AccountId: 011433970860
ContactId: 0c7d3762-2f40-47e5-bc34-06c32bd9a5b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2305320 ms
Total Talk Time (AGENT): 608075 ms
Total Talk Time (CUSTOMER): 809666 ms
Interruptions: 9
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/0c7d3762-2f40-47e5-bc34-06c32bd9a5b7_20250507T12:12_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 for the provider to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So may I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh, no, I have more to claims to check status.
[AGENT][NEUTRAL] How many do you have?
[CUSTOMER][NEUTRAL] In total, I have 3 claims.
[AGENT][NEUTRAL] For 3 different patients?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, I can help you, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII]. It's a direct line.
[AGENT][NEUTRAL] OK [PII], so first off, you will use my name that I gave you along with today's date as your call reference number for each one.
[AGENT][NEUTRAL] Next
[AGENT][NEUTRAL] Any information that I provide for you on any of the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And lastly, if we do have the claims on file and you need a copy of their explanation of benefits, you may print them by using the claim number by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So the.
[CUSTOMER][NEUTRAL] Uh [PII]. [PII].
[AGENT][NEUTRAL] Yes, sir. That would be the website to print the explanation of benefits if we have the claim on file.
[AGENT][NEUTRAL] And what is your first patient's policy number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, my first patient's policy number is 16345.
[AGENT][NEUTRAL] OK, that's not a policy number, that's a group number.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh yeah, the policy number is 00.
[CUSTOMER][NEUTRAL] 982-524
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you one moment please.
[CUSTOMER][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And [PII], what is your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. Date of birth will be
[CUSTOMER][NEUTRAL] [PII] and
[AGENT][NEUTRAL] OK, thank you. What is the data service and total bill amount please?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total bill amount is $400 even.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And the last movie the text.
[AGENT][NEUTRAL] OK [PII], so I do see that this claim was received. The received date was on [PII].
[AGENT][NEGATIVE] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 358-0916.
[AGENT][NEUTRAL] And the reason for the denial on this claim states this service is not covered when performed in a doctor's office or clinic.
[AGENT][NEGATIVE] Again, this service is not covered.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] When performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Under the member's plan.
[CUSTOMER][NEUTRAL] OK, so the
[CUSTOMER][NEUTRAL] OK, under the members plan, got it, just a moment.
[CUSTOMER][NEUTRAL] OK. So could you please tell me which CPT code is not covered under the member's plan?
[AGENT][NEUTRAL] 951-65.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, could you please repeat that once again? Your voice was breaking.
[AGENT][NEUTRAL] Yes, what is on the claim that you submitted? What is the claim, what is the procedure code on the claim you submitted?
[CUSTOMER][NEUTRAL] OK, yeah, it's 9495165.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] What will be the timely filing to submit the corrected claim?
[AGENT][NEUTRAL] There is no timely filing, and an appeal must be filed within 180 days from the date of the decision.
[CUSTOMER][NEUTRAL] Bear with me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And if you're sending an appeal, it must be.
[CUSTOMER][NEUTRAL] What will be the time?
[CUSTOMER][NEUTRAL] What will be the mailing address to submit and correct the claim?
[AGENT][NEUTRAL] The same address as the original claim was sent to?
[CUSTOMER][NEUTRAL] OK, could you please state the address once?
[AGENT][NEUTRAL] Yes, sir, if you'll go ahead and verify what you have, I can tell you if that's correct.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Is it [PII]?
[CUSTOMER][NEUTRAL] [PII], sorry, give me a minute. Yeah, it's, is it [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And Ail's mailing address will be the same?
[AGENT][NEUTRAL] Yes, and sent to attention appeals department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Very.
[AGENT][NEUTRAL] And is there any other information you need?
[CUSTOMER][NEUTRAL] And could you please tell me
[CUSTOMER][NEUTRAL] Yeah, is there any specific form for an appeal?
[AGENT][NEUTRAL] There is not, but it must be sent to the appeals department.
