AccountId: 011433970860
ContactId: d9944670-c7e7-4c7f-9290-071a7ef4bf60
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 666479 ms
Total Talk Time (AGENT): 178157 ms
Total Talk Time (CUSTOMER): 208701 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/d9944670-c7e7-4c7f-9290-071a7ef4bf60_20250612T16:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from provider office. I want to know the claim status.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Policy number is going to be, yeah, it's 2566431.
[AGENT][NEUTRAL] And that is 256-6431. May I please have the patient's name and date of birth? Go ahead.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Date of birth, please?
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Total bill, please.
[CUSTOMER][NEUTRAL] Total bill amount.
[CUSTOMER][NEUTRAL] $446.46.
[AGENT][POSITIVE] Thank you, and you can also check claim status via our secured portal that is [PII] and I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that total bill is 44646. I'm not finding a claim on file for that date of service and total bill.
[CUSTOMER][POSITIVE] Actually, we receive payment also.
[AGENT][NEUTRAL] You received what information?
[CUSTOMER][NEUTRAL] receive the payment on this claim and only one item, one item has been denied and uh I have claim number as, as well. Yes.
[AGENT][NEUTRAL] OK, but that total amount that you gave me is not the correct total amount.
[AGENT][NEUTRAL] You gave me $446.46.
[CUSTOMER][NEUTRAL] Yes, uh, the total.
[CUSTOMER][NEUTRAL] $446.46. This is the right amount.
[AGENT][NEUTRAL] That's, we don't have a claim on file for that total bill.
[CUSTOMER][NEUTRAL] To pay to the medical.
[CUSTOMER][NEUTRAL] Uh, allow me one minute. I have, I think a claim number which is
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The claim number
[CUSTOMER][NEUTRAL] Yes, 359-590-5.
[AGENT][NEUTRAL] OK, so for that claim, that's not the total bill charge that was submitted into us.
[CUSTOMER][NEUTRAL] Uh, what is the total amount?
[CUSTOMER][NEUTRAL] Because we have submitted to the primary.
[AGENT][NEUTRAL] You would have to give me that. We do not have that.
[CUSTOMER][NEUTRAL] OK, can you please provide the, the screen number status and provide you.
[AGENT][NEUTRAL] OK, so you're just needing to know what information you said just one lineage, is that what you're stating?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] No, the one line item has been denied for the A7038 was denied.
[AGENT][NEUTRAL] And you're needing to know the reason of that denial?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Yeah, why that it was denied.
[AGENT][NEUTRAL] It's a non-covered benefit, we do not cover non-disposables.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] But uh the disposable standard is a DMA product which is covered by the Medicare as well. So why it was denied.
[AGENT][NEUTRAL] As I previously stated, we do not cover non-disposables.
[AGENT][NEUTRAL] That's a non-covered for up under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Special policy not cover the disposable item.
[CUSTOMER][NEUTRAL] So it is PR.
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] This is in a PR denial.
[AGENT][NEUTRAL] Is it a PI denial?
[CUSTOMER][NEUTRAL] Patient, the patient.
[CUSTOMER][NEUTRAL] No, it's patient responsibility.
[AGENT][NEUTRAL] That's the provider's discretion.
[CUSTOMER][NEUTRAL] Mm, why it was, if it is the policy not covered, I think it's when the policy is not covered by patients.
[AGENT][NEUTRAL] We can't, we can't advise the the provider on how to bill. So it is the provider's discretion if they want to submit that to the insured.
[CUSTOMER][NEUTRAL] OK, non-covered under the patient plan.
[CUSTOMER][NEUTRAL] Allow me a minute only.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it is not covered under the member's plan only.
[AGENT][NEUTRAL] That is what I previously stated.
[CUSTOMER][NEUTRAL] OK. Can you please provide my member plan name?
[AGENT][NEUTRAL] This is their supplemental. This is their midlink supplemental plan.
[CUSTOMER][NEUTRAL] Supplemental plan.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And can you please spell your name?
[AGENT][NEUTRAL] It is spelled [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] with the last initial of [PII] and today's date used as the call reference. And is there anything else that I can assist you with today, [PII]? Go ahead.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Yeah, yeah, I have.
[CUSTOMER][NEUTRAL] Can you please provide the received date of the claim?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So for that claim, it does show that we received it on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] On call reference number is same for this.
[CUSTOMER][NEUTRAL] Your name and date of digit.
[AGENT][NEUTRAL] Yes, that's the call reference number.
[CUSTOMER][NEUTRAL] OK. Uh, I have one more patient with the same insurance.
[AGENT][NEUTRAL] May I please have that policy number?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah, it's 02566525.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And the data service in total bill.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and the total bill amount is $561.11.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I did pull that claim up for you. How may I assist you on the claim?
[CUSTOMER][NEUTRAL] Yeah, in the same way, the claim was denied for the code is 87038.
[AGENT][NEUTRAL] And that denial is the same where we do not cover non disposables.
[CUSTOMER][NEUTRAL] Uncovered. Is the patient plan name same?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] It is covered by the insurance but not covered to the patient and the patient plan.
[AGENT][NEUTRAL] We do not cover non-disposals.
[CUSTOMER][NEUTRAL] disposables are not covered by the insurance only.
[AGENT][NEUTRAL] Can't advise on any other insurance. I'm just giving you the information for this member in this policy.
[CUSTOMER][NEUTRAL] Actually, I want to clarify that that is not covered under the patient plan or it is not covered by the
[CUSTOMER][NEUTRAL] By the insurance.
[AGENT][NEGATIVE] As I'm stating, this memberer does not have coverage for non-disposables.
[AGENT][NEUTRAL] That is a non-covered benefit.
[CUSTOMER][NEUTRAL] OK, patient.
[CUSTOMER][NEUTRAL] OK OK um.
[CUSTOMER][NEUTRAL] Can you please provide the received date?
[AGENT][NEUTRAL] We received that claim on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Patient supplement plan. OK. Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Thank you for calling American Public Life. Have a great day.