AccountId: 011433970860
ContactId: e3e0140d-5235-4110-b3a2-6c89ac036aaa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 592500 ms
Total Talk Time (AGENT): 192942 ms
Total Talk Time (CUSTOMER): 210231 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/e3e0140d-5235-4110-b3a2-6c89ac036aaa_20250502T21:05_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider's office. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] I'm doing great, thank you for asking. Can you please help me with the first initial of your last name?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][POSITIVE] Thank you so much. Um, and I'm calling to check up on a claim denial. Can you please check and assist me on that?
[AGENT][NEUTRAL] Yes, I can help you with the claim denial and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure. So the best callback number is [PII].
[AGENT][NEUTRAL] And the member's policy number?
[CUSTOMER][NEUTRAL] And the policy number is
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. 02473227 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Member's first name is [PII] and last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the claim number for the claim you'd like me to check on with you?
[CUSTOMER][NEUTRAL] Sure, one second. The claim number is 35,872,220.
[AGENT][NEUTRAL] Alright, and this claim was denied because office visits are not covered by this policy and what questions did you have?
[CUSTOMER][NEUTRAL] So, is it patient's responsibility?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we're not the major medical insurance company. So be whatever your, um, policies or procedures are remaining or outstanding balances.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Um,
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Um, is it, uh, not covered under patient's plan or provider's contract?
[AGENT][NEUTRAL] Um, patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. I have uh another uh rep I mean, another claim to check for different member. Uh, before that, can you please help me with the reference number for this one?
[AGENT][NEUTRAL] Yes, the reference number for the entire call is going to be my name and today's date, and again, that's [PII] to my last name is [PII].
[CUSTOMER][NEUTRAL] OK. Um, are you ready for next member ID, [PII]?
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] 030, um sorry.
[CUSTOMER][NEUTRAL] Uh, it's 01780833 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the claim number for the denial?
[CUSTOMER][NEUTRAL] The claim number is 3586078.
[AGENT][NEUTRAL] Alright, and that claim was also denied because office visits are not covered on the policy, um, as well as, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] So 92083 and 92,250 were um denied.
[AGENT][NEUTRAL] Because it's not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK. Uh, is there, uh, anything we can do for that to get the reimbursement for these procedures?
[AGENT][NEUTRAL] No, because the um office visits are not covered by the member's policy, so it's unless the place of service changes, it's not going to, it's not covered by the member's policy office visit.
[CUSTOMER][NEUTRAL] OK. So basically, uh, the office visits are not covered under patient's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. I have one last thing to check.
[AGENT][NEUTRAL] OK, hold on, is it the same number?
[CUSTOMER][NEUTRAL] Let me know what you do.
[CUSTOMER][NEUTRAL] No, it's a different number.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] It's so
[CUSTOMER][NEUTRAL] 01887390 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], uh.
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you and the claim number?
[CUSTOMER][NEUTRAL] Um, well, um, [PII], for this one, we have not received any response. So could you please check and help me out with the claim status, general claim status?
[AGENT][NEUTRAL] Oh, sure. Yes, what's the date of service and the total bill?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's uh [PII]. Total charge is $399.20.
[AGENT][NEUTRAL] Go on.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what is the name of the provider's office on this claim?
[CUSTOMER][NEUTRAL] Uh, it's uh Insight Eye Institute.
[AGENT][NEUTRAL] Um, what's the name of the provider? This one came over differently.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. One second. Let me double check.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's what it's showing.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] All right, thank you for verifying. And again, just for the call, the information provided is a verification of benefits, not a guarantee of payment. So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 9227
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Code 99204 was denied because office visits are not covered on the policy.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, as per patient's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And code 92134 was denied because the insured's primary insurance provided full benefits, so there were no available benefits payable.
[CUSTOMER][NEUTRAL] OK. Uh, you said it was denied on
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Hold on one moment, let me go back to that. Hold on one second. Yes, [PII].
[CUSTOMER][NEUTRAL] Can you fax me the UB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]. Attention to my name.
[AGENT][NEUTRAL] [PII]. Attention, [PII], is that correct?
[CUSTOMER][NEUTRAL] Uh, yes, but just give me one second. Let me double-check the number.
[CUSTOMER][NEUTRAL] [PII]. The last four is [PII].
[AGENT][POSITIVE] Yes, that's what I have. That's correct.
[CUSTOMER][NEUTRAL] OK. And how much time will it take, [PII] to reach us?
[AGENT][NEUTRAL] Um, we usually say for fax is to give it at least an hour. If you haven't received it by the end of day today, you can definitely give us a call today or Monday to resend it for you.
[CUSTOMER][POSITIVE] OK. Uh, thank you so much. You said the reference number for the entire call will be your name and today's date, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you so much once again, [PII], for assisting me today. Have a wonderful weekend ahead. Bye-bye.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, just give me a sec. Let me double check if I have any other claims today with this.
[CUSTOMER][POSITIVE] No, I have only 3 today. So once again, thank you so much.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a good weekend. Bye-bye.
[CUSTOMER][NEUTRAL] Goodbye.
[CUSTOMER][NEUTRAL] Mhm.