AccountId: 011433970860
ContactId: f7dd1960-f381-4bae-b3cd-f67c88e29bb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 428089 ms
Total Talk Time (AGENT): 154020 ms
Total Talk Time (CUSTOMER): 235529 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/f7dd1960-f381-4bae-b3cd-f67c88e29bb9_20250624T17:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider office.
[AGENT][NEUTRAL] I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, what can we help you with today?
[CUSTOMER][NEUTRAL] I want to know the other claim status.
[AGENT][NEUTRAL] OK, I can check on a claim for you. Uh, can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Mhm. It's [PII].
[CUSTOMER][POSITIVE] So we'll be right
[AGENT][NEUTRAL] Thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, uh, can I get the policy number, please?
[CUSTOMER][NEUTRAL] Oh yeah, it's 01611530.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, and the number 8.
[AGENT][NEUTRAL] OK, and then
[AGENT][NEUTRAL] OK, what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Member's name is [PII]. The first name is spelled as [PII] and the last name is spelled as [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for verifying that. uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. And total bill amount is $284.96.
[AGENT][NEUTRAL] OK, that was [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, what was the uh tax ID for this provider please?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah, and the tax ID is [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] We.
[CUSTOMER][NEUTRAL] right now.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] to be
[CUSTOMER][NEUTRAL] on
[CUSTOMER][POSITIVE] Yeah you got it.
[CUSTOMER][NEGATIVE] No I cannot do that like.
[CUSTOMER][NEUTRAL] We.
[CUSTOMER][NEUTRAL] I'll be one.
[AGENT][POSITIVE] OK, I appreciate your patience. So I did find this claim, uh, looks like we paid a benefit of $40.57. Whenever you're ready I can go ahead and give you that claim number and check information.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I don't think it's about.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Are you ready for it?
[AGENT][NEUTRAL] OK, uh, that claim number is 3607114.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Please
[CUSTOMER][NEUTRAL] No this is.
[CUSTOMER][NEUTRAL] So we have that.
[AGENT][NEUTRAL] Are you still there [PII]?
[CUSTOMER][NEUTRAL] OK. Yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, what other information did you need?
[CUSTOMER][NEUTRAL] Uh, actually, uh, the one procedure called, uh, which is denied, that is A 7038 and
[CUSTOMER][NEUTRAL] What is the exact, exact reason of the denial?
[AGENT][NEUTRAL] Yes, so the denial reason was that the item did not meet the definition of durable medical equipment under this policy.
[CUSTOMER][NEUTRAL] You the.
[CUSTOMER][NEUTRAL] OK. Um, the patient has changed his policy because on [PII], we did receive the payment on the same procedure code.
[CUSTOMER][NEUTRAL] Yeah they give you a
[AGENT][NEUTRAL] I mean if you want to file an appeal you are more than welcome to.
[CUSTOMER][NEUTRAL] Is there any
[CUSTOMER][NEUTRAL] OK. So is there any changes in the policy?
[AGENT][NEUTRAL] No, there have not been any changes in the policy since, uh, this policy has been active since [PII].
[CUSTOMER][NEUTRAL] OK, so it's an incorrect denial, right?
[AGENT][NEUTRAL] Um, I'm not sure about that. Uh, when did you say that other claim was that we paid on this?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Wait a moment. Uh, the last, uh, the claim on which we received the payment is on [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm not showing that we paid for that procedure code either. I did find that claim 351-0177. We paid on all of the procedure codes except for a 7038, which is the same one we did not make a payment on for this one.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Could you please repeat the claim number?
[AGENT][NEUTRAL] The one in March?
[CUSTOMER][NEUTRAL] Yes, for the [PII].
[AGENT][NEUTRAL] Uh, let me get back to that. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was 3.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 344-521-6
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, so the patient plan does not cover this procedure for.
[AGENT][POSITIVE] Oh sorry, I'm sorry I gave you a different one. I'm so sorry that was an incorrect claim number I'll give you that correct one let me know when you're ready. I'm so sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] It's OK. I'm ready.
[AGENT][NEUTRAL] OK, that is 351-01777.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry about that. That is the one that has the same procedure code for [PII], uh, and we paid on the others except for this one, and it's the same denial reason. It does not meet the definition under this policy of a durable of durable medical equipment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK. Thank you so much. Please provide me 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 can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No, thank you so much. Bye-bye.
[AGENT][POSITIVE] Of course thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Oh hello hold up.