AccountId: 011433970860
ContactId: 03397f30-72fb-442a-8984-6af8219b1564
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1439849 ms
Total Talk Time (AGENT): 413764 ms
Total Talk Time (CUSTOMER): 470683 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/03397f30-72fb-442a-8984-6af8219b1564_20250107T17:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling on PFF Pro checking on our claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh-huh, I do have 5 claims for that.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm. Yes, I do. Uh callback number of [PII].
[CUSTOMER][NEUTRAL] [PII]. And I do have an extension of [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Let me grab that information. The policy ID starts with 18. I'm sorry, let me repeat that. It is uh 018.
[CUSTOMER][NEUTRAL] 462-60
[CUSTOMER][NEUTRAL] M as in Mike. L as in Larry, number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, I do see uh this is for [PII] for [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 for the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you. And uh we're looking at the date of service of uh [PII].
[CUSTOMER][NEUTRAL] And I have a charged amount of $15,382 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 15,000. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the name of the provider's office that would be on the claim?
[CUSTOMER][NEUTRAL] Mhm. This is for Holy Cross Hospital port.
[AGENT][NEUTRAL] Alright, so I'm sure we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 352-6304.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $249.75 to the provider.
[AGENT][NEUTRAL] Did you need the check information?
[CUSTOMER][NEUTRAL] Uh yes, uh, uh, so I just wanna know like, uh, as you stated, the, the payment was, the claim was uh 249.75 cents, right?
[AGENT][NEUTRAL] That's what was paid on the claim, yes.
[CUSTOMER][POSITIVE] Thank you so much. And uh yes, sir, I require the payment details.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The check number is 2012005.
[AGENT][NEUTRAL] It was a single check?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Enough.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] To [PII].
[AGENT][NEUTRAL] And it cleared on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right. uh, thank you so much for that information and uh I just wanna know like, uh, can you able to send me an EOB copy of this?
[AGENT][NEUTRAL] Yes, do you need an EOB copy for all the claims we go over today?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, and what's a good fax number for you?
[CUSTOMER][NEUTRAL] Thank you. And the fax number is [PII].
[CUSTOMER][NEUTRAL] 233
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh let me repeat that, it was [PII].
[CUSTOMER][NEUTRAL] [PII]. And uh can you please mention to attention to [PII]?
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you. Take your time.
[AGENT][NEUTRAL] OK, the next member's policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Next policy ID starts with 12.
[CUSTOMER][NEUTRAL] 41
[CUSTOMER][NEUTRAL] 93
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] M as in Mike. L as in Larry, number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh-huh. And uh,
[CUSTOMER][NEUTRAL] And I just wanna know like uh does the call reference remain the same or will be different for uh
[CUSTOMER][NEUTRAL] Patient.
[AGENT][NEUTRAL] No, the call reference number will be the same for the entire call, my name and today's date.
[CUSTOMER][NEUTRAL] Mhm. Then it makes sense. So, thank you so much. And uh I do see, uh, this is for patient care and group, [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For $737 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And with the name on this provider be the same or it's a different claim?
[CUSTOMER][NEUTRAL] Uh, this was, uh, claim will be on the same, uh, provider, ma'am.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, it will be on the same provider for intercom.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let me take a look. Do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Please take your time.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding, [PII]. I do apologize for that wait. Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I know.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I do have the claim here, um, and I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 348.
[AGENT][NEUTRAL] 4499.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh I just wanna like, uh, did you guys receive an primary UV?
[CUSTOMER][NEUTRAL] And uh it was being sent away back on [PII].
[AGENT][NEUTRAL] Let me see if this is it. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment, let me see if this is the total bill.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, this is it.
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] Just um.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Alright, so we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The claim number is 352.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 627 5.
[CUSTOMER][NEUTRAL] What.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $314.47.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And did you need that checking information?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Alright, so it's a single check?
[AGENT][NEUTRAL] It was issued on [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Check number [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And on [PII], the, the check cleared?
[CUSTOMER][POSITIVE] Check was cleared, OK.
[CUSTOMER][NEUTRAL] All right. And uh can you able to send me the UP copy of this?
[AGENT][NEUTRAL] Yes, did you need the EOB for the original or the the second claim?
[CUSTOMER][NEUTRAL] Second one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][POSITIVE] Thank you so much. And uh next ID starts with uh 015.
[CUSTOMER][NEUTRAL] 785
[CUSTOMER][NEUTRAL] 26 M as in Mike L as in Larry, number 8.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Is this for [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And again, just for the call, 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?
[CUSTOMER][POSITIVE] Thank you so much. And uh this is for [PII].
[CUSTOMER][NEUTRAL] For the charge amount of $6,575.40.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And would this be the same provider as well?
[CUSTOMER][NEUTRAL] Mhm. Yes, it is.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Alright, so shall we receive the claim on [PII]?
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 2310.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] As the outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] So outpatient benefits was being met, right?
[AGENT][NEUTRAL] Right, for [PII].
[CUSTOMER][NEUTRAL] OK. What, uh, like, uh,
[CUSTOMER][NEUTRAL] What was the benefit that was being provided for the, based on the procedure or based on the dollar value?
