AccountId: 011433970860
ContactId: e27c9efe-6899-40ed-830c-3f01eaccc22c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413320 ms
Total Talk Time (AGENT): 180426 ms
Total Talk Time (CUSTOMER): 188594 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/e27c9efe-6899-40ed-830c-3f01eaccc22c_20250108T20:42_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, this is, excuse me, I lost my voice there for a minute. This is [PII] with kidneys.
[AGENT][POSITIVE] You're OK.
[CUSTOMER][NEUTRAL] Uh, it's been a rough day. I've done a lot of talk that sure. I'm, I'm sure you have.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I just wanted to check the status of a claim.
[AGENT][POSITIVE] Oh, I'd love to help you with claims status.
[CUSTOMER][NEUTRAL] And I'm sorry, I didn't
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] I said I'd love to help you with claim status and then were you gonna ask for my name?
[CUSTOMER][NEUTRAL] Yes, I was. I for some reason, you sound like you're in a tunnel.
[AGENT][NEUTRAL] Oh, can you hear me better?
[CUSTOMER][NEUTRAL] I can hear you better there you are.
[AGENT][NEUTRAL] Sorry, my microphone, I guess like ended up by my shoulder. I'm so sorry. Miss [PII], my, my name is [PII] [PII]
[CUSTOMER][POSITIVE] No worries. No, that's no problem.
[AGENT][NEUTRAL] And before we get going on that claim status, do you mind if I also grab a good call back number?
[CUSTOMER][NEGATIVE] Not at all. It's [PII].
[AGENT][POSITIVE] Perfect. And then can I have that policy number when you're ready?
[CUSTOMER][NEUTRAL] Yes, ma'am. 021268-86.
[AGENT][POSITIVE] Thank you. And give me just a couple moments to get that policy loaded and pulled up.
[CUSTOMER][POSITIVE] No worries, you take your time. How are you doing today? Is it cold where you are? You getting snow and ice, or?
[AGENT][NEUTRAL] It is definitely cold, um, but it's sunny today. It's just gonna get kind of gross like Thursday and Friday, I think.
[CUSTOMER][NEUTRAL] Oh, that's how I'm in [PII] and that's how it is. It's very cold. It looks beautiful outside, sunny, but we have uh ice and wintery mix and then snow moving in tonight.
[AGENT][NEUTRAL] Taxes
[AGENT][NEUTRAL] Yeah, that's a little concerning so I'm [PII] based so um I bet we're gonna have something really similar.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, yeah, I, I work for um a company in [PII], and I was just talking to one of my guys in the billing department there and we were talking about how
[CUSTOMER][NEUTRAL] How we're basically twin states, how we get the same kind of weather.
[AGENT][NEUTRAL] Always, yes, it feels like that for sure, um, except I guess you're, I don't know, I'm thankful because it's always hotter in [PII] like.
[AGENT][NEUTRAL] Um, in the summer.
[CUSTOMER][NEUTRAL] It, it is.
[CUSTOMER][NEUTRAL] It is, it is very hot and I work remotely so I.
[AGENT][NEUTRAL] But you guys have way better barbecue, so, I mean, what can we do?
[CUSTOMER][NEUTRAL] This is true. This is true.
[AGENT][NEUTRAL] Miss [PII], what's your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] You got me on that.
[CUSTOMER][NEUTRAL] This is gonna be [PII], uh [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] Wonderful. Thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right and then do you have the claim number and you're looking for further information or did you want me to search it by date of service for you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, I think I have the claim number. I just had a look at our computer, our computer generated, um, EOB and I had an ICN number of 02126886. Does that sound like one of your claim numbers?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That was actually his policy number.
[CUSTOMER][NEUTRAL] OK then let me give you the date service. No, ma'am, I do not have a claim number.
[AGENT][POSITIVE] No worries, let me pull that up for you and whenever you're ready.
[CUSTOMER][NEUTRAL] OK, it's gonna be for [PII]. The bill amount was $197.
[AGENT][NEUTRAL] All right. Hang tight. I believe I see that claim.
[CUSTOMER][NEUTRAL] And I will take the claim number from you when you find it.
[AGENT][NEUTRAL] You bet you. Would you be able to verify for me again just the name of the facility on file for this claim?
[CUSTOMER][NEUTRAL] Kidney specialist at Central Oklahoma.
[AGENT][POSITIVE] Wonderful. OK, so I do see that claim number is 3541204.
[AGENT][NEUTRAL] It looks like we received the claim [PII] and then we processed it on [PII].
[AGENT][NEGATIVE] And then it looks like the claim was denied. The reason stating um office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On our side, it just said not medically deemed not medically necessary.
[AGENT][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] And so I was wondering, I was wondering what type of policy it was. So office visits are not covered on this plan.
[AGENT][NEUTRAL] Yeah, it looks like treatment done in an office setting could be covered, but the administrative charge is not.
[CUSTOMER][NEUTRAL] What do you mean the administrative charge?
[AGENT][NEUTRAL] The like 99214. What I don't know exactly what that procedure code is.
[CUSTOMER][NEUTRAL] Oh, the oh, the CPP because it's a, it's an office visit.
[AGENT][NEUTRAL] Yeah, so like, um, if like he had maybe had treatment done, he does have an office treatment writer to cover treatments in an office setting, but I think like that administrative like that general code is not covered, is how it works.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] If he had some type of procedure done, a different CPT code, then it would have been covered, but since it's this is more.
[AGENT][NEUTRAL] It could, could be, yes.
[CUSTOMER][NEUTRAL] Maybe more like a uh.
[CUSTOMER][NEUTRAL] Hospital policy or something?
[AGENT][NEUTRAL] We're actually kind of like, we're closer to a gap insurance, so we work to cover the co-pay, co-insurance and deductible for major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so if I put CPT code 99214 not covered, that would be sufficient.
[AGENT][NEUTRAL] I, I would think so, yeah.
[CUSTOMER][NEUTRAL] 2992.
[CUSTOMER][NEUTRAL] Covered I.
[CUSTOMER][NEUTRAL] Just trying to figure out how to word it to transfer it over to the patient. I'm sure he received an ELB stating that he was gonna be responsible.
[AGENT][NEUTRAL] We do send EOBs to all our insureds, so as long as all of our information is correct as far as um where to send it uh we we do mail them out yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. I will take the first initial of your last name, Ms. [PII], and a call reference number if you have them.
[AGENT][POSITIVE] You bet your first initial to my last name is B like boy, and then the call reference number is really easy. It's Ali B and today's date.
[CUSTOMER][POSITIVE] All right. Well, that is easy. Well, Ms. [PII], I hope you stay warm and stay safe and have a good New Year.
[AGENT][POSITIVE] Hey, you too. Thank you so much and thanks, Ms. [PII] for your patience today. You take care.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.