AccountId: 011433970860
ContactId: fcc326da-75da-4839-85b6-9816e6526616
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 442679 ms
Total Talk Time (AGENT): 131531 ms
Total Talk Time (CUSTOMER): 121059 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/fcc326da-75da-4839-85b6-9816e6526616_20250328T17:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Providers.
[AGENT][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider service to verify on our clients status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can you please give me your callback number, sir?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you sir and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And then what is the policy number, please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Policy number is
[CUSTOMER][NEUTRAL] 2023.
[CUSTOMER][NEUTRAL] 007 09 M as in Mary, L as in Lima 7.
[AGENT][NEUTRAL] OK, let me pull that policy up real quick.
[AGENT][NEUTRAL] OK, and can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm, yes, the date of services is 2 [PII] and the charge amount is 285 dollars.03 cents.
[AGENT][NEUTRAL] OK, and what was that? February, what was the day again?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] The charge amount is 285 dollars.03 cents.
[AGENT][NEUTRAL] OK, and then the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Mm, actually the primary.
[CUSTOMER][NEUTRAL] That's not paid anything. So your insurance is the prime.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It is NCHMD Incorporated.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up that claim and I'll be right back, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. I've got the claim pulled up for you.
[AGENT][NEUTRAL] The claim number is 3575077.
[AGENT][NEUTRAL] The claim was denied for two reasons. One is office visits are not covered by the patient's policy and.
[AGENT][NEUTRAL] The service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, can I know one thing? As it is 99214, it's just a consultation code for the office visits. How come uh insurance is not covering a consultation code?
[AGENT][NEUTRAL] Because office visits are not covered by the patient's policy.
[CUSTOMER][NEUTRAL] OK. So can I know what is the, uh, the patient policy contains uh what are the care cares or any other thing?
[CUSTOMER][NEUTRAL] What CPTs will be covered?
[AGENT][NEUTRAL] Uh, it's, uh, only deductible, co-pay and co-insurance that's covered on the policy, and the policy has to be, um,
[AGENT][NEUTRAL] Secondary to their primary insurance and this is just to verify benefits. It's not a guarantee of payment. Once the EOB is received, we pay based on what the primary has paid.
[CUSTOMER][NEUTRAL] OK, can I know who is the primary insurance for this, uh, patient?
[AGENT][NEUTRAL] Let me look real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a second.
[AGENT][NEUTRAL] United Healthcare.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So United Healthcare, uh, so the claim needs to be submitted to initially to United Healthcare, is that right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So he, uh, the United Healthcare's deductible or co-insurance or co-pay can be covered, is it right from the.
[AGENT][NEUTRAL] That depends. That depends on the claim that they send in that depends on their EOB once we receive it.
[CUSTOMER][NEUTRAL] OK fine.
[CUSTOMER][POSITIVE] No issues, um.
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] Yes, sir, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you, [PII], and have a nice day. Bye for now. Have a nice week. Be safe, bye for now.
[AGENT][NEUTRAL] You too [PII].
[AGENT][POSITIVE] Mm bye bye you have a good weekend and thank you for calling APL bye bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye bye.