[AGENT][NEUTRAL] Neither. For outpatient, um, the calendar year max is $2500 and that balance was used by the time your claim was received.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. Uh, so the patient has already met the patient or patient benefits so for 2024 and it was for 2500. Perfect. Thank you so much for that piece of information. And uh could you please uh provide me an UB copy of this?
[AGENT][NEUTRAL] Yes, I'm gonna send you an EOB for all the claims we go over today.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Listen, look.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][POSITIVE] Thank you. And uh let me grab that. One moment.
[CUSTOMER][NEUTRAL] Policy ID starts with 02.
[CUSTOMER][NEUTRAL] 47
[CUSTOMER][NEUTRAL] 326 M as in Mike. L as in Larry, number 8.
[AGENT][NEUTRAL] And that was 0247326?
[CUSTOMER][NEUTRAL] Uh, Mike Larry, number 8.
[AGENT][NEGATIVE] There's a a number missing.
[CUSTOMER][NEUTRAL] No problem missing. OK. Uh, let me, uh, check the card copy. All I have is, uh,
[CUSTOMER][NEUTRAL] 0247326
[CUSTOMER][NEUTRAL] M as in Mike. L as in Larry, number 8.
[AGENT][NEUTRAL] OK, um, what's the member's first and last name? I can search with the name because that's it's not enough numbers.
[CUSTOMER][NEUTRAL] OK, then, uh, let me provide you the first name is [PII], spelled as [PII].
[CUSTOMER][NEUTRAL] And the last name is [PII], spelled as [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] And do you need the, OK.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Patient date of birth?
[AGENT][NEUTRAL] Um, not yet. I have to get into the policy first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said the spelling of the first name is [PII]?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, here we go.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the policy number is 24732644 was the missing number.
[CUSTOMER][POSITIVE] Let me update that. Uh, thank you so much for that information.
[AGENT][NEUTRAL] You're welcome. And can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] Mhm. It is on [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim and the total bills?
[CUSTOMER][POSITIVE] Thank you. And uh
[CUSTOMER][NEUTRAL] We are looking on the date of service of um [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] For $303 even.
[AGENT][NEUTRAL] Thank you for that and can you verify?
[AGENT][NEUTRAL] Hold on. The name of the provider on the claim?
[CUSTOMER][NEUTRAL] Uh, this is also same uh Holy Cross Hospital fort.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 9247.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Aschology, speech, and occupational therapy are not covered under this policy, so it's not covered, a non-covered service.
[CUSTOMER][NEUTRAL] The night for?
[CUSTOMER][NEUTRAL] And uh could you please repeat the uh like in denial reasons for my documentation purpose?
[AGENT][NEUTRAL] So I'll spell the first word, K [PII] like [PII] like [PII], G like girl, Y like yellow.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Comm speech or occupational therapy are not covered benefits under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh what kind of policy does the patient was having?
[AGENT][NEUTRAL] Hold on one moment. So this is their Medlink supplemental gap insurance, so we apply to the co-pay, deductible and co-insurance after primary insurance?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Sorry to cut you off. Uh, actually, uh, when I was looking at uh UB copy of the primary, I do see uh
[CUSTOMER][NEUTRAL] The initially, primary has processed and applied towards a copay of $20. And I just wanna know, like, did you guys receive a primary UB copy?
[AGENT][NEUTRAL] So it's not denied because we didn't receive the primary EOB. The primary insurance has their own set of benefits as their secondary insurance. So for their secondary insurance, this service is not covered, which is why the co-pay was not reimbursed because we can only pay out uncovered charges.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Mhm. Makes sense. Uh, thank you so much enough for that, uh, information.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And, uh, and I haven't uh received any UB copy of this. Uh, could you please also send me a UB copy of this?
[AGENT][NEUTRAL] Yes, I'll be sending you an EOB copy of all the claims we go over today.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the next me[PII]'s policy number?
[CUSTOMER][POSITIVE] Thank you. And uh
[CUSTOMER][NEUTRAL] One per month.
[CUSTOMER][NEUTRAL] All right, uh,
[CUSTOMER][NEUTRAL] And the patient ID uh starts with uh
[CUSTOMER][NEUTRAL] It's loading. Oh, thank you. Uh it is uh 018.
[CUSTOMER][NEUTRAL] Yes. 16171.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] This is for [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Thank you. This is for [PII].
[CUSTOMER][NEUTRAL] Uh, and I do see uh this is for 16,000.
[CUSTOMER][NEUTRAL] $254.55.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's the same provider?
[CUSTOMER][NEUTRAL] Mhm. Yes. No, this is for [PII], uh.
[CUSTOMER][POSITIVE] Good [PII].
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received. Hold on one second.
[AGENT][NEUTRAL] Claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is 352-861-0.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And oops hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] On [PII], we paid out on the claim.
[AGENT][NEUTRAL] A total of $1140.40.
[AGENT][NEUTRAL] Did you need the check information for that?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] So it's a single check, check number 2013286.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The check was issued on [PII] and cleared on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was sent to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. Uh, thank you so much for that uh piece of information. And, uh, so I know you are able to send me an EB copy of this, uh, right, for all the claims what we have gone through?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right. Uh, thank you so much, [PII], for your valuable information and uh assistance for the day. You stay safe. Thank you. Bye for now.
[AGENT][POSITIVE] Thank you and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. Bye for now.
[AGENT][NEUTRAL] Bye bye.