[CUSTOMER][NEUTRAL] And OK and dinner you is
[AGENT][NEUTRAL] At the same mailing address as claims.
[CUSTOMER][NEUTRAL] And denied you is required by submitting an appeal or claim.
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Uh, denied EOB is required while submitting the claim or appeal once again.
[AGENT][NEUTRAL] It is not required.
[CUSTOMER][NEUTRAL] OK, shall we move to the next claim?
[AGENT][NEUTRAL] But you must
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] And get id[PII]
[CUSTOMER][NEUTRAL] I just, uh, what
[AGENT][NEUTRAL] And the next number's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Yeah, the next member's policy number is 2500293. And
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII]. Date of birth will be [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] [PII] amount will be $278 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hey, you said this claim was also received. It was received on 5-1-2025.
[AGENT][NEUTRAL] It was processed and denied on 52-2025.
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 7003.
[AGENT][NEUTRAL] And the denial reason is office visits.
[AGENT][NEGATIVE] are not covered by the above numbered policy.
[AGENT][NEUTRAL] The member's plan does not cover office visits.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Same over here today, but there is only one CPT code 99214 is not current under the member's plan. Am I right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And the further details will be the same.
[AGENT][NEUTRAL] I'm sorry, what did you say?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And the further details will be the same that you gave me for the previous claim.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Shall we move to the next claim?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK. And your last patient's policy number?
[CUSTOMER][NEUTRAL] 023-37280 M as in Mike, L as in Lima, and the number 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patients, yeah, the patient's first name is [PII] and the last name is
[CUSTOMER][NEUTRAL] [PII]. Date of birth will be [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] Date of service is [PII]. And the date of service, OK, sir, and the bill amount will be $3425 345 dollars even.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so this claim was also received. It was received on [PII].
[AGENT][NEGATIVE] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 1109.
[AGENT][NEUTRAL] And this policy was, excuse me, this claim was also denied as office visits are not covered by the above number policy. The member's plan does not cover office visits.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] The CPT code is 99214. Is it right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] This CPT code is not covered.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And the further details will be the same.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Now,
[CUSTOMER][NEUTRAL] Yeah, [PII]. Now you can transfer my call back in the queue because I have more claims on the file.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, OK, there's no need to how many claims do you have?
[CUSTOMER][NEUTRAL] OK, 123456 more 6 claims.
[AGENT][NEUTRAL] OK, [PII], I can help you with this, and then all of the information that I've already given you still applies. My name in today's date is your reference number?
[AGENT][NEUTRAL] Any information provided will be a verification of benefits and not a guarantee of payment and if the claim is on file and you need a copy of the explanation of benefits, you can print that by going to the portal website that I gave you.
[AGENT][NEUTRAL] And what is the next member's policy number?
[CUSTOMER][POSITIVE] OK, perfect. Thanks for the information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] My system is thinking. Give me a minute.
[CUSTOMER][NEUTRAL] Yeah, the next policy number is 1236655 M as in Mike L as in Lima and the number 7.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Clouding.
[CUSTOMER][NEUTRAL] The uh, the patient's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Data service and total bill amount.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the amount is $394 even.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] You said this claim was also received. The receive date on this claim is [PII].
[AGENT][NEGATIVE] Processed and denied on [PII].
[AGENT][NEUTRAL] Claim number is 358.
[AGENT][NEUTRAL] 0792.
[AGENT][NEUTRAL] And this claim was also denied as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The member's plan
[CUSTOMER][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] Mm. And the CPD code will be [PII]. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And the further details will be the same.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, yeah, uh, shall we move to the next claim then?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK. The next policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Yeah, the next policy number is 01762065.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 10.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Just like
[AGENT][NEUTRAL] What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is [PII]. I will spell the first name. It's [PII].
[CUSTOMER][NEUTRAL] And the last name is spelled and last name is pronounced as [PII]r something like that.
[CUSTOMER][NEUTRAL] Do you want me to spell the name?
[AGENT][NEUTRAL] Date of birth? That, that's not necessary.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Date of birth will be [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Data service and total bill amount.
[CUSTOMER][NEUTRAL] Data service is [PII].
[CUSTOMER][NEUTRAL] And the amount is $720 even.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] $720 is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's going.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was received also this claim was received on [PII].
[AGENT][NEGATIVE] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 0941.
[AGENT][NEUTRAL] And the denial states these services were rendered.
[AGENT][NEUTRAL] After coverage was terminated.
[AGENT][NEUTRAL] This policy had an effective date of [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And a term date of [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 31,930. OK, so the member was not acting on the date of service.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, bear with me. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Why?
[CUSTOMER][NEUTRAL] OK. Could you please tell me when was the last coordination of benefits were updated?
[AGENT][NEUTRAL] There would not be any coordination of benefit that's updated on this plan. This is a supplemental policy only we're not a major medical insurance.
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] OK, do you see any other pair, uh, patient, so, do you see any other payer listed for this patient?
[AGENT][NEUTRAL] No, you would have to contact the member.
[CUSTOMER][NEUTRAL] OK, and the further details will be the same, the timely filing and the mailing address.
[CUSTOMER][NEUTRAL] Shall we move to the next claim?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, next policy number.
[CUSTOMER][NEUTRAL] Uh yeah, system is thinking give me a minute.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, the next policy number is 02513096.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. The date of birth will be.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I had a.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK I have you sign.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is the date of service and total bill amount, please, [PII]?
[CUSTOMER][NEUTRAL] The, the, yeah, the date of service is [PII] and the total bill amount is $467.52.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, there is no claim on file for this member for [PII].
[CUSTOMER][NEUTRAL] OK, bear with me just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It just
[CUSTOMER][NEUTRAL] OK, uh, so [PII] is the member active on the date of service?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Policy effective date is 7-15-2024.
[CUSTOMER][NEUTRAL] OK, what will be
[CUSTOMER][NEUTRAL] And still active?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] And bear with me, and I do have one claim number. Could you please verify it for me? The claim number is 37278.
[AGENT][NEUTRAL] What is
[CUSTOMER][NEUTRAL] Yeah, OK. I will repeat it once again. It's 3727824113. Is it yours? Is it your
[AGENT][NEUTRAL] OK, that's not an APL? No sir, no sir, that's not a claim number for our company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And are you primary or secondary for this member?
[AGENT][NEUTRAL] This would never be a primary insurance. This is a hospital indemnity limited benefit plan. We are not a major medical insurance company.
[CUSTOMER][MIXED] OK, but you must be knowing your primary or secondary uh for this member.
[AGENT][NEUTRAL] And I just stated, we would not be a primary insurance. We are not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] OK, bear with me just a moment, I'm [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so as for the, OK, when was the last coordination of benefits updated? Do you have any information?
[AGENT][NEUTRAL] [PII], I don't know how else to tell you that there would not be a coordination of benefits with our company. We are not a major medical insurance carrier.
[CUSTOMER][NEUTRAL] OK. And do you have any PID?
[AGENT][NEUTRAL] For this plan, the payer ID that would be used to 64556.
[CUSTOMER][NEGATIVE] OK, and mailing address will be the same and there will be no timely filing.
[AGENT][NEUTRAL] I am, no, it would not, not for this policy. This policy has a different claims mailing address.
[AGENT][NEUTRAL] And the claims for this policy would be mailed to IMA.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what will be the claim submission timely filing?
[AGENT][NEGATIVE] No timely filing?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And what will be the preferred mode of submission?
[AGENT][NEUTRAL] You may mail that or electronically file that to that inform to that payer ID or.
[AGENT][NEUTRAL] PO box that I just provided for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's it, shall we move to the next claim?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't
[AGENT][NEUTRAL] And the next policy number?
[CUSTOMER][NEUTRAL] 02295813 M as in Mike L as in Lima and the number 8.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. Date of birth will be
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Thank you and what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] [PII] is the rate of service and the amount will be $247.88.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You want to pay that a member ID right?
[AGENT][NEUTRAL] OK, so this claim was also received. It was received on [PII].
