AccountId: 011433970860
ContactId: ff0931bc-9fe4-45d5-ae9d-df129cc78a57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 639780 ms
Total Talk Time (AGENT): 201956 ms
Total Talk Time (CUSTOMER): 172612 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/ff0931bc-9fe4-45d5-ae9d-df129cc78a57_20250423T16:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from Arizona Desert Dermatology, and I was just calling to get status on some claims.
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Uh yes, policy number is.
[CUSTOMER][NEUTRAL] 02277303 ML 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is for [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] And you're calling in for status of claim for this member?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] May I please have a date of service and total bill?
[CUSTOMER][NEUTRAL] Yes, first day of service is gonna be [PII] with the charge amount of $200.13.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I'm not seeing a claim on file for that date of service.
[CUSTOMER][NEUTRAL] Can you check another data service just to confirm?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, um, let's do [PII].
[AGENT][NEUTRAL] Total bill.
[CUSTOMER][NEUTRAL] Uh, charge amount on that's gonna be $175.98.
[AGENT][NEUTRAL] And that's 175 98.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. I'm not seeing a claim for that total bill.
[CUSTOMER][NEUTRAL] Uh, so, yep, and so we've submitted this multiple times, so I just wanted one confirm that because we've tried to send it electronically as well as um paper claim.
[CUSTOMER][NEUTRAL] And it looks like for all of her data service you guys haven't received any of the claims um so I just wanna just confirm we have everything correct on file or if there's another alternative for us getting these claims over to you guys.
[AGENT][NEUTRAL] OK, and what is the provider's name?
[AGENT][NEUTRAL] For the [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It should be for uh uh [PII].
[AGENT][NEUTRAL] Let me check this.
[AGENT][NEUTRAL] Now I do see.
[AGENT][NEUTRAL] For the date of service of [PII], we just received that claim. Let me check the receipt date on that one.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So for the date of service of [PII], we received it on [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] And as of right now, it hasn't been processed.
[CUSTOMER][NEUTRAL] OK, so that was on [PII].
[AGENT][NEUTRAL] And then we have.
[AGENT][NEUTRAL] Another one from that same provider that we received on [PII].
[AGENT][NEUTRAL] And that is for [PII].
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] So it looks like they came in on the [PII].
[CUSTOMER][POSITIVE] OK, yeah, which is so interesting because we submitted those on [PII] I'm sorry on [PII].
[CUSTOMER][NEUTRAL] Um, so for it, it must take a while to get into the system.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Well, it looks like these came in from the, they were submitted in via mail.
[CUSTOMER][NEUTRAL] And it looks like on that that would have been on [PII] is when we.
[CUSTOMER][NEUTRAL] Submitted on paper I believe.
[CUSTOMER][NEUTRAL] But regardless, I mean, I'm glad that you guys are showing. Can you, would you are you able to check one more data service for me just to make sure that those ones are on file as well?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, it's gonna be um [PII].
[AGENT][NEUTRAL] And the total bill please?
[CUSTOMER][NEUTRAL] Uh, first, so there's gonna be 3 claims for that data service. The first one's gonna be for $604.82.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the second one is gonna be for $273.66.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the third one is gonna be for $41 I'm sorry $41.63.
[AGENT][NEUTRAL] OK, let me check that for you.
[AGENT][NEUTRAL] So for the date of service of 108 for $604.82 that claim we do have on file and it has been processed. Let me get you that claim number and information.
[AGENT][NEUTRAL] So the receipt date on that claim was 4-15. It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1037. It shows that that claim process and it denied that office procedures are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Procedure is not covered.
[AGENT][NEUTRAL] And then in 273.
[AGENT][NEUTRAL] And then also for the one total charge 27366 that was also received on [PII] and processed on [PII] and that claim number is 359.
[AGENT][NEUTRAL] 1034. That will also process and denied that office procedures are not covered.
[CUSTOMER][NEUTRAL] So do you mind if I ask what kind of secondary plan this is? Or what kind of policy this is?
[AGENT][NEUTRAL] This is the
[AGENT][NEUTRAL] Yes, this is their supplemental or gap policy and it's based off of which benefit package that the member or group chooses.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So they must not have any type of like outpatient coverage then.
[AGENT][NEUTRAL] Let me check their benefits.
[AGENT][NEGATIVE] The only thing that, that is showing it doesn't have the office visits or the office procedure benefit writer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So which would pretty much include everything that's done in our office.
[AGENT][NEUTRAL] For the benefits, let me pull that up for you.
[AGENT][NEUTRAL] And in regards to the member's benefit, verification of coverage does not guarantee the payment of the claim for any office visit or office setting. This member does not have any benefits, but they do have other benefits available, just not for office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. OK, yeah, I just wanna make sure because then that way if the patient calls and we're able to to let him know that that's that's what's happening so.
[AGENT][NEUTRAL] OK, and then also if you're needing to check any claim status, you do have the option to go on to our secured portal and you will be able to pull that image up or EOB if that claim has been processed.
[CUSTOMER][NEUTRAL] OK, is that the um APL website?
[AGENT][NEUTRAL] It is secured. [PII].
[CUSTOMER][NEUTRAL] OK perfect yep I'm I was actually on there right now just trying to log in, get a log in so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] We will do that thank you I really appreciate your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] That should do it.
[AGENT][POSITIVE] Well, I do wanna thank you for calling American Public Life. You have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye.