AccountId: 011433970860
ContactId: e03b3b91-2bf2-43bb-a722-8221006b4c38
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1221709 ms
Total Talk Time (AGENT): 200571 ms
Total Talk Time (CUSTOMER): 304725 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/e03b3b91-2bf2-43bb-a722-8221006b4c38_20250611T14:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi. This is [PII]. I'm calling from providers billing office.
[AGENT][NEUTRAL] I'm sorry, I didn't get your name. Did you say [PII]?
[CUSTOMER][NEUTRAL] Yes, it's [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnect, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII] direct line.
[AGENT][NEUTRAL] OK, may I have the name of the facility you're calling from I know?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Skin and Cancer Associates
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][POSITIVE] OK thank you bye.
[CUSTOMER][NEUTRAL] Yeah, sure. Before that, this call is recording for quality and training purpose. Are you OK with the call recording? Yeah, thank you for confirming and um member ID is gonna be 02483110.
[AGENT][POSITIVE] Sure, yes, I can.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure. um.
[CUSTOMER][NEUTRAL] [PII]. [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you need claim status or you need uh liability or benefits, what type of service?
[CUSTOMER][NEUTRAL] Uh, no, actually, the claim is denied as a non-covered service. Can you please check that why it is denied for non-covered charges.
[AGENT][NEUTRAL] OK, what is the claim number or do you have the date of service?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Um, uh, I will go ahead with the date of service. It's, uh, [PII] $277 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] that
[AGENT][NEUTRAL] OK, so the denial reason on this one is office visits are not covered under this policy under the member's plan.
[CUSTOMER][NEUTRAL] You know, you know.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] lady.
[CUSTOMER][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, thank you for being on hold, um.
[CUSTOMER][NEUTRAL] On the date of uh
[CUSTOMER][NEUTRAL] [PII], we got the payments for office visit only um for A 9270 CPT. Can you please check that once?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 892, what's the CPT code?
[CUSTOMER][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's um
[CUSTOMER][NEUTRAL] A. 9270 T.
[CUSTOMER][NEUTRAL] For Botox.
[AGENT][NEUTRAL] Yeah, that, that is totally different. An office visit, 99214 is totally different from that code. The procedures are covered. Office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That means for ENM code office visit it will not cover, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] When
[CUSTOMER][NEUTRAL] Yeah, OK, is this one is a patient responsibility?
[AGENT][NEUTRAL] It's just not covered by us. Um, we don't, we're not the major medical, so it's up to the provider's discretion.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Shall we move ahead with next member ID?
[AGENT][NEUTRAL] OK, bear with me, let me go ahead and make a note on this one. You don't need any other information on this one? I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][NEUTRAL] Yeah, I want to call reference. Before that, can you please spell your name once?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. Can you please share the call reference for this particular number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's name.
[CUSTOMER][NEUTRAL] Yeah, OK, fine.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Go be one more minute. I'm finalizing the note.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] Yeah, the next policy number is 02443498 M as in Mary, L as in Lima 7.
[CUSTOMER][NEUTRAL] We don't install.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] You well.
[CUSTOMER][NEUTRAL] [PII] $277 even.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Uh, it's [PII]. Yes.
[AGENT][NEUTRAL] 13, OK.
[AGENT][POSITIVE] Thank you. OK, let me see if I can find this one.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I'll do it.
[AGENT][NEUTRAL] OK, so this scenario is the same one as the previous one. Of visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need the claim number?
[CUSTOMER][NEUTRAL] Uh, just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is the EOB is uh available with you?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Is the UOB uh available with you?
[CUSTOMER][NEUTRAL] For this denial is the EOB has been generated.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] An EOB has been generated, yes.
[CUSTOMER][NEUTRAL] OK. Actually, can you please share the COB to our fax numbers?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Uh, if you don't mind, can you please share the, the previous, uh, for previous member also, I want the AOP.
[AGENT][NEUTRAL] I will have to get all the information again because I'm already out of the account. That's why I asked if there's anything else before I finalize.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, actually, I have only two, IDs with a particular policy. So, with this, uh, particular, uh, payer. So if possible, can you please reopen that and share that AOP also? Why? Because we need to bill patient.
[AGENT][NEUTRAL] When we, when we
[AGENT][NEUTRAL] Yes, I do understand, Ms. [PII], but we will have to do one at a time. Once I finalize this one we can go back to the beginning, OK?
[CUSTOMER][NEUTRAL] Yeah, OK. Sure.
[AGENT][NEUTRAL] So go ahead with the fax number.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Yeah, thank you for confirming.
[CUSTOMER][NEUTRAL] The fax number is gonna be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 835.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, I'm repeating once again.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, it's 702.
[CUSTOMER][NEUTRAL] 8,351,020.
[AGENT][NEUTRAL] To our attention?
[CUSTOMER][NEUTRAL] And attention, my name is [PII]. My name is [PII]
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And again, that fax number is [PII].
[CUSTOMER][POSITIVE] Excellent.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You before I move to the next one, so if you don't mind holding for me, let me go ahead and send this out to you right now.
[CUSTOMER][NEUTRAL] Yeah, OK, for sure. And how much time it will take for the fact?
[AGENT][POSITIVE] Thank you. Mhm.
[AGENT][NEUTRAL] A few minutes, I'm gonna send it right now.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I went ahead and send that one, Miss [PII], um, what is the, um, old policy number, the ones the one previous?
[CUSTOMER][NEUTRAL] Yeah, it's uh 02483110.
[AGENT][NEUTRAL] And what was the date of service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With the bill amount of $277 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm waiting on the system to fax this over, OK, one moment.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] OK, it should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, have you shared that it will be to a fax number?
[AGENT][NEUTRAL] Yeah, the fax number you provided to me the [PII].
[CUSTOMER][POSITIVE] Yes, exactly. Thank you so much. This is all needed for today.
[AGENT][POSITIVE] OK. Well, thank you for calling APO. Have a good day, Ms. [PII].
[CUSTOMER][POSITIVE] Yeah, thank you. Have a great day. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah