AccountId: 011433970860
ContactId: 0cd79763-7c34-4c6a-81bd-01738ba10fef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 844210 ms
Total Talk Time (AGENT): 286526 ms
Total Talk Time (CUSTOMER): 168429 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/0cd79763-7c34-4c6a-81bd-01738ba10fef_20250522T12:43_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, this is [PII] calling from provider office. I'm calling regarding the claim status. Before proceeding, I would like to share you this call is recorded for training and quality purpose. Is it OK for you, [PII]?
[AGENT][NEUTRAL] That is fine. And did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Spell your name for me, please.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] Thank you. And what is a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that. And we probably how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] 5 claims.
[AGENT][NEUTRAL] Are they for 5 different patients or all for the same patient and different dates of service?
[CUSTOMER][NEUTRAL] A different patient.
[AGENT][NEUTRAL] OK, so we probably a couple of things, um, up front, you will use my name that I gave you along with today's date as your call reference number for each.
[CUSTOMER][NEUTRAL] OK. Can you spell out your name?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alsopoli and
[CUSTOMER][NEUTRAL] Can you repeat it again slowly?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] You're welcome and replying any information that is provided on any of the claims will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file once I provide you the claim number if you need a copy of the explanation of benefits, you can print them yourself by going to our portal at [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Am [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] You're welcome. And what is the first member's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It will be 02359542. Am I clear Lima number 8?
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] What is the date of birth of your patients?
[CUSTOMER][NEUTRAL] [PII] 13, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] [PII], with total charge, $5000 even.
[AGENT][NEUTRAL] 5000, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEGATIVE] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 359-5900.
[AGENT][NEUTRAL] And the reason for the denial on this claim, state please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you provide the fax number?
[AGENT][NEUTRAL] [PII] attention claims.
[CUSTOMER][POSITIVE] OK. Thank you so much. And can you also provide me the effective date, date and the date of the member?
[AGENT][NEUTRAL] There is no term date. The policy has an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, shall I move on to the next claim, please?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and the next number's policy number?
[CUSTOMER][NEUTRAL] Sure. 01617104.
[CUSTOMER][NEUTRAL] Mike Lima number 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Sure. [PII]. The total charge $500 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This claim was also received. The received date is [PII].
[AGENT][NEUTRAL] was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3591944.
[AGENT][NEUTRAL] And the reason for the denial on this one [PII] is also the same thing. We need your primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] more next year.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It will be 1435599 M. Mike Lima number 8.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. She [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Data service and total build amount.
[CUSTOMER][NEUTRAL] [PII] with total charge of $375 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So this claim was also received. The received date is [PII].
[AGENT][NEGATIVE] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 359-563-2.
[AGENT][NEGATIVE] And this claim was also denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much. And for same member same date of service with different charge amount.
[AGENT][NEUTRAL] This is for the same patient, same member, different data service?
[CUSTOMER][NEUTRAL] Yeah. Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Same date of service, different charge amount.
[AGENT][NEUTRAL] OK, what is the bill amount?
[CUSTOMER][NEUTRAL] $905.
[AGENT][NEUTRAL] This claim was received for [PII], denied for [PII].
[AGENT][NEUTRAL] The claim number is 3592379 and it was denied for the same reason. We need the primary insurance company's explanation of benefits.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. And the last name?
[AGENT][NEUTRAL] For a different member?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK one moment.
[CUSTOMER][POSITIVE] For sure.
[AGENT][NEUTRAL] OK, and then the last policy number?
[CUSTOMER][NEUTRAL] Sure. 02312677.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And what is your patient's name and date of birth please [PII]?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With the total charge, $500 even.
[AGENT][NEUTRAL] And you said the data service is 38 of 2024?
[AGENT][NEUTRAL] Is that correct? OK, there is no claim on file for that data service.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Can you provide me the effective date and term date?
[AGENT][NEUTRAL] The policy is active, so there is no term date.
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] Active from
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you also provide me the timely filing limit?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. Have a good day.
[AGENT][NEUTRAL] And then, yes, ma'am. And one last thing on this one, we will also have to have a, a copy of the primary insurance company's explanation of benefits with the claim.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. All right. Well, again, [PII], is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] OK, well, you're very welcome and thank you for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Yeah you too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.