AccountId: 011433970860
ContactId: fe829471-e1e0-44e7-9732-cf29fbeb3d34
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 647330 ms
Total Talk Time (AGENT): 172215 ms
Total Talk Time (CUSTOMER): 236715 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/fe829471-e1e0-44e7-9732-cf29fbeb3d34_20250422T18:37_UTC.wav
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[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for provider to check on additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. How was your day?
[AGENT][NEUTRAL] Uh, it is fine. And so you're needing a dish, how about yours first off?
[CUSTOMER][POSITIVE] Yes, good.
[AGENT][NEUTRAL] Oh, that's good. And so you need the initial information on the denied claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And could you please spell your first?
[CUSTOMER][NEUTRAL] Uh, my first name is [PII]. Last name [PII].
[AGENT][NEUTRAL] Same for me?
[AGENT][POSITIVE] Thank you and [PII], what is your
[AGENT][NEUTRAL] Callback number?
[CUSTOMER][NEUTRAL] You mean the call, the callback number is [PII]. It's a direct line with no extension.
[AGENT][NEUTRAL] Thank you. And what is the um policy number for the member that you're calling in regards to today?
[CUSTOMER][NEUTRAL] It's 01603412.
[AGENT][POSITIVE] Thank you one moment while I get the member's information, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] 1st, 1st name is [PII]. Last name [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the data service and total bill amount please.
[CUSTOMER][NEUTRAL] Data service is [PII].
[CUSTOMER][NEUTRAL] 2025 February 24, 2025 and the bill amount is $240 even.
[AGENT][NEUTRAL] And the claim number?
[CUSTOMER][NEUTRAL] Just a moment, please.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] I do show a different
[CUSTOMER][NEUTRAL] The amount on my end. Just a moment, please.
[CUSTOMER][POSITIVE] Thank you for your patience and the bill amount is 400.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $35 even.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] 435. Is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh I have a claim number as well.
[AGENT][NEUTRAL] Mhm. And what is that?
[CUSTOMER][NEUTRAL] Uh, the claim number is 35835557.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so yes, sir, I do see that this claim has been denied.
[AGENT][NEUTRAL] Um, what type of questions do you have on here today regarding this claimladwin?
[CUSTOMER][NEUTRAL] Uh, uh, this is showing as a dinner as a non-covered service. May I know whether it is non-covered under the member's plan or providers contract or payer guidelines?
[AGENT][POSITIVE] Yeah, that is correct.
[AGENT][NEUTRAL] Members plan
[CUSTOMER][NEUTRAL] May I know the member's plan name, please?
[AGENT][NEUTRAL] Medlink, this is a supplemental policy.
[CUSTOMER][NEUTRAL] Uh, meddling.
[CUSTOMER][NEUTRAL] It is a supplement plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is correct. It is not.
[CUSTOMER][NEUTRAL] And may I know the members, members plan type?
[AGENT][NEUTRAL] Major medical insurance.
[AGENT][NEUTRAL] Supplemental.
[CUSTOMER][NEUTRAL] Medicare supplement plan.
[CUSTOMER][NEUTRAL] Sorry, sorry, it's not a Medicare. OK, thank you.
[AGENT][NEUTRAL] No, mhm.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Just meddling uh members plan name is Medli supplement plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. And this claim is last processed on [PII]?
[AGENT][NEUTRAL] One moment. Let me go back to that screen.
[AGENT][NEUTRAL] That is correct. And if you need a copy of the explanation of benefits with the remarks on there, you may print that directly from our portal by going to [PII] now that you do have the claim number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, OK, no problem. I can, uh, can I have the spelling of your name on the card reference number?
[AGENT][NEUTRAL] My name in today's date will be the call reference number and my name is [PII].
[CUSTOMER][NEUTRAL] And just a moment, [PII] and I do have another one claim that will be the last claim. Can you please help me with that claim?
[AGENT][NEUTRAL] What is the?
[CUSTOMER][NEUTRAL] And sorry for the not in in informing you previously.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] Uh, member ID number is 025.
[CUSTOMER][NEUTRAL] 844-54
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And the same with this one, any information that I provide for you would be a verification of benefits and not a guarantee of pay.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient's first name is [PII]. Last name [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Reporting
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] What is the data service and total bill amount?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] State of service and total bill amount.
[CUSTOMER][NEUTRAL] Data services, um,
[CUSTOMER][NEUTRAL] March.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $975.17.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you. Claim number?
[CUSTOMER][NEUTRAL] Uh, the claim number is
[CUSTOMER][NEUTRAL] Uh, it is.
[CUSTOMER][NEUTRAL] 3583658.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] OK, and how can I help you with this claim?
[CUSTOMER][NEUTRAL] Uh, this claim is also, uh, the 96127 and 9938 code has been denied as a non-covered service. May I know whether it is non-covered under the member's plan or providers contract or payer guidelines?
[AGENT][NEUTRAL] Members plan.
[CUSTOMER][NEUTRAL] May I know the member's plan name for this one, please?
[AGENT][NEUTRAL] This is a limit, a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] Hospital.
[CUSTOMER][NEUTRAL] Indemnity.
[CUSTOMER][NEGATIVE] limited training.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Right, thank you. And the claim number for this claim is 3583658, right?
[AGENT][POSITIVE] OK. You're welcome.
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] Processed on [PII].
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And you can use that same portal if you need a copy of that explanation of benefits as well.
[CUSTOMER][NEUTRAL] And the color?
[CUSTOMER][NEUTRAL] Thank you. The call reference number is your name and today's date, right?
[AGENT][POSITIVE] That is correct. Mhm.
[CUSTOMER][POSITIVE] Thank you. Thank you, [PII], for assisting me today. Kindly, have a great, great day.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][POSITIVE] I hope you have a great day too, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, no, thank you.
[AGENT][POSITIVE] OK, well then, thank you for calling APL. Have a wonderful day.
[CUSTOMER][NEUTRAL] Bye for now.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.