AccountId: 011433970860
ContactId: ea6f12ee-3abf-45f6-974a-8efa0d79c101
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 693659 ms
Total Talk Time (AGENT): 152914 ms
Total Talk Time (CUSTOMER): 194387 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/ea6f12ee-3abf-45f6-974a-8efa0d79c101_20250306T18:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider office. Uh, looking for general claim status.
[AGENT][NEUTRAL] OK, what's your name, sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Pronounce it.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] 0, OK. And what's the policy number?
[CUSTOMER][NEUTRAL] 01986309.
[AGENT][NEUTRAL] OK, thank you. What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and do you pronounce your name [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you said that you're checking claim status?
[CUSTOMER][NEUTRAL] Uh yes. Uh, sorry, we got a denial in this claim, so I just want to talk about the denial.
[AGENT][NEUTRAL] OK, what's the claim number?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Do you have the claim number since you have a denial, do you have the claim number?
[CUSTOMER][NEUTRAL] Let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] Uh, sorry, I don't have any claim number.
[AGENT][NEUTRAL] But you know that it's denied?
[CUSTOMER][NEUTRAL] Uh, it's showing guidelines not met. It's just showing in the system.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] What's the data service and the charge?
[CUSTOMER][NEUTRAL] Data service is [PII] and the charge amount is
[CUSTOMER][NEUTRAL] Uh, give me a moment. Let me give you charge amount.
[CUSTOMER][NEUTRAL] Charge amount is $448.39.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the procedure code on the claim?
[CUSTOMER][NEUTRAL] Uh, I just want to talk about 8087038.
[AGENT][NEUTRAL] A 7038.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what type of equipment was that?
[CUSTOMER][NEUTRAL] Mm, it was
[CUSTOMER][NEUTRAL] Filter air disposable standard.
[AGENT][NEUTRAL] I feel
[AGENT][NEUTRAL] OK, you said it was a filter?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, disposable items are not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, it was not under the policy. What uh kind of plan member have, may I know the plan member plan name?
[AGENT][NEUTRAL] Yeah, it's a supple, it's a Metlink policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] DME is covered under the policy, but the disposable items are not covered.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Time is not covered.
[CUSTOMER][NEUTRAL] OK. May I know your name?
[AGENT][NEUTRAL] It's [PII] last name is [PII]. Any other questions?
[CUSTOMER][NEUTRAL] Oh, I have another claim.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] Is it for the same person?
[CUSTOMER][NEUTRAL] No, it was a different.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] You can also check your status online at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the next policy number?
[CUSTOMER][NEUTRAL] 02049543.
[AGENT][NEUTRAL] And is it the same thing, you need clarification of a denial?
[CUSTOMER][NEUTRAL] Uh, regarding this, uh, does
[CUSTOMER][NEUTRAL] Insurance covered Medicare deductible, sorry, any deductibles, not Medicare.
[AGENT][NEUTRAL] 11 moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the data service and the total charge?
[CUSTOMER][NEUTRAL] Total service is [PII] and the total charge amount is
[CUSTOMER][NEUTRAL] Mm mm $369.25.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the procedure code?
[CUSTOMER][NEUTRAL] Um, procedure code E 0431 and E1390.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, so I'm showing that the charges were applied towards the uh calendar year deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So 47.03 was applied towards deductible for EL0431 and $2.08 8 $208.80 was applied towards deductible for code E 1390.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] Uh, does insurance covered?
[AGENT][NEUTRAL] It went towards their deductible under the APL policy.
[CUSTOMER][NEUTRAL] Yes, so it's going to be processed?
[CUSTOMER][NEUTRAL] If it's covered.
[AGENT][NEUTRAL] The claim was already processed. this policy has a deductible of 500 and so the charges were applied towards deductible.
[CUSTOMER][NEUTRAL] OK, but it got from the primary and the American Public Life is a second APL.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So 2 is going to be processed or not? May I just don't know?
[AGENT][NEUTRAL] OK, there's a deductible under this policy as well.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So when we process the claim.
[AGENT][NEUTRAL] The amounts payable were applied towards the deductible under this policy.
[CUSTOMER][NEUTRAL] OK. Because it's not showing process from my end.
[CUSTOMER][NEUTRAL] That's why I'm asking.
[AGENT][NEUTRAL] Yeah, so that's the status of the claim.
[CUSTOMER][NEUTRAL] OK. So it's going to be processed or it is the process?
[AGENT][NEUTRAL] It has already been processed sir and applied towards the deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need the claim number? Uh-huh.
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] Yes, yes. OK.
[AGENT][NEUTRAL] Let me know when you're ready for the claim number.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] OK. It's 355.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 89
[CUSTOMER][NEUTRAL] At the end of the moment
[AGENT][NEUTRAL] 52.
[CUSTOMER][NEUTRAL] OK. Give me a moment.
[CUSTOMER][NEUTRAL] OK. May I know the call reference number?
[AGENT][NEUTRAL] My name in today's date, [PII] and first initial and last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII], uh, just want to know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, is there any, hm, check number or something for
[CUSTOMER][NEUTRAL] We have for deductible.
[AGENT][NEUTRAL] OK, there was no check issued.
[CUSTOMER][NEUTRAL] And what was the date of deductible?
[AGENT][NEUTRAL] The date the claim was processed?
[AGENT][NEUTRAL] Was [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][POSITIVE] OK. Thank you for the information.
[AGENT][POSITIVE] All right. Any other questions I can help out with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Have a good day.