AccountId: 011433970860
ContactId: 0c52afb8-a5c6-4cb5-a700-326013cc110d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1255989 ms
Total Talk Time (AGENT): 447559 ms
Total Talk Time (CUSTOMER): 431550 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/0c52afb8-a5c6-4cb5-a700-326013cc110d_20250228T13:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from Bobada check status.
[AGENT][NEUTRAL] OK, [PII], did you say you were needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Uh, that is [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status?
[CUSTOMER][NEUTRAL] Uh, I have 2 claims.
[AGENT][NEUTRAL] For the same patient or different patients?
[CUSTOMER][NEUTRAL] Uh, in the same patient, or let me just check, is this the same or different. Just a minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, 2 claim is for same patient and another one is different.
[AGENT][NEUTRAL] So you have a total of 3 claims to check?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, [PII], yes, I can help you and you will use my name that I gave you along with today's date. Correct, as your call reference. Uh-huh. That will be my name in today's date. Also, any information that I provide for you, [PII], on the claims will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of any of the explanation of benefits, you may print those by going to our portal.
[CUSTOMER][NEUTRAL] [PII], right?
[CUSTOMER][NEUTRAL] OK, the call reference number?
[AGENT][NEUTRAL] At [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is your first patient's policy number with the, the one with the two dates of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yeah, sure.
[CUSTOMER][NEUTRAL] This is the policy number is 01739515.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK and uh what is your patient's name and date of birth on this policy?
[CUSTOMER][NEUTRAL] Uh, I'm sorry.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK, sure. The patient's name is [PII]. And the date of birth, that is [PII].
[AGENT][NEUTRAL] Thank you. And the first date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] OK, sure. And just the date of so just allow me a moment. Uh let me just check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. The date of service, the first one is December.
[CUSTOMER][NEUTRAL] Um, sorry, that is [PII], [PII], sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes. [PII]. And
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is that bill amount?
[CUSTOMER][NEUTRAL] For [PII], that is, total charge amount is 370 dollars.029 cents.
[AGENT][NEUTRAL] 09 or 02?
[CUSTOMER][NEUTRAL] 099 cents.
[AGENT][NEUTRAL] OK. And then give me, go ahead and give me the other date only because I, I, yeah, just go ahead and give me the other date and total bill amount as well.
[CUSTOMER][NEUTRAL] OK. The, the uh the data service that is [PII] and the total charge amount is 140 dollars.07 cents.
[AGENT][NEUTRAL] OK, so now on this policy number that you initially gave me, we do not have any claim those claims are not on file on this policy. This policy was actually not active for your dates of service.
[AGENT][NEUTRAL] This policy number termed 81 of 2023. Let me see if there is another policy that is active and there is, so I need to give you a, another policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so just one moment.
[CUSTOMER][NEUTRAL] Uh, when it was a storm, you said?
[AGENT][NEUTRAL] Give me a moment and I'll go back to that screen.
[AGENT][NEUTRAL] The policy number that you gave me termed 81 of 2023.
[CUSTOMER][NEUTRAL] OK, sure. Um,
[AGENT][NEUTRAL] OK, so the policy that was active for your data service that you should have is.
[AGENT][NEUTRAL] 02
[AGENT][NEUTRAL] 357692.
[AGENT][NEUTRAL] This policy has an effective date of [PII] and it is active, no termination date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me see if we receive those claims and process them under this correct policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so for the first date of service of [PII] for 370 dollars.09 cents, there is no claim on file.
[AGENT][NEUTRAL] For that data service.
[CUSTOMER][NEUTRAL] 47
[CUSTOMER][NEUTRAL] OK, let me just
[AGENT][NEUTRAL] And there is also no claim on file for [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So, uh, you're only receiving via mail or uh electronically also?
[AGENT][NEUTRAL] Both, they may be mailed electron either will be fine.
[AGENT][NEUTRAL] And on both of these claims, [PII], you will also need to send us a copy of the primary insurance company's explanation of benefits for each of those dates of service, OK.
[CUSTOMER][POSITIVE] Yes. Yes, yes.
[CUSTOMER][POSITIVE] Yes, we do.
[CUSTOMER][NEUTRAL] OK, no claim on file for the date of service and uh [PII].
[CUSTOMER][NEUTRAL] Oh, and May, so it was effective that new policy is effective on [PII] to the date, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] There is no termination. OK, sure. Thank you so much. And may I know what is the uh timely limit to send the um claim?
[AGENT][POSITIVE] That is correct.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] There are, there is no timely filing limit with our company.
[CUSTOMER][NEUTRAL] OK. No time 5.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK. And may I know what's your payer ID? The to payer ID?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much. And your mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Uh, could you please repeat that, uh, CT after that, uh, the code number?
[AGENT][NEUTRAL] I'm sorry, what was the ques what was your question again?
[CUSTOMER][NEUTRAL] That [PII] after [PII] after that the um ZIP code number.
[AGENT][NEUTRAL] The state is OK, so it's [PII], [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Fine, sir.
[CUSTOMER][POSITIVE] Thank you so much, yeah.
[AGENT][NEUTRAL] Yes sir. And then also once we have received and processed this claim or these claims, we do have a portal that you should be able to check claim status and have access to our explanation of benefits and the portal website is it located at [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Uh, thank you so much, [PII], for this information.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And is there anything else, [PII], that I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For this member is done, I, uh, I'm moving to the next member ID whenever you're ready. Just a moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK OK.
[AGENT][NEUTRAL] So just one moment please.
[CUSTOMER][POSITIVE] Uh, sure, take your time, no issues.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, give me just one second, [PII].
