AccountId: 011433970860
ContactId: 05918fe8-afb4-45f9-8caf-45d66e54ab6a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1054520 ms
Total Talk Time (AGENT): 263661 ms
Total Talk Time (CUSTOMER): 399984 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/05918fe8-afb4-45f9-8caf-45d66e54ab6a_20250521T12:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling back of the provider's office to check on the claim status. How are you doing?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] I'm doing great thank you so much for asking that.
[AGENT][POSITIVE] Alright, I'm happy to check on a claim. What's the policy number?
[CUSTOMER][NEUTRAL] Get the policy number 02450367.
[CUSTOMER][NEUTRAL] I'm sorry, it's 365.
[AGENT][NEUTRAL] All right, one moment.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Date of service is [PII]. There's a date range to [PII]. And the total bill amount is uh $29,0025 even.
[AGENT][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] We do not have any claims on file for that member.
[CUSTOMER][NEUTRAL] Oh, so the claim is not on file, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Could you just provide me your payer ID to resubmit the claim again?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] May I know the mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you. May I know the patient effective date and the termination date?
[AGENT][NEUTRAL] Effective date is [PII].
[AGENT][NEUTRAL] Patient is still active, no termination date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. OK. May I know the group name and the group ID of the patient?
[AGENT][NEUTRAL] Uh yes, let me pull that up.
[AGENT][NEUTRAL] Uh, the group number is 26188.
[CUSTOMER][NEUTRAL] 261-88. OK.
[AGENT][NEUTRAL] The group name is FG Construction. That's F as in Frank, G as in George, Construction.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Constriction. OK.
[CUSTOMER][NEUTRAL] May I know the patient plan type?
[AGENT][NEUTRAL] Uh, we are the members secondary insurance. This is a Medlink plan.
[CUSTOMER][NEUTRAL] Medin, OK.
[CUSTOMER][NEUTRAL] May I know, do you have time to check another claims?
[AGENT][NEUTRAL] Yes, I can check another one. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, let me check that in the patient. And uh may I know how many claims you can check in a call?
[AGENT][NEUTRAL] As many as you have.
[CUSTOMER][POSITIVE] Thank you. I do have uh here.
[CUSTOMER][NEUTRAL] Yeah, 7 claims. Do you have time for that?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, thank you. And the conference number will be the same or different for the calls?
[AGENT][NEUTRAL] They're all the same, which is gonna be my name with my last initial in today's date. My name is [PII], that's [PII] Last initial is going to be [PII], and then today's date.
[CUSTOMER][POSITIVE] Thank you so much for that. And shall I move with the next member ID?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] Yeah. Member ID number is uh.
[CUSTOMER][NEUTRAL] Yes, it's 02134882.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] S
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII] and her date of birth is [PII].
[AGENT][POSITIVE] Thank you. Da just service.
[CUSTOMER][NEUTRAL] And the date of service will be [PII]. There is a date range to [PII]. Total bill amount is $27,354 even.
[AGENT][NEUTRAL] Alright, thank you. So we did receive a claim for [PII] on [PII]. The claim is processed on [PII]. Uh, the claim was denied. We need a detailed explanation of benefits from the primary insurance showing the deductible co-pay co-insurance.
[CUSTOMER][NEUTRAL] Yeah, so you need primary you'll be, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh, may I know who's the primary payer for this patient?
[AGENT][NEUTRAL] We do not have that information. You would have to check with the insured.
[CUSTOMER][NEUTRAL] OK. May I know when the patient update the CUP last?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] When it was updated last?
[CUSTOMER][NEUTRAL] Yeah, the COB patient when updated the COB last.
[AGENT][NEGATIVE] There, there is no coordination of benefits.
[CUSTOMER][NEUTRAL] OK. All right. And I do find here the primary care of the patient is 8 now. May I know, you, one moment.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting. Yeah, I do see here that uh we have the primary care of the patient is Aetna, and I do have that UB.
[CUSTOMER][NEUTRAL] Could you just provide me your fax number uh so that I'll fax that to you.
[AGENT][NEUTRAL] 877.
