AccountId: 011433970860
ContactId: 00be47c4-fdd5-475e-8bf5-4966442bdbad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1016390 ms
Total Talk Time (AGENT): 334996 ms
Total Talk Time (CUSTOMER): 373279 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/00be47c4-fdd5-475e-8bf5-4966442bdbad_20250610T14:26_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I need your assistance to look the claims.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with claims. Can you repeat your name for me, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] 3 clients with 3 different patients.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the first member's policy number?
[CUSTOMER][NEUTRAL] I have plans.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I have a
[CUSTOMER][NEUTRAL] 020
[CUSTOMER][NEUTRAL] 12,930 [PII] that means ML and then 7 number 7.
[AGENT][NEUTRAL] Thank you, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII]. Bill is $50 even. Uh meantime, uh mind to spell out your name?
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] My name is [PII] The [PII].
[CUSTOMER][NEUTRAL] right
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] ECG consultants of Beth style LC.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 671
[AGENT][NEUTRAL] So I'm showing that this claim was received on [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And tell me one thing.
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 5659.
[CUSTOMER][NEUTRAL] What happened that uh like to pay $1.50.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the maximum benefit payable for this data service has been met.
[CUSTOMER][NEUTRAL] Uh, may I know how it was being met? That means a dollar wise or uh visit wise?
[AGENT][NEUTRAL] I understand. Hold on one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Let me see what it was.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] So the benefit is $500 up to $500 per calendar day. So by the time your claim came in, that $500 had already been applied to another claim.
[CUSTOMER][NEUTRAL] OK, the only phone number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That means the dollar value has been accessed, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Can you send me the denied UOB to my fax?
[AGENT][NEUTRAL] Yes, what's a good fax number for you?
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] you got it. Do you wanna repeat?
[AGENT][NEUTRAL] I'm fine. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, you may keep my name in the attention box for reference. Sorry.
[AGENT][NEUTRAL] Well, you need an
[AGENT][NEUTRAL] OK. Will you need the explanation of benefits for all the claims we go over?
[CUSTOMER][NEUTRAL] Yeah, for all the 3 which we are discussing, please mind to attach the same facts with my name in the attention box.
[AGENT][POSITIVE] OK, I understand. Thank you.
[CUSTOMER][NEUTRAL] And whenever you're done, mhm, when you're done, let me know. I have a couple of questions for this, uh, please, that's fine, thank you.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, what questions do you have?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, in this, what was the patient plan name and the plan details under which that, uh, value have been exhausted?
[AGENT][NEUTRAL] Wait a minute. Say that one at a time. What's the plan name?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Plan name plan type or patient policy details.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so this is a Medlink policy. It's a supplemental gap insurance policy?
[CUSTOMER][NEUTRAL] OK, in this case I have a secondary due for uh insurance coverage for $8.01. Should I need to bill with the patient or should I go with a bill?
[AGENT][NEGATIVE] I don't understand. Repeat that please.
[CUSTOMER][NEUTRAL] Secondary insurance due amount. I have $8.01. Can I, can I bill this to patient as a patient responsibility or should I need to uh appeal the services which you are having to me?
[AGENT][NEUTRAL] The $80.01 where is that coming from? Are you saying you have another claim you want to file?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And now, please hear carefully, [PII]. You're the secondary insurance, right?
[AGENT][NEUTRAL] OK, hold on, sir. Wait a minute. I'm sorry, hold on one second. You're speaking very fast and I'm trying to understand you. It's not that I don't understand what's happening. I don't understand what you're saying. So if you can slow down, we can work together. So the $80 the amount that you gave is not on this claim, so I'm unaware of what you're referencing, which is what I'm asking.
[CUSTOMER][NEUTRAL] Hm, hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] 1, OK.
[CUSTOMER][NEUTRAL] Let me have a clear explanation. You're the secondary insurance need to pay the primary insurance responsibility or the primary insurance left to balance, right?
[AGENT][NEUTRAL] Of the same claim that was denied that we just went over?
[AGENT][NEUTRAL] Are you speaking of something differently? The claim was denied.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Same.
[CUSTOMER][NEUTRAL] Claim have some amount due but you denied the claim unfortunately the due amount I need to bill the patient.
[AGENT][NEUTRAL] We do not determine patient responsibility.
[CUSTOMER][NEUTRAL] Um, then what do I need to do with the second due amount?
[AGENT][NEUTRAL] That will be up to you as the provider. Do you write it off? Do you bill the patient, that's up to your policies on remaining or outstanding balances.
[CUSTOMER][NEUTRAL] This is what I'm asking. Yeah, that is what clarity I'm asking. OK, fine, and, uh, and, um, uh, confirm the claim number I have, yeah, thank you so much. 3605659, is this the claim?
[AGENT][NEUTRAL] And I've answered it, sir.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello. OK, and can I expect your fax?