[AGENT][NEGATIVE] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 0815.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the reason for the denial on this policy is also that office visits are not covered, and this is under the member's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the CPT code will be 99213. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And the further details will be the same.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Shall we move to the next claim?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] And the next policy number?
[CUSTOMER][NEUTRAL] It's 016.
[CUSTOMER][NEUTRAL] 11733 M as in Mike, L as in Lima, and the number 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII] and the date of birth will be [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the first name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The data service and total bill amount please.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] And the amount is $369 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Because
[AGENT][NEUTRAL] OK, so there is no claim on file for him for that data service.
[CUSTOMER][NEUTRAL] OK, for the date of service, the claim is not on file.
[AGENT][NEUTRAL] Correct. Now with this claim, when you do file this claim, [PII], we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] Along with the claim.
[CUSTOMER][NEUTRAL] So we need to send a copy of you, yeah, along with the claim. OK, just a moment and
[AGENT][NEUTRAL] You need to send the primary EOB and the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bear with me just a moment. Could you please tell me is the patient active on the date of service?
[AGENT][NEUTRAL] Yes, and the effective date of the policy is [PII] and it is still active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. And are you primary or secondary?
[AGENT][NEUTRAL] Again, this, we are not a major medical insurance, we would not be primary ever.
[AGENT][NEUTRAL] This is a supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the previous detail and the further details will be the same for the coordination of benefits, timely filing and the mailing address.
[AGENT][POSITIVE] No, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please tell me your pay ID because for the previous one the pay ID was different and for this one, what will be the pay ID?
[AGENT][NEUTRAL] This one is [PII].
[CUSTOMER][NEUTRAL] OK. Just a moment, [PII], give me a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, shall we move to the next claim I the the last claim on file which I have.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and the next policy number?
[CUSTOMER][NEUTRAL] The next policy number will be
[CUSTOMER][NEUTRAL] 022 06070.
[AGENT][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name will be, first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so for this gentleman's um insurance there is another company that you would need to contact regarding claim status. That company is Webb TPA.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Their phone number is [PII].
[CUSTOMER][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII]. And I'll be happy to transfer you to them if you would like.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, you can transfer my call to them.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with first?
[CUSTOMER][POSITIVE] No, [PII], you have helped me a lot. Thanks for your assistance and have a great day.
[AGENT][POSITIVE] OK. Well, you're welcome. Well, thank you, [PII]. I hope you have a great day too, and if that is all that I can help you with, thank you again for calling APL.
[CUSTOMER][POSITIVE] And thanks for my call.
[AGENT][POSITIVE] And give me, you're welcome, and one moment and I will get you connected.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Welcome to Web TPA, the administrator for the Limited Benefit Health Insurance program underwritten by American Public Life Insurance Company.
[CUSTOMER][NEUTRAL] If this is an emergency, please hang up and dial [PII].
[CUSTOMER][NEUTRAL] If you are a member calling about your premium billing or need to make changes to your account, such as an address change, add or drop a dependent, or you wish to modify your coverage in any way, please call American Public Life at [PII].
[CUSTOMER][NEUTRAL] For questions regarding pharmacy services, please contact Caremark at [PII]. Please note, using a PPO provider can reduce the amount you pay out of pocket for services you receive.
[CUSTOMER][NEUTRAL] Network discounts continue after you have exceeded the maximum allowed visits, testing days, and hospital confinement days. Please call [PII] to locate a provider in the Beach Street PPO network.
[CUSTOMER][NEUTRAL] This call may be recorded for quality assurance and training purposes.
[CUSTOMER][NEUTRAL] If you are calling on behalf of a hospital, physician, or other provider of services, please say provider or press one now.
[AGENT][NEUTRAL] Provider
[CUSTOMER][POSITIVE] I can help you with things like eligibility, benefits, claim status, and more.
[CUSTOMER][NEUTRAL] How can I help you?
[AGENT][NEUTRAL] Claim status.
[CUSTOMER][NEUTRAL] Sorry.