[AGENT][NEUTRAL] 3659423
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much. And may I know the claim number for this?
[AGENT][NEUTRAL] 357.
[AGENT][NEUTRAL] 4051.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much, [PII], with the next claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] To the next member ID you'll be.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's 01723392 M as in Mike, L as in Larry.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is uh [PII].
[CUSTOMER][NEUTRAL] And her date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the data service?
[CUSTOMER][NEUTRAL] The date of service is [PII]. Total bill amount is $3,344 even.
[AGENT][NEUTRAL] Claim is received for this on [PII].
[AGENT][NEUTRAL] The claim was denied [PII]. We need the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The primary EOB, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] May I know who's the primary payer for this patient?
[AGENT][NEUTRAL] We do not have that information. You would have to check with the insured.
[CUSTOMER][NEUTRAL] All right. OK.
[CUSTOMER][NEUTRAL] Let me check that. Just give me a moment.
[CUSTOMER][NEUTRAL] Right, OK. I can see here that the Al HMO Florida is the primary career for this patient here. So, may I send the, you'll be
[CUSTOMER][NEUTRAL] With the fax number which you provided previously.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Alright thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Could you just provide me the claim number for this?
[AGENT][NEUTRAL] Claim number is gonna be 351-826-4.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you. I want with the next claim.
[CUSTOMER][NEUTRAL] OK, so the next member ID is 01850635.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and her date of birth is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you and then data service?
[CUSTOMER][NEUTRAL] The date of service is [PII]. The amount is $12,536 even.
[AGENT][NEUTRAL] Claim is received on [PII]. Claim was denied on [PII], requesting the primary EOB.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] All right. Let me check that who's the primary care for this patient.
[CUSTOMER][NEUTRAL] OK, I can see here that the Aetna is the primary career.
[CUSTOMER][NEUTRAL] Let me check that but I do have an EUB.
[CUSTOMER][NEUTRAL] Is there any attention for the fax number?
[AGENT][NEUTRAL] Uh, you can just mark attention claims.
[CUSTOMER][NEUTRAL] All right. OK. So I do have an UB. OK I'll fax that to you, uh, one with next claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next member ID is 01978557 M [PII].
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII], I'm sorry, it's [PII], and her date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Patient date of services number [PII]. Total bill amount is $13,715 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Claim is received on [PII].
[AGENT][NEUTRAL] Claim was denied on [PII], requesting the primary EOB.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Primary payer for this patient here is UC, yeah.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right. I do have a primary you'll be here. I'll fax that to you. Thank you. And could you just provide me the claim number for this?
[AGENT][NEUTRAL] 3558917.
[CUSTOMER][NEUTRAL] 17. Thank you. I'll the next claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, member ID is 01899454 M as in Mike L as in Larry, number 7.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name is uh.
[CUSTOMER][NEUTRAL] [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And the policy number was 0189.
[AGENT][NEUTRAL] 9454.
[CUSTOMER][NEUTRAL] Yeah it's 9454 M as in Mike L as in Larry and number 7.
[AGENT][NEGATIVE] That information doesn't match.
[CUSTOMER][NEUTRAL] Let me check that again.
[CUSTOMER][NEUTRAL] I don't have another number here.
[AGENT][NEUTRAL] I can check by their name or social if you have that, but that doesn't bring up that information for me.
[CUSTOMER][POSITIVE] All right. OK. No problem. We'll move with the next claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. So the next member ID was uh.
[CUSTOMER][NEUTRAL] 02021828 M [PII] in [PII].
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] Data service
[CUSTOMER][NEUTRAL] Number 7, 2024. The amount is $24,0063.46.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Claim was denied [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] requesting the primary EOB.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, I do have a primary. You'll be here.
[CUSTOMER][NEUTRAL] I'll fax that to you.
[CUSTOMER][NEUTRAL] And may I know the claim number for this?
[AGENT][NEUTRAL] 356.
[AGENT][NEUTRAL] 0302.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's all for today. Thank you so much for your assistance, Ms. [PII]. You have a great day.
[AGENT][POSITIVE] You too, [PII]. Take care.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.