AccountId: 011433970860
ContactId: deede30a-9494-4986-8484-cb23b5a89de7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 778890 ms
Total Talk Time (AGENT): 255218 ms
Total Talk Time (CUSTOMER): 164197 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/deede30a-9494-4986-8484-cb23b5a89de7_20250527T14:16_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 [PII], I'm [PII]. Last name initial [PII].
[CUSTOMER][NEUTRAL] Calling from
[CUSTOMER][POSITIVE] So advanced pain management.
[AGENT][NEUTRAL] OK, [PII], how can I help you this morning?
[CUSTOMER][NEUTRAL] Uh well, looking for claim clarification.
[AGENT][NEUTRAL] You're needing the the reason for a denied claim, is that correct? Clarification on the denial?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII] and it's a direct line?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] That is 02337756.
[CUSTOMER][NEUTRAL] M as in Mary, I as in India, 8.
[AGENT][NEUTRAL] OK. That would be an L and not an I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the patient's date of birth is [PII].
[AGENT][NEUTRAL] OK, just a moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any information that I do provide today will be a verification of benefits and not a guarantee of payment. Give me just one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and if you could please re-verify your patient's name and date of birth.
[CUSTOMER][NEUTRAL] Sure. That is [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right. And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Um, the data service is [PII] and the bill amount is $1300 even.
[AGENT][NEUTRAL] OK. Thank you, [PII]. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, bear with me, um, [PII], I apologize, my system is running.
[AGENT][NEUTRAL] Slowly at the moment.
[CUSTOMER][NEGATIVE] Slow.
[CUSTOMER][POSITIVE] Sure, not a problem. Take your time.
[AGENT][POSITIVE] Uh, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you happen to have the claim number that you're calling about today, [PII]?
[CUSTOMER][NEUTRAL] My number is 360-1212.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I can see that that claim was denied as a duplicate of previously submitted expenses.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Can you put it?
[AGENT][NEUTRAL] And.
[AGENT][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Can you put your Virgin claim status?
[AGENT][NEUTRAL] Yes, I'm waiting for that to load.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so the original claim number is 352.
[AGENT][NEUTRAL] 8794.
[AGENT][NEGATIVE] And this one was denied.
[CUSTOMER][NEUTRAL] The plan
[CUSTOMER][NEUTRAL] Sorry, original client number is 352-874, right?
[AGENT][NEUTRAL] 3352-8794.
[CUSTOMER][POSITIVE] OK, sure. Thank you and the receipt on and on.
[AGENT][NEUTRAL] I'm just waiting on the system.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] For that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She received 11-8-2024 and denied on 11-12-2024.
[CUSTOMER][NEUTRAL] OK, 11 8 and 1112.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and uh can I claim any reason?
[AGENT][NEUTRAL] Office visits are not covered?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And also, this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEGATIVE] Office is not covered and
[AGENT][NEGATIVE] The other codes were denied as this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, when perform under that?
[CUSTOMER][NEUTRAL] Doctor's office or clinic?
[CUSTOMER][NEUTRAL] It's not covered under the patient plan or medical providers plan?
[AGENT][NEUTRAL] Patience.
[AGENT][NEUTRAL] Patient
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, now that you have the original claim number, you can print that from our portal at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] And is there anything else that I can help you with this morning, [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Are you looking for another claim general reason?
[AGENT][NEUTRAL] For the same member? Because I asked you if it was one and you said yes.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Uh, with the same, uh, patient, so that I just stay the one.
[CUSTOMER][NEUTRAL] OK, before that, can I, can I get they get they call us for this call?
[AGENT][NEUTRAL] My name and today's date will be your call reference numbers. What's the next data service for this number and total bill amount?
[CUSTOMER][NEUTRAL] Sure. The date of service is [PII] and the bill amount is $1300 even.
[AGENT][NEUTRAL] Same data service I mean same build amount, correct?
[CUSTOMER][POSITIVE] That's that's right.
[CUSTOMER][NEUTRAL] And uh the claim number is?
[AGENT][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, what is the claim number?
[CUSTOMER][NEUTRAL] 360-1201
[AGENT][NEUTRAL] Yes, that was denied as a duplicate of previously submitted expenses also.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] Give me a moment. I'm sorry, but my system is moving slowly.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so the original claim on that was received on 224-25.
[AGENT][NEUTRAL] And it was denied on 225, 25, [PII].
[AGENT][NEUTRAL] And that claim number is going to be 3567893.
[CUSTOMER][NEUTRAL] 7893 and uh
[AGENT][NEUTRAL] And that one.
[AGENT][NEGATIVE] It was denied for the same reason as the other claim. Office visits are not covered, and this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure. Uh, well, you said the other courts is not covered under the patient plan, right?
[AGENT][NEUTRAL] Yes, these are the, yes, it's not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK. Can you provide the
[CUSTOMER][NEUTRAL] Other code list which is not covered under the patient plan.
[AGENT][NEUTRAL] No, sir, I can't.
[CUSTOMER][NEUTRAL] Sure. OK, can you provide the office receipt?
[AGENT][NEGATIVE] There's not a list. No.
[CUSTOMER][NEUTRAL] Of this is not covered under the patient plan or uh?
[AGENT][NEUTRAL] Patient.
[CUSTOMER][NEUTRAL] Protestant
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that means, uh, when looking for other codes that wish to for recording purpose, not for the billing but.
[AGENT][NEUTRAL] Uh, no, sir, I don't have a list of codes. No, sir, I don't have a list of codes. This is a supplemental policy that must be submitted with the primary insurance company first and then with a PO for review.
[CUSTOMER][NEUTRAL] Not for the claim billing.
[CUSTOMER][POSITIVE] OK, sure, not a problem.
[CUSTOMER][NEUTRAL] Sure. Uh, well, uh, how do you spell your good name?
[AGENT][NEUTRAL] [PII] and my name and today's date will be your call reference number. And again, if you need a copy of either one of those original explanation of benefits, you may print it from our portal that I gave you at [PII].
[CUSTOMER][NEUTRAL] Sure, OK, [PII], your last name initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No. OK, sir. [PII].
[AGENT][NEUTRAL] Pardon me?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK. Well, is there anything else, [PII], I could, else [PII] I can help you with today?
[CUSTOMER][NEUTRAL] Well, you have provided record information on the claim. Thank you.
[AGENT][POSITIVE] Well, you're very welcome. So again, thank you for calling APL and I hope you have a very nice day.
[CUSTOMER][POSITIVE] Sure, have a nice day to you.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye. Bye bye.
[CUSTOMER][POSITIVE] Have a nice day bye.
[CUSTOMER][NEUTRAL] Bye bye.