AccountId: 011433970860
ContactId: dcbc67c3-2cdd-4e5f-a567-c8c1e45a7771
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1162420 ms
Total Talk Time (AGENT): 392330 ms
Total Talk Time (CUSTOMER): 248698 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/dcbc67c3-2cdd-4e5f-a567-c8c1e45a7771_20250428T15:00_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] Yeah, hey, my name is [PII]. I'm calling from provider's office. I'm looking for a claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh, actually I have 3 claims.
[AGENT][NEUTRAL] OK, you have 3 claims, and it's for different members that you have a data service, is that correct?
[CUSTOMER][NEUTRAL] D of service is [PII].
[AGENT][NEUTRAL] OK. No, no, sir. Hold on just a moment, please. Did you say you have 3 patients to check claim status for?
[CUSTOMER][NEUTRAL] Yeah sure.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, [PII], I can help you with those. And what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. So first off, [PII], you will use my name that I gave you along with today's date as each of your call reference numbers.
[AGENT][NEUTRAL] Also, any information that I provide for you on the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And if we do have the claims on file and you need a copy of the explanation of benefits, once you have the claim number you can print that from our portal by going to secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, uh, please, can you repeat that? [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The first word is secured.
[CUSTOMER][NEUTRAL] OK, that's the portal, OK.
[AGENT][NEUTRAL] Yes, the first word is secured. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] 80140581 M as in Michael L as in Lion 8.
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] And you said 01.
[CUSTOMER][NEUTRAL] Mm, yes, sure.
[AGENT][NEUTRAL] 405821 was the first part of the number, is that correct?
[CUSTOMER][NEUTRAL] Yeah, it's 1100140581.
[CUSTOMER][NEUTRAL] That's the number before the alphabets.
[AGENT][NEUTRAL] OK. Repeat the number one more time, [PII], because that's something different than you said before.
[CUSTOMER][NEUTRAL] Uh, it's 0140581. After that, it's M as in Michael, L as in line, 8.
[AGENT][NEUTRAL] OK, so that number is not valid. Do you have a copy of the ID card?
[CUSTOMER][POSITIVE] Uh, sweet, I will check that.
[CUSTOMER][NEUTRAL] No, I didn't have the ID card for this patient.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] I can try and search by the name. Do you have the full social security number?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] I only have the member ID number that I provide you.
[AGENT][NEUTRAL] Yes, sir, and that's an incorrect number. What's the patient's last name?
[CUSTOMER][NEUTRAL] It's uh, [PII].
[AGENT][NEUTRAL] [PII] is the last name.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment. And what is the first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], one moment.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And what is her date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so the correct policy number that you should have is 01.
[AGENT][NEUTRAL] 48.
[AGENT][NEUTRAL] 581.
[CUSTOMER][NEUTRAL] 4 H.
[AGENT][NEUTRAL] No, 8.
[AGENT][NEUTRAL] The number 8.
[CUSTOMER][NEUTRAL] H, OK.
[AGENT][NEUTRAL] 0, so again, 01480581.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII] and total bill amount is $127.98.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, so I do not have a claim on file for her for this state of service and this total bill amount.
[CUSTOMER][NEUTRAL] Can you please check the bill amount $471?
[AGENT][NEUTRAL] OK, so is the billed amount 127.98 or 471?
[CUSTOMER][NEUTRAL] 471.
[AGENT][NEUTRAL] So this claim was received.
[AGENT][NEUTRAL] The received date for this claim was [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 35.
[CUSTOMER][NEUTRAL] Uh, what's the denied reason.
[AGENT][NEUTRAL] Would you like the claim number first?
[CUSTOMER][NEUTRAL] Uh, yeah, yeah, yeah. What's the claim number?
[AGENT][NEUTRAL] 357.
[AGENT][NEUTRAL] 7312.
[AGENT][NEGATIVE] And the reason for the denial states this service.
[AGENT][NEGATIVE] Is not covered.
[AGENT][NEUTRAL] When performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The members supple the members.
[CUSTOMER][NEUTRAL] Hm, please hold for a second.
[AGENT][NEUTRAL] The member's plans, this members.
