AccountId: 011433970860
ContactId: df0bc62b-9b38-4eca-a992-60ec69255ae6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 662859 ms
Total Talk Time (AGENT): 193218 ms
Total Talk Time (CUSTOMER): 89559 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/df0bc62b-9b38-4eca-a992-60ec69255ae6_20250529T13:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. I am calling from a provider's office regarding a claim.
[AGENT][NEUTRAL] OK, I can help you with claim status. Um, can I get your name and a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII] and callback number is [PII].
[AGENT][POSITIVE] OK, thank you so much, [PII]. And do you have the uh policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02587156.
[AGENT][NEUTRAL] OK, give me just a moment to look that up.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Uh, data service is 42-25.
[AGENT][NEUTRAL] Alright, let me check.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Do you know what the uh total bill amount is?
[CUSTOMER][NEUTRAL] $89.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEGATIVE] It looks like it was denied and let me see why.
[AGENT][NEUTRAL] OK, it looks like office visits aren't covered under her policy.
[AGENT][NEUTRAL] I'm sorry, under his policy.
[CUSTOMER][NEUTRAL] OK, um, so with their policy, what all like what does it cover?
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Oh, and let me give you the claim number too. I apologize. Um, it's 360-1543.
[AGENT][NEUTRAL] And let me check and see what they, their policy has, and I will say that this is a Medlink policy, so secondary gap as well.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] This is just a verification of benefits and not a guarantee of payment. They have an inpatient benefit of up to $2500 per calendar year.
[AGENT][NEUTRAL] With a $0 deductible. Um, they also have an outpatient benefit max of up to $500 per calendar day with a $0 deductible. These do need to be related to an accident or illness.
[AGENT][NEUTRAL] Uh, she has an office, or he has an office treatment writer and a cancer, uh, outpatient treatment writer.
[AGENT][NEUTRAL] And it looks like he also has independent lab, a DME or durable medical equipment, um, writer as well.
[AGENT][NEUTRAL] But for the inpatient, outpatient needs to be due to an accident or illness, but there's no office visits, only office treatments.
[CUSTOMER][NEUTRAL] What does that mean?
[CUSTOMER][NEUTRAL] OK, so you all do coverro screens?
[AGENT][POSITIVE] We cover what? I'm, I'm sorry.
[CUSTOMER][NEUTRAL] So do you all cover like drug screens? Do we do um bill for those as well?
[AGENT][NEUTRAL] I would have to look, let me look into their actual policy, um, for their definitions. I don't.
[AGENT][NEUTRAL] I know they have diagnostic testing. I don't know if it's considered for that.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] Just give me one moment, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said drug screening?
[CUSTOMER][NEUTRAL] Yeah, um, so we do a drug test, um, due to us being a pain management office, and I know he's got a couple of claims we'll be submitting to you all should be at any time, honestly. Uh, so I didn't know if that was something that was that was covered. So we bill for the drug test and then like the drug, like the panel that they use.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the drug test.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It doesn't say that they don't, but let me look at their lab writer and see.
[AGENT][NEUTRAL] I don't see anything specifically related to drugs or screening being
[AGENT][NEUTRAL] On here as an exclusion or as a benefit. The only thing I do see that could be relevant is an independent lab facility. Uh, so we'll pay out of the out of pocket amount for diagnostic testing in an independent lab facility. I don't know if you, if you code that as diagnostic testing since it's just a drug screening.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But it would go towards their outpatient. That's the only thing I see that could be possibly relevant.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] So I did have a question back to the original plane. So it wasn't an office visit. It was um
[CUSTOMER][NEUTRAL] I don't know how to describe it. I'm not a builder or a coder, so I can only, I don't really know how to explain certain things, but these are calls that are made to the patient, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Kind of like as a follow up so that I guess that falls under office visit.
[AGENT][NEUTRAL] Yeah, if it's a follow up or anything that has, that's not getting treatment, um, unless it's considered inpatient or outpatient, it's not going to, it'll be under an office visit.
[AGENT][NEUTRAL] Unless they were getting treatment in the office.
[AGENT][NEUTRAL] Are you still there?
[AGENT][NEUTRAL] [PII], can you hear me?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] [PII], can you hear me?
[AGENT][NEUTRAL] [PII], are you there?