[AGENT][NEUTRAL] Yes, that's the claim number I gave you.
[CUSTOMER][NEUTRAL] Hold
[AGENT][NEUTRAL] I'll be sending all the faxes at the end of the call.
[CUSTOMER][NEUTRAL] Give me a second to the next policy under the same provider, OK? Please give me a sec.
[AGENT][NEUTRAL] Yes, but I'm noting this policy, so I'll let you know when I'm ready for the policy number. Thank you.
[CUSTOMER][NEUTRAL] Mhm hm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm then uh they've been so so so so.
[CUSTOMER][NEUTRAL] Whenever you're ready.
[AGENT][NEUTRAL] I'll let you know. Hold on one moment.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] And the next member's policy number?
[CUSTOMER][NEUTRAL] Policy number I have uh 02 02203919 [PII] that is ML and number 7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Chip
[CUSTOMER][NEUTRAL] Member is [PII], [PII].
[AGENT][NEUTRAL] Thank you and the date of service and total bill for the claim?
[CUSTOMER][NEUTRAL] Data service I have [PII]. Bill is same $50 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] 58.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 58
[AGENT][NEUTRAL] 63
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider, $1.64.
[CUSTOMER][NEUTRAL] Is there any patient responsibility for the $1.64?
[AGENT][NEUTRAL] No, we were billed $1.64 and we paid $1.64.
[CUSTOMER][NEUTRAL] No more responsibility, uh, continue with the check card EFT details for the payment.
[AGENT][NEUTRAL] Can I continue? Yes, I can. Um, so the check number, it was a single check, 2046801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] It was mailed to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] If the check is not received by [PII], you can give us a call and we will check on the check and reissue if needed.
[CUSTOMER][NEUTRAL] How about the clear of cashi dates? Do you have anything?
[AGENT][POSITIVE] No, it's outstanding, that's.
[AGENT][NEUTRAL] It was just sent to you last week or 2 weeks ago.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's coming from [PII], so you probably haven't received it yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 22 weeks to process the pay.
[CUSTOMER][NEGATIVE] I didn't pay no business here I have this information and uh uh I do have the single payment for dollar 64 cents. Check number is 2046801. Claim number is 3605863. Is this correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, let's go on with the last patient with a different provider and that is different, uh, tax ID or provider. OK, let me have one quick moment, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh mind to attach the UOB. Hope you have that.
[AGENT][NEUTRAL] I'll be sending EOBs of all the claims we go over.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] And I'm ready for the next member when you are.
[CUSTOMER][NEUTRAL] 1272924, Mike Lima ML 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you. May I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] This is with a different provider. I hope you know that the data service I have [PII].
[AGENT][NEUTRAL] OK, wait a minute, hold on one second.
[CUSTOMER][NEUTRAL] Sure, sure, sure.
[AGENT][NEUTRAL] Alright, so the policy number that you gave me is no longer active. It was effective from [PII]. There is an active policy though, let me look, let me get that information and see if there's a claim on there. Hold on one second.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And you said the total bill is 50 as well?
[CUSTOMER][NEUTRAL] Yes, no, 50, not 500.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 500
[AGENT][NEUTRAL] 500
[CUSTOMER][NEUTRAL] $217 for $500 yes, yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So the correct policy number is 213.
[AGENT][NEUTRAL] 8760
[AGENT][NEUTRAL] This policy has been effective since [PII].
[AGENT][NEUTRAL] And I'm looking for the claim.
[CUSTOMER][NEUTRAL] So the policy I have 2,138,760.
[AGENT][NEUTRAL] Yes, that's the active policy number.
[CUSTOMER][NEUTRAL] So[PII]?
[CUSTOMER][POSITIVE] Thank you, thank you so much.
[AGENT][NEUTRAL] And can you verify the name of the provider on the claim?
[CUSTOMER][NEUTRAL] [PII] MDBA.
[AGENT][NEUTRAL] So you received the claim on [PII].
[AGENT][NEUTRAL] It was also processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 5005.
[AGENT][NEUTRAL] And we pay to the claim a total of $30.
[CUSTOMER][NEUTRAL] Go ahead with the payment details.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Check number is 204.
[AGENT][NEUTRAL] 635 8.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] A single check?
[AGENT][NEUTRAL] Mailed to [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] And it is still outstanding.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, uh, just for a recap, uh,
[CUSTOMER][NEUTRAL] Client got paid with a single amount of $30 even check number is 2046358. Cli ID I have 360505, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, uh thank you call reference.
[AGENT][NEUTRAL] The call reference number for the entire call will be my name and today's date. Again, that's [PII].
[CUSTOMER][POSITIVE] Thank you, thank you so much.
[AGENT][POSITIVE] You're welcome. You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] Nothing. That's fine. I'm fine. Thank you. You take care.
[AGENT][POSITIVE] Have a great day. Bye bye.