[CUSTOMER][NEUTRAL] Yeah, yeah, but
[AGENT][NEUTRAL] The members supplemental policy does not cover this procedure when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] The member's plan is?
[CUSTOMER][NEUTRAL] OK. Uh, can you please hold for a second?
[AGENT][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] Um, the member is not eligible for the service, right?
[AGENT][NEUTRAL] No, so that's not what I said.
[AGENT][NEGATIVE] I read you the exact remark. It says this service is not covered.
[AGENT][NEUTRAL] When performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm this is. Are you primary payer or secondary payer?
[AGENT][NEUTRAL] This is a 2nd, this is a supplemental policy to the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, can you please give me the reason for the non-covered again?
[AGENT][NEGATIVE] It's not covered for the member's plan.
[AGENT][NEUTRAL] The supplemental policy does not cover this service when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need any other information on this policy before we move to the next one?
[CUSTOMER][NEUTRAL] No, actually, I didn't need any sir can we move to the next one, your next member ID is
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It's 01071095.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth please uh [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Data service and total bill amount.
[CUSTOMER][NEUTRAL] Date of service is [PII] and total bill amount is $491.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, so on this, this claim was received on [PII].
[AGENT][NEUTRAL] Process on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 9582.
[AGENT][NEUTRAL] There was a benefit paid?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In the amount of $25.
[CUSTOMER][NEUTRAL] And 64 cents, right?
[AGENT][NEUTRAL] $25 even.
[AGENT][NEUTRAL] And there were more and that was on.
[CUSTOMER][NEUTRAL] Uh, actually, I need to uh.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Actually you did I schedule for the CPD 992. OK, OK, OK.
[AGENT][NEGATIVE] 99213 is denied as the maximum benefit amount for treatment provided during this visit has been exhausted. No benefits are available for this service.
[CUSTOMER][POSITIVE] Maximum benefit deni.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I'm not saying to you.
[AGENT][NEUTRAL] With the $25 benefit paid?
[AGENT][NEUTRAL] That was the payment, the maximum benefit for services provided during this office visit is exhausted.
[CUSTOMER][NEUTRAL] Mm, can you please hold for a second? I'm checking on this my system.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Are you a primary payer for this patient or a secondary?
[AGENT][NEUTRAL] No, sir, this is a secondary policy.
[AGENT][NEUTRAL] This is a supplement to the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there any other information that you need on this one, [PII]?
[CUSTOMER][NEUTRAL] Uh, the remaining balance on [PII] is $25.64. Why did not you pay that?
[AGENT][NEUTRAL] As I read you the remark with the $25 payment, this is the maximum benefit amount for services provided during this office visit.
[AGENT][NEGATIVE] And it's exhausted with that payment.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And again, is there any other information you need before we move on?
[CUSTOMER][NEUTRAL] Uh, yeah, we move on to the next question.
[CUSTOMER][NEUTRAL] The next member ID is 2312712.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Date of service is [PII]. Total bill amount is $790.
[AGENT][NEUTRAL] I'm sorry, how much was the billed amount?
[CUSTOMER][NEUTRAL] $709. It's 709.
[AGENT][NEUTRAL] 709. OK, thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] Denied on [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 667 7.
[AGENT][NEUTRAL] And the 99205 was denied as office visits are not covered.
[AGENT][NEUTRAL] By the above numbered policy. The member's policy does not cover office visits.
[AGENT][NEUTRAL] Code 76881.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] please provide copies of your explanation of benefits of update.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you please give me the callback reference number?
[AGENT][NEUTRAL] As I stated initially, it would be my name along with today's date.
[CUSTOMER][NEUTRAL] Uh, can you please tell me your date? Tell me, can you please tell me your name again?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] First initial to last name [PII].
[CUSTOMER][NEUTRAL] OK. And after your name, it's today's date for the callback reference number, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Have a nice day.
[AGENT][POSITIVE] OK. Well, you're welcome. I hope you have a nice day, [PII]. Is there anything else I can help you with this morning?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, well then, thank you again for calling APL.
[CUSTOMER][NEUTRAL] OK, bye bye.
[AGENT][NEUTRAL] Bye-bye.