AccountId: 011433970860
ContactId: d430bd7c-4387-4c6d-b732-4000191acaf8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 425859 ms
Total Talk Time (AGENT): 103864 ms
Total Talk Time (CUSTOMER): 119443 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/d430bd7c-4387-4c6d-b732-4000191acaf8_20250512T20:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from UT Regional One Physicians to decision on claims. Could you help me?
[AGENT][NEUTRAL] Yes, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] OK, thank you. And you have the policy number for that patient?
[CUSTOMER][NEUTRAL] 02457992
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And date of service and bill charges.
[CUSTOMER][NEUTRAL] [PII], bill for $215.98.
[AGENT][NEUTRAL] OK give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, it looks like we received that claim 35-2025. Process 312-2025.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] May I know why it is denied as non-covered?
[AGENT][NEUTRAL] The benefit provides an amount when covered person receives treatment in ER, urgent care, physician's office, physical or occupational therapy facility.
[AGENT][NEUTRAL] Treatment in outpatient hospital is not covered by the policy.
[CUSTOMER][NEUTRAL] So, can you go ahead and be patient for this?
[AGENT][NEUTRAL] This is a secondary policy, a supplemental policy, so we can't instruct on whether to bill patients.
[CUSTOMER][NEUTRAL] Who is primary for this policy?
[AGENT][NEUTRAL] Uh, I don't show a primary insurance. You'd have to check with the patient.
[CUSTOMER][NEUTRAL] Uh, you told that this is a secondary policy, right?
[AGENT][NEUTRAL] It's a, it's a supplemental policy. It's a hospital indemnity plan. It's supplemental.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, it is a hospital.
[CUSTOMER][NEUTRAL] Internet plan.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So Medicare supplement, can we consider it as Medicaid supplement?
[AGENT][NEUTRAL] Uh, we don't have anything to do with Medicare.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you have any other insurance information?
[AGENT][NEUTRAL] I don't have any other insurance information. You'd have to contact the patient.
[CUSTOMER][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Let me check if I do have any information regarding any other insurance. No, I have United Healthcare.
[CUSTOMER][NEUTRAL] Let me check just a moment. Could, do you have any information regarding the patient CUP was updated or not?
[AGENT][NEUTRAL] I, I don't, I don't show any other coverage. So you'd have to check with the patient to see what information they have.
[CUSTOMER][NEUTRAL] They don't
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. Could you help me with the next claim for the same patient?
[AGENT][NEUTRAL] The data service and bill charges?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Bill for $336.44.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, it looks like we received this on.
[AGENT][NEUTRAL] Receive [PII]. Process [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh looks like
[AGENT][NEUTRAL] And the policy terminated [PII], so this claim was denied.
[CUSTOMER][NEUTRAL] Received and processed on.
[CUSTOMER][NEUTRAL] What is the effective date of policy?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And term it is?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] So it is not active photos.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So do you have any claim for the date of service?
[AGENT][NEUTRAL] Yes, it was processed [PII].
[AGENT][NEUTRAL] Do you need the claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 3543126.
[CUSTOMER][NEUTRAL] 3126. Is it denied or processed?
[AGENT][NEGATIVE] Denied.
[CUSTOMER][NEUTRAL] Stating that? What is the denial reason?
[AGENT][NEGATIVE] The policy was not effective on the date of service.
[CUSTOMER][NEUTRAL] On date of service.
[CUSTOMER][NEUTRAL] Member policy.
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] Effective from
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] Bill pay. OK, just a moment. I have to check another.
[CUSTOMER][NEUTRAL] OK, can I have the call reference number?
[AGENT][NEUTRAL] It's my name is [PII].
[AGENT][NEUTRAL] In today's date.
[CUSTOMER][NEUTRAL] S T E
[CUSTOMER][NEUTRAL] Could you spell it out for me?
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much for assisting me, [PII]. Have a great day.
[AGENT][POSITIVE] Thanks for calling APL. You as well. Bye bye.