AccountId: 011433970860
ContactId: dacc30ec-b116-4093-aab2-698f29a7f9a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 506299 ms
Total Talk Time (AGENT): 146434 ms
Total Talk Time (CUSTOMER): 292497 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/dacc30ec-b116-4093-aab2-698f29a7f9a9_20250324T16:32_UTC.wav
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[AGENT][NEUTRAL] For calling APL. my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Hi, yes, [PII], my name is [PII] calling from doctor's office. I'd like to verify uh claim status.
[CUSTOMER][NEUTRAL] I say I I.
[AGENT][POSITIVE] I'd be happy to assist with claim status [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Yes, [PII], no extension.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, the policy number, yes, uh, policy number patient is the one that says inpatient or outpatient one is specialist office doesn't matter, OK, 02308028 ML 8.
[AGENT][NEUTRAL] It doesn't matter.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Last name is [PII], and date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And you said you're a specialist office visit?
[AGENT][NEUTRAL] Specialist office?
[CUSTOMER][NEUTRAL] Yeah, dermatology, mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show.
[AGENT][NEUTRAL] That would fall under outpatient and the outpatient per day maximum is $500. Now, the only thing included in that would be the treatment and procedures. The copay associated with the physician's charges would not be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine. I just wanna make sure.
[CUSTOMER][NEUTRAL] Um, so the, the date of service is [PII] total bill amount $150.
[AGENT][NEUTRAL] 128 2025.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] So [PII].
[AGENT][NEUTRAL] And your tax ID?
[CUSTOMER][NEUTRAL] Tax ID is [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah
[AGENT][NEUTRAL] I'm not sure we received the claim.
[AGENT][NEUTRAL] From your tax ID for that data service.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] We send it by fax 128 2025 1 $150.
[AGENT][NEUTRAL] Oh, so we.
[CUSTOMER][NEUTRAL] Oh you
[AGENT][NEUTRAL] That came through as an insurer submitted claim.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And it was denied because the
[AGENT][NEUTRAL] Physician's charges are not covered under the policy. Let me go back and look at that because it came through as a insured submitted.
[CUSTOMER][NEUTRAL] See
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] No, but no, she didn't submit it. We submitted it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, it was supposed to be covered something was supposed to be paid because she had a biopsy done.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] She had a biopsy done.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was in insurance submitted, OK.
[AGENT][NEUTRAL] OK. Wait a minute. So,
[CUSTOMER][NEUTRAL] it
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] That's not the tax.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that one did not, because we needed a
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] They must have sent it to the wrong.
[CUSTOMER][POSITIVE] Department exactly.
[CUSTOMER][NEUTRAL] I'm pretty sure there's nothing wrong on the claim. I, I tried, but everything.
[AGENT][NEUTRAL] No, that's um
[AGENT][NEUTRAL] That's um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm so she didn't they.
[AGENT][NEUTRAL] DH one this should.
[AGENT][NEGATIVE] We can, I, I'm surprised she didn't ask for a better copy. Maybe I'm reading this wrong. Maybe, hold on one second, DM.
[AGENT][NEUTRAL] And a DH
[AGENT][NEUTRAL] Mm.
[AGENT][NEGATIVE] Yeah, they denied it for office business not covered, but I don't even see how she could see.
[AGENT][NEUTRAL] The procedure code.
[AGENT][NEUTRAL] Because we can't see all we all that was sent was a cover letter and an EOB correct?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] No, no, no, I have like I send the whole thing, the, the claim form, everything when I know.
[CUSTOMER][NEUTRAL] I it's a fax cover sheet claim form and the AOB of the primary insurance that's from [PII].
[AGENT][NEUTRAL] OK. Well, we don't have that.
[AGENT][NEUTRAL] We don't have that on the.
[CUSTOMER][NEUTRAL] OK, yeah, then then then maybe that something went in so it went, it went in the wrong.
[CUSTOMER][NEUTRAL] I, I'll I'll re-fax it, but honestly it should be covered because it was a biopsy done.
[AGENT][NEGATIVE] OK, that would be covered, but this one denied, but it, it went to the insured it denied as office visits, not covered, but
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No, but it was an office visit, but she had a biopsy done that day, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm gonna resend refax it, right?
[CUSTOMER][NEUTRAL] Refax that one and I'll and um then attach.
[AGENT][NEUTRAL] And make sure it's a claim form.
[CUSTOMER][NEUTRAL] Oh, I did, I, I.
[CUSTOMER][NEGATIVE] I know, I know how it works. I know you, you can't just send in the EOB and the cover letter. No, you have to send in the claim form, not there and process it. Maybe the claim form didn't claim form didn't, I don't know, didn't, was not received. Maybe it was not received.
[CUSTOMER][NEUTRAL] Yeah, so, um.
[CUSTOMER][NEUTRAL] Um, I'll send it again. That's fine, but I know we have to fill out the claim form, attach the EOB of the primary insurance, right? I'll resend it. I'll resend the claim form for 128, and she came again in March, so I'll resend those and call back again.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You went my what?
[AGENT][NEUTRAL] OK, was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Let me see if there's somebody else here after.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] See see see over when I it's going to say lane.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You'll see, uh OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, um, it's for I, I wanna check for one more patient if you can check it for me.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Policy number is 01816558M as in Mary L8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Asent's name is um [PII] and last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] I, I.
[AGENT][NEUTRAL] OK, I don't see that we received that claim, and I also see they weren't covered with us. Their policy ended with us [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, so that's not his policy. OK, I have to figure out like what's his, what's his, uh, secondary, OK, alright.
[CUSTOMER][NEUTRAL] OK, so I'll send the other thing and.
[CUSTOMER][POSITIVE] Make sure OK OK thank you very much for your help.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] it's