AccountId: 011433970860
ContactId: fec2033d-532d-4a03-a029-10ddd71cac13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 895510 ms
Total Talk Time (AGENT): 204288 ms
Total Talk Time (CUSTOMER): 250908 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/fec2033d-532d-4a03-a029-10ddd71cac13_20250328T17:15_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]. How are you doing today?
[AGENT][POSITIVE] I'm doing good, [PII]. How are you doing today, sir?
[CUSTOMER][POSITIVE] I'm also doing good, thank you for asking. I believe you said your name is [PII], which is [PII] Is that correct?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. May I know first initial to your last name? I apologize.
[AGENT][NEUTRAL] That's A
[CUSTOMER][NEUTRAL] OK, mine is [PII]. I'm calling for AIDS Healthcare Foundation to check on the additional information of the claim that has been denied. And please know this call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] OK, um, I can help you with the claim, [PII], can you please give me your callback number just in case the call gets dropped?
[CUSTOMER][NEUTRAL] Sure, it's [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient first name is [PII], last name is [PII]. Date of birth, [PII].
[CUSTOMER][NEUTRAL] Member ID is 02094905 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK. All right. And let me pull that policy up real quick.
[AGENT][NEUTRAL] OK, can you give me the, uh, date of service, please?
[AGENT][NEUTRAL] And the charge amount.
[CUSTOMER][NEUTRAL] Date of service is [PII] this year, total charge amount $49.88.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, let me check. Give me one moment.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. As per checking, primary has paid.
[CUSTOMER][NEUTRAL] In this claim and left over the $40 which is a co-payment.
[AGENT][NEUTRAL] $40. OK. All right. And then what is the name of the facility that you were calling from [PII]?
[CUSTOMER][NEUTRAL] Do you?
[CUSTOMER][NEUTRAL] AIDS Healthcare Foundation.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim and I will be right back.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], this is [PII] back with you again. You said that the claim had been denied. um, can you give me the claim number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure. We have received the correspondence, uh, there is a claim number. Let me tell you one moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] The claim number.
[CUSTOMER][NEUTRAL] It's 3576036.
[AGENT][NEUTRAL] OK, 3576036. OK, let me look that up.
[CUSTOMER][NEUTRAL] OK, give me one moment. I apologize, I apologize. One moment.
[AGENT][NEUTRAL] I was gonna say that's for a different member.
[CUSTOMER][NEUTRAL] Yeah, yeah, actually.
[CUSTOMER][NEUTRAL] Let me tell you one moment. I apologize.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you ask for the claim number, OK. Give me one moment.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Claim number is 357-532-4.
[AGENT][NEUTRAL] OK, thank you. That's the claim that I had initially pulled up but the.
[AGENT][NEGATIVE] Uh, charge amount was not the same.
[CUSTOMER][NEUTRAL] It's $286.34.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, so let me look at this claim real quick.
[AGENT][NEUTRAL] OK, it says that the services were rendered after the coverage was terminated.
[AGENT][NEUTRAL] And the policy terminated on [PII].
[AGENT][NEUTRAL] And there are no other active policies.
[CUSTOMER][NEUTRAL] OK. The service was rendered after the coverage terminated, I believe you said.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Policy effective date.
[AGENT][NEUTRAL] The effective date of the policy is
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it was terminated on [PII] and the policy effective date is [PII] term date.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, the effective date is from, uh, I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] To [PII], yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Give me one moment. Let me check from my side.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Oh, dang it, I just.
[CUSTOMER][POSITIVE] OK, thank you so much for patiently waiting and thank you so much for holding the line. Sorry for the long wait. May I know the call reference number for this call, please?
[AGENT][NEUTRAL] Yes, you can use my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. I have one more member with me. Could you help me out with that also?
[AGENT][NEUTRAL] OK, let me finish my note and we'll move on to that one.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, what's the next member's name?
[CUSTOMER][POSITIVE] OK, I'm fetching, fetching the details faster for you. Just one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting and thank you so much for holding the line. Sorry for the long wait. I apologize for this story.
[AGENT][POSITIVE] Yes, of course. That's OK.
[CUSTOMER][NEUTRAL] OK. The next member is for checking.
[CUSTOMER][NEUTRAL] The member ID is 02563777 M as in Mike, L as in Lima, 8.
[CUSTOMER][NEUTRAL] It's under the different facility. Name is Florida Women Care LLC and the NPI is 1386823243.
[AGENT][NEUTRAL] OK, and then what is the um member's name and date of birth?
[CUSTOMER][NEUTRAL] Member first name as per checking, which is [PII]. Last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, and let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] Claims, claims claims.
[AGENT][NEUTRAL] OK, and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Sure. As for checking the data of service for this member is
[CUSTOMER][NEUTRAL] [PII] with the total charge amount of $394 even.
[AGENT][NEUTRAL] We had a break in the phone, can you please repeat that um charge amount for me?
[CUSTOMER][NEUTRAL] $394 even.
[AGENT][NEUTRAL] Thank you. And then what is the charges after the primary insurance paid?
[CUSTOMER][NEUTRAL] The charges for the remaining is $40 even.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look this one up for us and I'll be right back.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have the claim for you now.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 6036.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK. Uh, give me one moment, let me check.
[CUSTOMER][NEGATIVE] Denied because
[AGENT][NEUTRAL] Office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Patient policy or patient's plan?
[AGENT][NEUTRAL] For the plan and policy.
[CUSTOMER][NEUTRAL] OK, let me check. Give me one moment.
[CUSTOMER][POSITIVE] OK, thank you so much for patiently waiting and thank you so much for holding the line. Sorry for the long wait.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] May I know the call reference number for this call, please?
[AGENT][NEUTRAL] Yes, sir. You can use my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK. For this one also the same. OK, no problem. Thank you so much for helping me out and for the assistance. Have a wonderful day ahead. Stay safe, [PII], and happy weekend.
[AGENT][POSITIVE] Thank you, [PII]. You have a happy weekend too, and thank you for calling APL. Is that all I can help you with today?
[CUSTOMER][POSITIVE] Yeah, thank you so much, [PII].
[AGENT][POSITIVE] You're welcome. You take care. Bye-bye, sir.
[CUSTOMER][NEUTRAL] You too. Bye-bye.