AccountId: 011433970860
ContactId: f060645b-ff88-45fc-ba43-f4699f01d27d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 601099 ms
Total Talk Time (AGENT): 269011 ms
Total Talk Time (CUSTOMER): 251712 ms
Interruptions: 5
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/f060645b-ff88-45fc-ba43-f4699f01d27d_20250401T15:20_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, good morning. Myself [PII]. I need your assistance to check the claims.
[AGENT][NEUTRAL] OK, yeah, I'd love to help you with claim status today and did you say your name was [PII] or did I not catch you correct?
[CUSTOMER][POSITIVE] Correct, no, that's fine, that's correct. You have been done good, mhm.
[AGENT][POSITIVE] Correct, OK.
[AGENT][NEUTRAL] Thank you and [PII] we're gonna check some claim status. Do you mind if I go ahead and snag a quick call back number?
[CUSTOMER][NEUTRAL] Mm, I have [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Can I have your name it's spell?
[AGENT][NEUTRAL] Yes, it's [PII], [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Yeah my pleasure [PII], how many claims are we gonna be checking today?
[CUSTOMER][NEUTRAL] Only one client for a single patient I have one client.
[AGENT][NEUTRAL] Only one?
[AGENT][POSITIVE] No worries, let's go ahead and do it. If you don't mind, I'll start with that policy number for you.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] I have that member ID as 1542679 M like Mary.
[AGENT][POSITIVE] OK perfect thank you.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Your patient's first and last name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Policy is under [PII] [PII].
[AGENT][POSITIVE] Thank you. I do appreciate that. Give me just one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] And what is the date of service and the bill amount we were wanting to look at?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII] of this year, [PII] and that's the charge I have.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 168 even.
[AGENT][NEUTRAL] 168.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mhm, yep.
[AGENT][NEUTRAL] OK, let me take a look at something real quick for you.
[CUSTOMER][NEUTRAL] 8829.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] [PII], I do see that your patient actually has an updated policy number with us. Would you like that for your records?
[CUSTOMER][NEUTRAL] Please.
[AGENT][POSITIVE] Perfect. So I'm showing here policy number is 022017887.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Oh, it's my pleasure, and let me try to find that claim now that I have that right policy pulled up.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And would you be able to verify for me, pretty please, the name of the facility on file?
[CUSTOMER][NEUTRAL] Mm provider group I'm calling from uh.
[CUSTOMER][NEUTRAL] Zinter Wellness LLC.
[AGENT][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] G I N T E R.
[AGENT][NEUTRAL] Alright, I do see that claim here. It looks like we received your claim on [PII].
[AGENT][NEUTRAL] Oh, is that correct?
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] No. No, no. OK, hold on.
[CUSTOMER][NEUTRAL] That the.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] That would not be correct.
[CUSTOMER][NEUTRAL] Cross
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] 261. I'm so sorry I pulled up the wrong claim number.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I have the primary pay date as mm mm primary pay date is on [PII] [PII] you have OK continue.
[AGENT][NEUTRAL] Um, we received it [PII].
[AGENT][NEUTRAL] Yeah, we received it [PII]. Um, we processed it [PII] for you. I show your claim number listed is 3571621.
[AGENT][NEGATIVE] And I do show that that claim did get denied. I have the reason stating that office visits are not covered by the above number policy.
[CUSTOMER][NEUTRAL] OK, you don't pay for office visits, general office visit, right? I also have that primary payment even though you're not paying.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, so the primary insurance might well might still make a payment, but under this policy, the gap, it's not gonna cover office visits, so it might cover like an emergency room outpatient visit, but not an office visit.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, do you mean to explain, or sorry, not explain, sorry, uh, would you mind to get me the help out, uh, policy name or the plan name in which that you haven't, uh, able to pay this general offices this coverage.
[AGENT][POSITIVE] No worries.
[AGENT][NEUTRAL] Yeah, so the planning for this policy is Mealin, and it's our gap insurance, so it's like the secondary to help with co-pay co-insurance deductibles.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, here I have one more important question that I do have, as I mentioned, the secondary due with this 25, uh, for a co-pay for the member. With this I need to have bill with you or should I go with this as a bill for member?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, so I mean you're always welcome to appeal, um, that's always your right so if that's something you need to do, let me know and I can at least let you know what those next steps are. um, as far as like determining patient responsibility because APL is a secondary policy company and we only offer limited insurance, we're not allowed to determine patient responsibility that would be up to the major medical provider and then the the facility, the office.
[CUSTOMER][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm mhm.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Um, all we can do is just process it, um, and if it has benefits, pay it, and if not, not.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Mm mm, even though we have been with an appeal also approaching, you're no longer paying for this office. It's of copay $25 right, not for this not for this data service, but in general, mm, that is what my concern, mhm.
[AGENT][NEUTRAL] Yeah, so this particular policy.
[AGENT][NEGATIVE] This particular policy there's no benefits in an office, so other policies might have benefits in an office, but this one doesn't.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm. And here I have from your, uh, one of your colleagues have been provided that I have a postbox address for an app bill for my reference [PII] that is [PII] that is in [PII] State. OK. uh [PII] for the fax. I have [PII].
[AGENT][NEUTRAL] That is all correct, yes, you would just make it instead of making all of it to APL claims it would go to APL appeals.
[CUSTOMER][NEUTRAL] and Ali.
[CUSTOMER][NEUTRAL] OK, OK, that's fine, thank you, and LA, can I request you, you mind to please send me this denyDOB to my fax.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, I'd love to fax that to you. Give me just one second to get that program pulled up. I didn't already have it loaded.
[CUSTOMER][POSITIVE] Please take your time and let me know once you're done.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You're having a wonderful day so far?
[CUSTOMER][NEUTRAL] Mhm. It's somewhat tight and busy as of now has been working for 4 to 5 members continuously. How about you?
[AGENT][NEGATIVE] Oh, no.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Goodness. Um, I'm having.
[CUSTOMER][POSITIVE] And thank you so much for asking.
[AGENT][POSITIVE] You're welcome. I'm having a pretty good day. I got to start with a nice coffee, so I feel like I'm on top of the world.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, and let's see, um, I.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEGATIVE] Coming to [PII] there, it was been hotter.
[AGENT][POSITIVE] It is, yeah. So we're [PII] based and it's, it actually got cold the last two days, but it was really nice and warm this weekend and that felt really nice.
[CUSTOMER][NEUTRAL] Somewhat?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And this year it might be somewhat uh drastic changes. Let's see.
[AGENT][NEUTRAL] Yes, I've noticed that. It seems like the weather's all over the place, but I'm just gonna hope for the best, I guess.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, and that ox box did load up for me finally [PII], do you want me to make that attention to yourself?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Perfect and what's the number I'm gonna be sending that to my friend?
[CUSTOMER][NEUTRAL] 561.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And then 303 and then 2133 and thank you so much for being a friend to me also [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, you're welcome. I got you here at [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, you got it.
[AGENT][POSITIVE] Perfect. I'm gonna send on that right now. You can expect it anywhere in 10 to 15 minutes as long as it goes through.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] Thank you so much for your help and once again it's a claim number I have 3571621 denied or you're going not, you're not going to pay this office visits, right?
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] Correct, yes, we don't cover office visits on this policy, you betcha.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm. Conference note in here.
[AGENT][NEUTRAL] Oh, call reference, um, we don't have a number but you can use my name [PII] my last initial B and today's date.
[CUSTOMER][POSITIVE] Nice meeting you. I hope you have a wonderful day. Stay blessed. bye bye.
[AGENT][POSITIVE] You too bye bye thank you.