AccountId: 011433970860
ContactId: d5daeee3-f603-4b6d-bd32-c09965c9c9e5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333709 ms
Total Talk Time (AGENT): 159352 ms
Total Talk Time (CUSTOMER): 101346 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/d5daeee3-f603-4b6d-bd32-c09965c9c9e5_20250429T14:23_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with BJC Healthcare. I was calling to check status of a claim.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the policy number is 01935519.
[AGENT][NEUTRAL] Could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII], you're calling to verify benefits eligibility. Let me give you the correct policy number. Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 226-745-7. It's 226-7457.
[CUSTOMER][NEUTRAL] 2267457. That is the policy number, OK.
[AGENT][NEUTRAL] This policy has been active since [PII] and it's currently active.
[AGENT][NEUTRAL] And you're calling to verify benefits and eligibility for what place of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it is, let's see.
[CUSTOMER][NEUTRAL] A doctor's office. It's an office visit.
[AGENT][NEUTRAL] So the member's policy does not have office visits, however, it does have an outpatient benefit where the treatment received in the office falls under the outpatient benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the outpatient benefits per calendar year is $6000 and this is not a guarantee of benefits, just a disclaimer of the policy's coverage. And when I say the treatment received in the office, meaning as any procedure that's completed in the office is covered under the outpatient benefits, but the visit is not covered.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] OK, this is not covered. um.
[CUSTOMER][NEUTRAL] Is there um a claim status line I could see if there because we sent the claim in so I was wondering if there's an EOB with that.
[AGENT][NEUTRAL] So you're calling to check the status of a claim?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] [PII] for $196.
[AGENT][NEUTRAL] And what is your procedure called?
[CUSTOMER][NEUTRAL] 99213.
[AGENT][NEUTRAL] So that's considered as an office visit which is not covered. Mm, 3473, give me one moment because they have a facility 3473 3473 so the claim was received [PII] it was processed [PII], and there was no payment due to the policy not covering office visits. Would you like that claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] It is 3573473. It's 3573473. And I apologize, what was your name?
[CUSTOMER][NEUTRAL] 3.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Um, can you fax me that EOB?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Give me one moment, I'm gonna get your fax number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I have [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Hi, [PII], is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][NEUTRAL] Thanks for calling AP and calling. I have a question. Are you aware of our online web online, um, providers portal that you can check the status of claims?
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] At [PII]?
[CUSTOMER][NEGATIVE] Seems like I tried to get on it.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, and I couldn't for some reason cause I do have a
[AGENT][NEUTRAL] Would you like for me to walk you through it?
[CUSTOMER][NEUTRAL] I've been on it before. Um.
[CUSTOMER][NEUTRAL] Uh, so let me try again and see.
[CUSTOMER][MIXED] Um, what the deal is, why I couldn't get on it. Um, but thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So when it asks you, um, when it asks you for the patient's account number it'll be the patient account that's in box number.
[AGENT][NEUTRAL] Um, 26.
[AGENT][NEUTRAL] On the UB.
[AGENT][NEUTRAL] Well, on the 1500 box number 26. Mhm.
[CUSTOMER][NEUTRAL] 26.
[CUSTOMER][NEUTRAL] Oh, I see. OK.
[CUSTOMER][NEUTRAL] All right, I'll note that then. And can I have a call reference number?
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[AGENT][NEUTRAL] We don't provide those [PII], however, you can use my name in today's date as a reference.
[CUSTOMER][NEUTRAL] OK. And what was your name again? I'm sorry.
[AGENT][NEUTRAL] No, no worries. It's [PII] and today's date.
[CUSTOMER][POSITIVE] OK. All right. Thank you.
[AGENT][POSITIVE] You're welcome, thanks for calling APL have a great day.
[CUSTOMER][NEUTRAL] Bye-bye.