AccountId: 011433970860
ContactId: e4f8c767-b094-4284-8b11-c83865e5153e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401040 ms
Total Talk Time (AGENT): 113230 ms
Total Talk Time (CUSTOMER): 159599 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/e4f8c767-b094-4284-8b11-c83865e5153e_20250623T20:56_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Sorry for that. I didn't get your name. Could you please tell me your name once again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] calling on behalf of Broader's office to check on the claims.
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII] OK and can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Sure, and the callback number is [PII].
[AGENT][NEUTRAL] Got it thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Sure, and I'm having the policy number with me and the policy number is going to be
[CUSTOMER][NEUTRAL] Yeah, and the policy number is 02166569.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Patient's name is uh [PII], and the patient's date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] That the service for this claim is going to be [PII] and with the bill amount of $205 even.
[AGENT][NEUTRAL] OK, that was [PII] for $205.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, so I did find this claim [PII] looks like we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Claim has been denied for offices it is not covered under the patient policy or provider policy.
[AGENT][NEUTRAL] Under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh that was not covered and
[CUSTOMER][NEUTRAL] This plan.
[CUSTOMER][NEUTRAL] Mhm. OK. So,
[CUSTOMER][NEUTRAL] uh this patient going to be responsible for the payment?
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. So upon checking from R&B form, we have received the payment from the primary insurance actually.
[AGENT][NEUTRAL] OK, this policy, their secondary medical does not cover office visits.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] I got the call reference number.
[AGENT][NEUTRAL] That would be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Yes, actually, I'm having some other claims for the same patient with a different data services.
[AGENT][NEUTRAL] This is for the same number you said?
[CUSTOMER][NEUTRAL] Yes, yes, it is for the same number, but for the different data services.
[AGENT][NEUTRAL] Got you. OK, what was that next date of service?
[CUSTOMER][NEUTRAL] The next date of service is going to be uh [PII] with the bill amount of $408 even.
[AGENT][NEUTRAL] That was 408.
[CUSTOMER][POSITIVE] Mm. Yes, exactly.
[AGENT][NEUTRAL] OK, and [PII].
[CUSTOMER][NEUTRAL] Hm, yes.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we received this claim as well that denial reason is the same as the other office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Same as them, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So the call reference number is also going to be the same.
[AGENT][NEUTRAL] Yes, that would be the same uh for any claim that we check.
[CUSTOMER][NEUTRAL] OK, I'm going with the next date of service and the next date of service is going to be [PII] and with the billed amount of $408 even.
[AGENT][NEUTRAL] OK, that was [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim denial reason is the same as well as office visits are not covered, we were unable to pay a benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Going with the last data of service and the last claim also.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm. Yes. And the last data service here, it is going to be $619 data services [PII] at the bill amount of $619 even.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, you said uh that was [PII] correct?
[CUSTOMER][NEUTRAL] Mm yes, [PII].
[AGENT][NEUTRAL] [PII] I'm not showing that we've received any claims for that date of service for this number.
[CUSTOMER][NEUTRAL] Uh, actually, we're having the claim number with us.
[AGENT][NEUTRAL] OK, what was that claim number?
[CUSTOMER][NEUTRAL] Uh, yes, and the claim number here it is going to be.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 359-978-87
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the, and the bill amount is $619.
[AGENT][NEUTRAL] I have that as a completely different member.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim is for a different member.
[CUSTOMER][NEUTRAL] Uh, actually, the data service, mm, OK, so the call reference number is going to be the same, I think so, right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. So thank you for the information which you provided me here, [PII]. It was nice talking with you. Have a nice day and take care. Bye-bye.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] You too thank you bye bye.
[CUSTOMER][NEUTRAL] Mhm.