AccountId: 011433970860
ContactId: dbb71c5e-f234-4098-a948-b44d49ecb0e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393690 ms
Total Talk Time (AGENT): 121562 ms
Total Talk Time (CUSTOMER): 163598 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/dbb71c5e-f234-4098-a948-b44d49ecb0e3_20250403T19:21_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is Easy. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is uh [PII] calling from provider office. I have the member details. You can check and give me the claim status for me.
[AGENT][NEUTRAL] Um, yes, sir. I can assist you with claim status. Could I get your name again first and a good callback number?
[CUSTOMER][NEUTRAL] Yeah, the callback number [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] This is direct line, no extension.
[AGENT][POSITIVE] Thank you. And your name, please?
[CUSTOMER][NEUTRAL] My name is uh [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Yeah, the policy number, uh,
[CUSTOMER][NEUTRAL] 018.
[CUSTOMER][NEUTRAL] 479
[CUSTOMER][NEUTRAL] 80
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, the patient name [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The date of birth, uh [PII].
[AGENT][NEUTRAL] Thank you and now I need the date of service and bill charges for the claim you're calling about.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The bid amount of $4,582 even.
[AGENT][NEUTRAL] OK. Yes, sir. We received that claim on.
[AGENT][NEUTRAL] [PII], the claim processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3,383,430.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm showing that this claim is denying because home health care services are not covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You need for, uh, could you please repeat again the denied reason?
[AGENT][NEUTRAL] Home healthcare services are not covered under the policy.
[CUSTOMER][MIXED] Covered the policy, not covered on.
[CUSTOMER][NEUTRAL] The policy. OK, uh.
[CUSTOMER][NEUTRAL] OK. Uh, could you please, uh, send me the you will be fax. I will give the fax number to you.
[AGENT][NEUTRAL] Yes, what's the fax number, please.
[CUSTOMER][NEUTRAL] Yeah, the fax number [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do I mention it to you?
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][NEUTRAL] OK. So it's [PII] [PII] [PII]?
[CUSTOMER][NEUTRAL] Yes. [PII].
[AGENT][NEUTRAL] OK. You should receive it in about 10 minutes. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Yeah, give me a second. Uh, uh, could you please spell your name?
[AGENT][NEUTRAL] Um, it's spelled [PII].
[CUSTOMER][NEUTRAL] OK. Uh, you said the claim for this code not covered under the policy, but, uh, uh, already this code is paid for any previous claim?
[CUSTOMER][NEUTRAL] The member having any other claim?
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] No, I'm not showing any on file where it paid previously.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, because the, previously, the, the primary is also denied for, uh, the primary uh insurance also denied. After that, uh, the balance follow to secondary. You said the secondary also denied for the service not covered under the policy.
[CUSTOMER][NEUTRAL] So, uh, can I, OK, can I send an uh pill that is OK for you?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Yes, you can.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we'll go to the same.
[CUSTOMER][NEUTRAL] Uh, could you please tell me the billing fax number?
[AGENT][NEUTRAL] Um, [PII] and please attention it to the claims department.
[CUSTOMER][NEUTRAL] OK. Applying time limit.
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If there are any uh uh you said uh this code is not covered under the policy, but, uh, which services you, you are, uh, covered for this member? there are any specific code?
[AGENT][NEUTRAL] Inpatient and outpatient hospital services, but no services provided in home is covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, home. But uh already we, our, our code is 1040. That is a home, that is correct. To, to place of service that is home. But uh you said uh you are uh denied.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] You can take to rep of this claim.
[AGENT][NEUTRAL] I'm sorry, what's your question?
[CUSTOMER][NEUTRAL] Yeah, you said uh you have uh covered the inpatient uh uh in inpatient code, that's correct.
[AGENT][NEUTRAL] If a service take place inpatient, if they're, while they're admitted in the hospital or for outpatient hospital services, it, it may be covered under the policy, but if the service is taking place at home like on this claim, then it will be denied. There's no coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, could you please give me the call reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um, is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Yeah, that's all for the day. Thank you for so much for asking. You have a wonderful day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mhm bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.