[CUSTOMER][POSITIVE] Yes, take your time.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And actually, [PII], uh, I
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For this checking, I just got to know the same insurance number, but the patient number name is different for that um and ring.
[CUSTOMER][NEUTRAL] Uh, let me just confirm.
[CUSTOMER][NEUTRAL] I do apologize for that. Uh, could you please check with this same policy number or the name, uh, and name is, um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so first off, on the, OK, let me go back to the other policy because there is, OK, what was?
[AGENT][NEUTRAL] What is the patient's name and date of birth again?
[CUSTOMER][NEUTRAL] OK. I'm giving you that. The, you have the member uh ID right?
[AGENT][NEUTRAL] Uh, the same policy, correct?
[CUSTOMER][NEUTRAL] Yes, yes. That's the same for.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Actually, yeah, you already sent me that is for [PII], there is no claim for the month of [PII], right?
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] We've already
[AGENT][NEUTRAL] You said 117. You gave me 1107-2024.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Yes, yes.
[AGENT][NEUTRAL] No, yes, the two claims for [PII] are not on file.
[CUSTOMER][NEUTRAL] Yeah. And for, for the same insurance card number, I have one more patient name is here. Just a moment, I'm giving the name.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 17
[CUSTOMER][NEUTRAL] Uh yes. The patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth.
[AGENT][NEUTRAL] What's the spell the first name? I'm not understanding the first name.
[CUSTOMER][NEUTRAL] [PII]. That is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The OK, so the first, uh, what's the date of birth?
[CUSTOMER][NEUTRAL] Uh, the date of birth is [PII].
[AGENT][NEUTRAL] OK, so the first letter of, OK, and what's
[AGENT][NEUTRAL] OK, so you're saying [PII]. That is not what we have on record.
[CUSTOMER][NEUTRAL] Uh, not [PII], that is [PII].
[CUSTOMER][NEUTRAL] Algebra.
[AGENT][NEUTRAL] [PII]. OK, [PII]. OK, and the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, total, the date of service or
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That is on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. [PII] and the total charge amount is $140.
[CUSTOMER][NEUTRAL] And 7 cents.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEGATIVE] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] In just
[AGENT][NEUTRAL] 8085.
[AGENT][NEUTRAL] And the reason for the denial on this claim is that office visits are not covered under this policy. This supplemental policy, [PII] does not cover office visits.
[CUSTOMER][NEUTRAL] OK. So, um, when you receive that, you said 79.
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] What is the receipt date you said?
[AGENT][NEUTRAL] The received date and was.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] [PII] denied [PII]. Mhm.
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 8085.
[CUSTOMER][NEUTRAL] OK, that is a claim number and it is denied for this office which is.
[AGENT][NEGATIVE] Office visits are not covered.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Of his visit.
[CUSTOMER][NEUTRAL] OK, not covered under this patient plan or 2 months, uh, it is.
[AGENT][POSITIVE] That is correct, [PII]'s plan.
[CUSTOMER][NEUTRAL] OK. Uh, patients plan.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, let me just verify I need the payment for it.
[CUSTOMER][NEUTRAL] So, um, as for checking, uh, initially,
[CUSTOMER][NEUTRAL] The primary had processed already that they paid, right?
[AGENT][NEUTRAL] But this supplemental policy?
[AGENT][NEUTRAL] Does not cover office visits.
[CUSTOMER][NEUTRAL] The ancient but uh.
[CUSTOMER][NEUTRAL] OK, supplement this policy, right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, as for checking, it's not covered under the patient plan and you're saying this is
[AGENT][NEUTRAL] Yes, so that's what I said.
[CUSTOMER][NEUTRAL] Mhm. And the, and supplemental policy not covered this type of service, right? And the.
[AGENT][NEUTRAL] That is correct. Under the patient's plan, the patient's supplemental policy, the member's plan does not cover office visits.
[CUSTOMER][NEUTRAL] OK. So, uh, what did you need to send a corrected claim for this?
[AGENT][NEUTRAL] If you wish to file an appeal, you may do that within 180 days from the date of the decision.
[AGENT][NEUTRAL] And it would need to be put to attention appeals department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 180 days from the last process date and uh um
[CUSTOMER][NEUTRAL] There's an uh fax number.
[CUSTOMER][NEUTRAL] Send a field.
[AGENT][NEUTRAL] [PII] attention appeals department.
[CUSTOMER][NEUTRAL] OK, go slow. Could you please repeat that uh fax number again, and that is 877365 after that?
[AGENT][NEUTRAL] One,
[AGENT][NEUTRAL] 942-3 attention appeals department.
[CUSTOMER][POSITIVE] Yes. Thank you so much. Sas department.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for this.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And uh for the same number, uh, I'm moving to the next date of service for surgery. Just saying, that is the date of service is for the same number. [PII].
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Total bill amount.
[CUSTOMER][NEUTRAL] $370.09.
[AGENT][NEUTRAL] No claim on file.
[CUSTOMER][NEUTRAL] OK. No claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And just so here, let me I'm looking for the next number ID. Just one second, please.
[CUSTOMER][NEUTRAL] I'm looking to that.
[AGENT][NEUTRAL] OK, so you
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, no, no. I, I'm already done. I just, I'm verifying that data service I gave you, you sure if that is correct or not.
[AGENT][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, that is right. Uh, so I'm not on file, so we can file this claim, um, at the electronic[PII]. It's OK. Thank you so much, uh, [PII], for your valuable time to me, uh.
[AGENT][NEUTRAL] You're welcome. And again, remember that you must also send us the primary insurance company's explanation of benefits with each claim that you'll be filing.
[CUSTOMER][NEUTRAL] OK, sure.