office or clinic. It was in a doctor's office.
[CUSTOMER][NEUTRAL] OK, so can you please
[CUSTOMER][NEUTRAL] Tell me where these services are paid.
[AGENT][NEUTRAL] Sure, hold on one moment.
[CUSTOMER][NEUTRAL] Covered
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So this is the member secondary insurance. It covers inpatient facilities and outpatient facilities. Outpatient facilities is the urgent care, emergency room, outpatient surgeries, diagnostic testing in an outpatient facility, not the place of service office, no in-office um coverage on this policy.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] So can we send this claim with the
[CUSTOMER][NEUTRAL] In hospital benefit card number?
[AGENT][NEUTRAL] It's not the card, OK, so the inhospital or outpatient policy certain number, that's the policy number. The ML 7 or 8 at the end, that's just for the card. So the policy number changing is not is not going to change the coding on the claim. It's where it was done. If it's in the doctor's office, it's not covered by this policy.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy not covered by policy.
[CUSTOMER][NEUTRAL] So what is the benefit for the members?
[AGENT][NEGATIVE] For your claim, there is no benefit. That's why it was denied. It's not covered by the policy.
[CUSTOMER][NEUTRAL] For this insurance.
[CUSTOMER][NEGATIVE] OK, so no benefit for this time.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][POSITIVE] Thank you so much and your call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. And again, that's [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Mm, no, that's all for today.
[AGENT][POSITIVE] Alrighty well thank you so much for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] Thank you, thank you.
[AGENT][POSITIVE] You're welcome. Thank you. Bye-bye.