AccountId: 011433970860
ContactId: db291eb4-5d1a-418f-a636-00fee4165f24
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 486190 ms
Total Talk Time (AGENT): 122359 ms
Total Talk Time (CUSTOMER): 132111 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/db291eb4-5d1a-418f-a636-00fee4165f24_20250221T19:13_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm calling from the providers of Florida Women's Care LLC that you gonna denied claim. Could you please help me with that?
[AGENT][POSITIVE] It would be my pleasure to assist you with that, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you said you would need information on a denied claim. Do you have that claim number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 356.
[CUSTOMER][NEUTRAL] 0630.
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you, and this was for data service 115-2025?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And I'm showing that the claim was denied as the services are not covered when performed in a doctor's office. So it's for the place of service that is not covered.
[CUSTOMER][NEGATIVE] Uh, it was denied as.
[CUSTOMER][NEUTRAL] Services not covered under our doctor's office.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] But the correspondence, I mean, yeah we also states that the claim was denied benefits has not been reduced, uh, I'm sorry.
[CUSTOMER][NEUTRAL] Uh, the policy is inactive.
[AGENT][NEUTRAL] The policy is active.
[CUSTOMER][NEUTRAL] OK, just a moment let me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this claim was processed as primary or secondary.
[AGENT][NEUTRAL] Secondary
[CUSTOMER][NEUTRAL] Yeah, because
[CUSTOMER][NEUTRAL] This was a covered service primary process and applied to its deductable. If the place of service was incorrect, what was the primary insurance processing the CPD code then?
[AGENT][NEUTRAL] Now, the um primary insurance has different benefits. Her, her APL Medlink gap policy does not cover services in a doctor's office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I place your call in 2 minutes sir to verify this, please.
[AGENT][NEUTRAL] You can.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, you just stated that this services is not covered when performed in doctor's office, and I do have one more question. Are lab services covered under the patient's plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it would have to be in an outpatient hospital or an inpatient hospital stay.
[CUSTOMER][NEUTRAL] Um, it was
[CUSTOMER][NEUTRAL] Yeah, this was an outpatient service. I mean the laboratory service.
[AGENT][NEUTRAL] Right, but
[CUSTOMER][NEUTRAL] Which was rendered in our facility.
[AGENT][NEGATIVE] That's correct, which was billed as a place of service 11, so it's not covered.
[CUSTOMER][NEUTRAL] Yeah, but place of service 11 is outpatient itself, right.
[AGENT][NEUTRAL] No, it's a physician's office.
[CUSTOMER][NEUTRAL] That's my question, yeah.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Only the outpatient and inpatient, two types of services are covered under the patient's plan, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And this doctor's visit and all are not covered on the patient's plan.
[AGENT][NEUTRAL] That's correct. Any services in a doctor's office are not covered.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] OK, thank you. Just a moment. I will document all the information which you provided me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please provide me the receipt date of this claim, please?
[AGENT][NEUTRAL] That claim was received on.
[AGENT][NEUTRAL] [PII]. I'm sorry, let me check that again. I apologize.
[CUSTOMER][POSITIVE] That's that's you take your time.
[AGENT][NEUTRAL] That claim was received on [PII].
[AGENT][NEUTRAL] And processed on to [PII].
[CUSTOMER][NEGATIVE] 2425 received 2625 process denied us.
[CUSTOMER][NEUTRAL] Can I get the plan name, please?
[AGENT][NEUTRAL] It is a secondary Medlink gap policy.
[CUSTOMER][NEUTRAL] Secondary, could you please spell that meddling?
[AGENT][NEUTRAL] M as in Mike, E as in Echo, D as in Delta. L as in Lima, I as in India, N as in November, K as in Kilo. Medlink gap.
[CUSTOMER][NEUTRAL] And the claim number is the same claim number which I provided you, right?
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] OK. Could you please spell me your name, please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] What about the
[CUSTOMER][NEUTRAL] Caller reference number please.
[AGENT][NEUTRAL] Call reference number would be my name and today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for your assistance. It was great speaking with you. Have a great weekend bye.
[AGENT][POSITIVE] And thank you, [PII] for calling APL. It was my pleasure to assist you and I hope you have a great weekend as well. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye.