AccountId: 011433970860
ContactId: fce9b33a-b3e1-40e6-927c-f49ae2576531
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1534729 ms
Total Talk Time (AGENT): 397891 ms
Total Talk Time (CUSTOMER): 313276 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/fce9b33a-b3e1-40e6-927c-f49ae2576531_20250418T15:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office and looking on a claim status. Can you help me?
[AGENT][NEUTRAL] Yes, I can help you with claim status today. What did you say your name was again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], do you have that policy number on you?
[CUSTOMER][NEUTRAL] Yes. It's 945132.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Yeah. The callback number is [PII].
[AGENT][NEUTRAL] OK, perfect. And the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then do you have that data service and the charge amount?
[CUSTOMER][NEUTRAL] Yes. The date of service is [PII] for $150 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we paid $25.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] So for [PII] for $150.
[AGENT][NEUTRAL] Yes, it looks like we just paid $25 of that amount.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, and it looks like the received date was [PII] and the process date was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what provider's office are you calling from again?
[CUSTOMER][NEUTRAL] It's integrated dermatology of South Miami.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, let me look into their policy and see why we pay $25 only, OK?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, actually, I have a doubt. Actually, we have billed the office and usually from your insurance on the previous patient's claim, we have got the denial that the office visit is not covered under the patient's meddling supplement policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like the reason why we pay $25 is because this was a, a physician outpatient treatment and for this policy that covers $25 per visit.
[CUSTOMER][NEUTRAL] So balance $20.69.
[AGENT][NEUTRAL] I'm showing that we paid $25.
[CUSTOMER][NEUTRAL] OK. And actually, I have a question. So the office visit is covered under meddling policy? Because for my uh for multiple claims, we have got one the denial for the office visit, only this claim is paid.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So it looks like for their policy.
[AGENT][POSITIVE] They have an outpatient benefit.
[AGENT][NEUTRAL] And the max is $250 per covered person per calendar day.
[AGENT][NEUTRAL] For an outpatient service.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So it is covered office visit.
[AGENT][NEUTRAL] Yes, it looks like it for the policy, but since this was a physician's outpatient,
[AGENT][NEUTRAL] Uh, for physician office, it only covers $25 per visit.
[AGENT][NEUTRAL] And that's maximum of 4 visits per covered person.
[CUSTOMER][NEUTRAL] Uh, OK, one moment. So maximum of 4 office visits is covered for a year.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And, and also, uh,
[CUSTOMER][NEUTRAL] Only $25 is allowed for, for the office visit or uh
[CUSTOMER][NEUTRAL] According to the uh may I know the maximum dollar amount?
[AGENT][NEUTRAL] So that is for the physician office visit.
[CUSTOMER][NEUTRAL] $25.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK. And may I know the payment information?
[AGENT][NEUTRAL] Yes, would you like the check number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it is 203-803-9.
[AGENT][NEUTRAL] And then I also have that claim number if you would like it.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] It is 358-722-5.
[CUSTOMER][NEUTRAL] 358-7225
[AGENT][NEUTRAL] Yes, 358-722-25. Yes. This is not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK, so the check is a bulk.
[AGENT][NEUTRAL] Sorry, go ahead.
[CUSTOMER][NEUTRAL] So the check is a bulk check or a single check, single check?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Yes, so the check is in the amount of $25.
[AGENT][NEUTRAL] And it looks like the issue date for this check is [PII].
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know the pay to address?
[AGENT][NEUTRAL] Sorry, what was that?
[CUSTOMER][NEUTRAL] May I know the pay to address?
[AGENT][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Clintmore Road.
[AGENT][NEUTRAL] 226.
[AGENT][NEUTRAL] Boca Raton.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And uh as the check has been cleared?
[AGENT][POSITIVE] So it looks like the check is still outstanding.
[AGENT][NEUTRAL] So it's in the process.
[CUSTOMER][NEUTRAL] OK. And this, you will be also send to the provider's office with the check?
[AGENT][NEUTRAL] Uh, the check should be separate.
[CUSTOMER][NEUTRAL] OK. So, you'll be has been sent to the provider's office.
[AGENT][NEUTRAL] Yes, the EOB has already been sent to the provider's office.
[CUSTOMER][NEUTRAL] OK. Already been sent to the provider's office or with the check.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And can you spell your name for me?
[AGENT][NEUTRAL] Yeah, of course. It is [PII]
[AGENT][NEUTRAL] Last [PII] [PII] or sorry, that's the reference number. It's just [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII], yes. Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And your last name, [PII]?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK. And I have one more patient to verify. Can you help me?
[AGENT][POSITIVE] Yes, I can help you with that today.
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] OK. And call reference for this patient?
[AGENT][NEUTRAL] The call reference number would be my first name, last initial, and then today's date.
[CUSTOMER][NEUTRAL] [PII] had entered his seat.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And the next member ID is 02559264.
[AGENT][NEUTRAL] OK, and the patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, and then are we checking uh claim status on [PII] as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's the date of service?
[CUSTOMER][NEUTRAL] It's uh [PII] for $302 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] And you said $402?
[CUSTOMER][NEUTRAL] 302, 302.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, sorry.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Actually, I have the claim number as well.
[AGENT][NEUTRAL] Yes. Uh-huh.
[CUSTOMER][NEUTRAL] Shall I provide you the claim number?
[AGENT][NEUTRAL] Uh, just one moment. I'm still looking at for this claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, I'm still looking for the correct claim number for that amount.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, I'm not finding that charge amount for $302 on here.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's [PII] for $302. Actually, I have the claim number. Can you check with that claim number? It's a follow-up call only.
[AGENT][NEUTRAL] Oh, yes.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] It's it's 3573715.
[AGENT][POSITIVE] OK, I see that one. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what provider's office are you calling from?
[CUSTOMER][NEUTRAL] Integrated dermatology of South Miami.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we paid $61.49.
[CUSTOMER][NEUTRAL] Yeah, and actually I'm, uh, so the check number is 2032026. Am I right?
[AGENT][NEUTRAL] Uh, the check number for this one is 203-8365.
[CUSTOMER][NEUTRAL] It's 203-836-5.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 203-8365. And it was issued on?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Sorry, just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And it looks like the issue date is [PII].
[CUSTOMER][NEUTRAL] Uh, sir, it's 3:10 or 4:10?
[AGENT][NEUTRAL] 4:10. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Actually, we have called on [PII] and we have got another check number with um issue date on [PII].
[AGENT][NEUTRAL] You said you guys called on [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Well, it looks like we, that's when we issued the check was 4:10 for the 6149.
[CUSTOMER][NEUTRAL] OK. And you can check with the check number which I have.
[AGENT][NEUTRAL] Yes, OK, what's the check number that you have?
[CUSTOMER][NEUTRAL] It's 203-2026.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK, so it looks like the check number that you have is in the amount of 6149, and we did void that check.
[AGENT][NEUTRAL] And then we reissued a check. So maybe you guys called and then there was an issue with receiving the check, so then we voided it and then reissued it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So, may I know when it was voided?
[AGENT][NEUTRAL] Yes, so this check number was voided. So the new one that I gave you would be the newest check.
[CUSTOMER][NEUTRAL] So it was voided on [PII] and issued with the new check on [PII]. Am I right?
[AGENT][NEUTRAL] Uh, let me, let me check our notes really quick and see when that was voided.
[AGENT][NEUTRAL] Um, I'm not seeing why this check was voided. It might have been maybe the wrong address.
[AGENT][NEUTRAL] Or something along those lines, but we did reissue a check.
[CUSTOMER][NEUTRAL] OK. May I know
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I know the pay to address for the new check?
[AGENT][NEUTRAL] Yes, ma'am. I can do that. Just a second. Let me go back.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that address is [PII].
[AGENT][NEUTRAL] Clentmore Road, 226.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It's, it's also a single check for uh $61.61 dollars 49 cents.
[AGENT][POSITIVE] Yes, that is correct. Mhm.
[CUSTOMER][NEUTRAL] And may I know the receive and process date of the claim?
[AGENT][POSITIVE] Yes, I can get that to you.
[AGENT][NEUTRAL] Let's see, it is received date for [PII] and the processed date for [PII] as well.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] The claim number is 3587847.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. And uh your bill has been sent to the provider's office with the check?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah and this office. So the last claim number has been voided, am I right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, honey.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] For the information you provided me.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Mm. That's all for today. Thank you for asking and thank you.
[CUSTOMER][NEUTRAL] For the information you provided me on this call.
[AGENT][POSITIVE] Yes, thanks for calling.
[AGENT][POSITIVE] Yeah, of course. Thanks for calling APL. Have a good day, [PII]. Mhm.
[CUSTOMER][POSITIVE] Mhm. Thank you.
[CUSTOMER][POSITIVE] You do as well. Thank you. Bye.
[AGENT][POSITIVE] All right. Thank you. Bye.