AccountId: 011433970860
ContactId: dc695ac8-ff31-41f2-8d2e-8ea57cded817
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 464420 ms
Total Talk Time (AGENT): 197445 ms
Total Talk Time (CUSTOMER): 138586 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/dc695ac8-ff31-41f2-8d2e-8ea57cded817_20250102T17:34_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office and I'm looking for a claim status.
[AGENT][NEUTRAL] OK, [PII] you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you and how many clients do you have to check status on today?
[CUSTOMER][NEUTRAL] Mm, I have 2 friends.
[AGENT][NEUTRAL] OK, are they for the same member or different members?
[CUSTOMER][NEUTRAL] Same number.
[AGENT][NEUTRAL] OK, so [PII], you will use my name that I gave you along with today's date as your call reference number for each, and also any information that I do provide for you will be a verification of benefits and not a guarantee of payment. So what is your patient's policy number?
[CUSTOMER][NEUTRAL] Uh yes. The member ID number is 02100475.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Member name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][POSITIVE] I said thank you.
[CUSTOMER][POSITIVE] Uh, welcome.
[AGENT][NEUTRAL] And what is the first date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Date of service is [PII]. And uh and the total amount on this claim is
[CUSTOMER][NEUTRAL] $1300 even.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, and you did say [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we do not have a claim on file for her for that date of service.
[CUSTOMER][NEUTRAL] OK. Can I get the patient policy effective date and the term date?
[AGENT][NEUTRAL] The effective date is [PII] and the policy is still active. There is no term date.
[CUSTOMER][NEUTRAL] Time defining limit to submit the claim.
[AGENT][NEGATIVE] No timely filing limit.
[CUSTOMER][NEUTRAL] OK. Can I get the payer ID and the address so we can submit the claim?
[AGENT][NEUTRAL] Payer ID 60801.
[AGENT][NEUTRAL] Claims address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] And on this claim, [PII], we will also have to receive, you'll need to send a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK. Uh, I'll repeat the address you gave [PII]. OK. [PII], right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh, could you help me with the next date of service for member?
[AGENT][NEUTRAL] I can. What's the next data service in total bill amount?
[CUSTOMER][NEUTRAL] Yes, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Next, date of service is [PII] for total amount of $196 even.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was you said 196. Yes, this claim was received.
[AGENT][NEUTRAL] And just one moment, I'll provide you that information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The call was received on [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3541841.
[AGENT][NEUTRAL] And the reason
[AGENT][NEUTRAL] For the denial is office visits are not covered by the policy.
[AGENT][NEUTRAL] The supplemental policy decision doesn't cover office visits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Just a moment.
[CUSTOMER][NEUTRAL] You said the, the date is [PII], right?
[AGENT][NEUTRAL] Is that the process date that I gave you?
[CUSTOMER][NEUTRAL] OK, um, just a moment.
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] It was received on [PII] and denied on [PII].
[CUSTOMER][NEUTRAL] Offices that are non-covered as per the member plan or the provider contract?
[AGENT][NEUTRAL] Member.
[CUSTOMER][NEUTRAL] Could you provide me the member plan name?
[AGENT][NEUTRAL] Medlink
[AGENT][NEUTRAL] Supplemental.
[CUSTOMER][NEUTRAL] Math, could you spell that?
[AGENT][NEUTRAL] M E D L I N K. This is a supplemental policy.
[CUSTOMER][NEUTRAL] OK. Is this a PPO HMO plan?
[AGENT][NEUTRAL] Neither. We are not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK. Um, just a moment.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, uh, is the provider is in network or out of network?
[AGENT][NEUTRAL] There is no network with this plan?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And also, can you tell me that uh is the diagnosis code or ICD 10 is not covered for this?
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Uh, is the diagnosis code or the ICD 10 is not covered under, under the member plan?
[AGENT][NEUTRAL] Office office visits?
[AGENT][NEGATIVE] Are not covered.
[CUSTOMER][NEUTRAL] OK. Only the office visit.
[CUSTOMER][NEUTRAL] OK. Can I get the claim, uh sorry, you already gave the claim number 3541841, right?
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] That is correct, uh huh.
[CUSTOMER][NEUTRAL] OK. Uh, could you spell your name for me?
[AGENT][NEUTRAL] [PII] and my name in today's date will also be your call reference number and if you need a copy of the explanation of benefits, you may print that from our portal.
[AGENT][NEUTRAL] And that website you go to is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for providing details. Have a great day. Bye.
[AGENT][POSITIVE] Yeah, you too, if that's all I can help you with, and thank you again for calling APL [PII] and I hope you have a nice afternoon as well.