AccountId: 011433970860
ContactId: f5a7777d-364d-47da-bde7-362852b05513
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1049140 ms
Total Talk Time (AGENT): 239170 ms
Total Talk Time (CUSTOMER): 257238 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/f5a7777d-364d-47da-bde7-362852b05513_20250310T16:31_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] I'm calling from the doctor's office trying to check on a claim for uh one of our patients.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII] Can I please get your callback number?
[CUSTOMER][NEUTRAL] Sure. I have [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. Just a second.
[CUSTOMER][NEUTRAL] Excuse me, just a sec.
[AGENT][POSITIVE] Yes, sir. Go ahead and take your time.
[CUSTOMER][NEUTRAL] All right, I have it. Uh, so for the name is [PII].
[CUSTOMER][NEUTRAL] Uh, would you need the member ID first, or like do you need the name and date of birth first?
[AGENT][POSITIVE] Either way, whichever is easiest for you.
[CUSTOMER][NEUTRAL] All right. Um, the member ID I will go with is 97.
[CUSTOMER][NEUTRAL] 1111.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for that member ID?
[CUSTOMER][NEUTRAL] The patient associated with it is [PII].
[CUSTOMER][NEUTRAL] Date of birth for [PII] is [PII].
[AGENT][NEUTRAL] OK, let me look him up real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] The total bill for it is $301.75.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary paid their part?
[CUSTOMER][NEUTRAL] Uh, it's $50. That is
[CUSTOMER][NEUTRAL] Charged amount after pri primary paid.
[AGENT][NEUTRAL] OK. And then can you please give me the name of the facility?
[CUSTOMER][NEUTRAL] Sure. It's uh SSK Ophthalmology.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII], can you give me the name of the facility one more time, please?
[CUSTOMER][NEUTRAL] Sure. SSK.
[CUSTOMER][NEUTRAL] Ophthalmology.
[CUSTOMER][NEUTRAL] Or it might be a Span SCI center.
[AGENT][NEUTRAL] Yes, OK, it's gonna be a brief hold. I think I found it. I'll be right back, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you so much [PII] for holding for me. I do have the claim. The claim number is 356-835-0. The claim was received [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was processed on [PII] and the claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK. So any type of office visit, is not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Just a sec.
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] I have uh
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Yes, I have 2 more data service for the same patient, and I just need to confirm whether it is the same thing. I guess it is the same thing cause we have built the office visit it and it might be denied, but I just need the claim number for it. So can you help me with that?
[AGENT][POSITIVE] Absolutely. What's the next day of service?
[CUSTOMER][NEUTRAL] All right. Uh, before we move on, can I verify the claim number that you just gave me? Do you have it open?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. I have 356-835-0, was that it?
[AGENT][POSITIVE] Yes, that's correct. That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next date of service for the same patient is [PII].
[AGENT][NEUTRAL] And what is the charge amount?
[CUSTOMER][NEUTRAL] $416.74.
[AGENT][NEUTRAL] And after primary, what's the amount?
[CUSTOMER][NEUTRAL] Uh, that would be 16.54 I guess.
[AGENT][NEUTRAL] OK, and it's the same facility?
[CUSTOMER][NEUTRAL] It is the same facility, yes.
[AGENT][NEUTRAL] OK and you wanna go ahead and give me the other data service and I'll look them both up together together?
[CUSTOMER][NEUTRAL] Sure. Actually, uh, it would be $50.
[CUSTOMER][NEUTRAL] After the primary paid.
[CUSTOMER][NEUTRAL] And uh the, the date of service would be.
[AGENT][NEUTRAL] On the first one?
[CUSTOMER][NEUTRAL] Yes, on the first one, it would be uh $50.50 dollars, not $16.54 but 50 $50.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For [PII] and then uh the next date of service I have is [PII].
[CUSTOMER][NEUTRAL] [PII]. And uh
[CUSTOMER][NEUTRAL] The total, yes, remaining balance uh after primary pay is $50 for this one as well, $50.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] And then what is the initial charge?
[CUSTOMER][NEUTRAL] OK. The bill amount for 722 is
[CUSTOMER][NEUTRAL] $728.56.
[AGENT][NEUTRAL] OK, and it is the same facility.
[CUSTOMER][NEUTRAL] Yup, yes.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a brief hold. I'm gonna look up these claims for you and I'll be right back, [PII]
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me, [PII] OK, for the data service of [PII].
[AGENT][NEUTRAL] Excuse me, the claim number is 356-836-2.
[AGENT][NEGATIVE] And it was denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][POSITIVE] Perfect. OK.
[AGENT][NEUTRAL] And then the data service 722 of 24.
[AGENT][NEUTRAL] The claim number is 357.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] 1568.
[CUSTOMER][NEUTRAL] All right. Uh, just a sec.
[AGENT][NEGATIVE] And and also denied for the same reason, office visits are not covered.
[CUSTOMER][NEUTRAL] OK. Just to be sure of the claim number, it's 3571568, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And uh when was this one, I, when was the 7:22 uh claim tonight?
[AGENT][NEUTRAL] Let me look for you real quick.
[AGENT][NEUTRAL] OK, the first one for um [PII]/20 was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And then the one for 72224 was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] And yes, so that would be it, uh.
[AGENT][NEUTRAL] And also the one, the one for.
[AGENT][NEUTRAL] The one for 722-2024 also had a note on there that uh dental benefits are not covered under this policy.
[AGENT][NEUTRAL] This is a medical plan.
[CUSTOMER][NEUTRAL] OK, that would be for the.
[CUSTOMER][NEUTRAL] OK, but that would, that then I would be for uh
[CUSTOMER][NEUTRAL] I did a different uh
[CUSTOMER][NEUTRAL] CD code, right?
[AGENT][NEUTRAL] Uh, let me look and see.
[AGENT][NEUTRAL] Right, it just says um.
[AGENT][NEUTRAL] Exclusion, dental isn't covered.
[AGENT][NEUTRAL] Under this policy that this policy covers for accident or sickness.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. So this policy only covers the services given with regards to accident or sickness only?
[AGENT][NEUTRAL] Only, yes.
[AGENT][NEUTRAL] For medical.
[CUSTOMER][NEUTRAL] So you can uh and by the way, this is a medical claim. Uh, we have the medical claims and this is a Medicare supplement claims. So, yes, this is a medical one but not a dental, but uh
[CUSTOMER][NEUTRAL] Uh, uh, would you be able to provide me the UB for 722 cause this is like there are many data, uh, sorry, many CPD codes and
[CUSTOMER][NEGATIVE] It's quite confusing, so.
[AGENT][NEUTRAL] Yes, absolutely. um, what is your, um,
[AGENT][NEUTRAL] Fax number.
[CUSTOMER][NEUTRAL] Vaccine? Sure.
[CUSTOMER][NEUTRAL] I have the fax number as 866.
[CUSTOMER][NEUTRAL] 473.
[CUSTOMER][NEUTRAL] 1161.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][POSITIVE] Thank you, [PII]
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK [PII] I've got that on its way to you now.
[CUSTOMER][NEUTRAL] All right. Lastly, I just need the reference number for our call, and that would be it.
[AGENT][NEUTRAL] OK, uh, you can use my name, it's [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] All right, Mr. Try. Thank you for your help. Have a good day.
[AGENT][POSITIVE] You're welcome, [PII] Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] That work better. Nothing else. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right. You have a good day and thank you for calling APL. Bye-bye, sir.
[CUSTOMER][POSITIVE] You too. Bye. Thank you.