AccountId: 011433970860
ContactId: 0d18da99-8463-4eb9-a1b3-08f51454e622
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2384949 ms
Total Talk Time (AGENT): 691422 ms
Total Talk Time (CUSTOMER): 549595 ms
Interruptions: 6
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/0d18da99-8463-4eb9-a1b3-08f51454e622_20250421T18:02_UTC.wav
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[AGENT][NEUTRAL] Afternoon. 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 tell you, hello.
[AGENT][NEUTRAL] I'm sorry, I was not able to.
[AGENT][NEUTRAL] I'm, I need for you to repeat your name. I was not able to understand what you said initially.
[CUSTOMER][NEUTRAL] Sure. Hi, this is [PII] calling from provider of.
[AGENT][NEUTRAL] Can you spell your name for me?
[CUSTOMER][NEUTRAL] Yeah, sure. Before that, this call is recorded for training and quality purpose. Is it OK for you?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Um, my name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] Actually, I have 7 claims.
[AGENT][NEUTRAL] For 7 different patients, or is it 1 patient with multiple dates of service?
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] 7 for different patients.
[AGENT][NEUTRAL] OK, and each of the 7 patients have 1 data service. It's a total of 7 claims altogether, is that correct?
[CUSTOMER][NEUTRAL] Uh 7 patients, 7 different date of services.
[AGENT][NEUTRAL] OK. So, [PII], you will use my name that I gave you. Again, that is [PII], the first initial to my last name is [PII]. And you will use my name in [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can you spell your name?
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That will be your rep. You're welcome and that will be your reference number along with today's date, my name and today's date for each claim. Also, any information that I provide for you today will be a verification of benefits and not a guarantee of payment. And lastly, recall it, if we do have the claims on file and you need a copy of the explanation of benefits, once you have the claim number, you will be able to print those yourself from our portal by going to secured.
[CUSTOMER][POSITIVE] Thank you, [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so bear with me just one moment, [PII], OK?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so, what's the first member's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It would be 1317924.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient name is [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] The nearest
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth is December.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Sure. Date of service is [PII] with the total charge $905 even. And we submitted the primary UB on [PII] via fax.
[AGENT][NEUTRAL] OK, and do you already have the claim number for this claim?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, I have.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Claim number will be 356-8005, right?
[AGENT][NEUTRAL] OK, so there was another claim number has been issued upon the receipt once we've received the primary insurance explanation of benefits. So the claim number that it was processed under is 357.
[AGENT][NEUTRAL] 987 9.
[CUSTOMER][NEUTRAL] 35798799, right?
[AGENT][POSITIVE] That is correct. Yes, ma'am. And there has been a payment.
[AGENT][NEUTRAL] Issued on this claim?
[AGENT][NEUTRAL] And the benefit and then has been issued in the amount of $500.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The benefit payment has been issued in the amount of $500.
[AGENT][NEUTRAL] On single check, 203-474-5.
[CUSTOMER][NEUTRAL] And uh
[AGENT][NEUTRAL] And that was issued on
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, actually, give me one sec.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] That was the current date.
[CUSTOMER][NEUTRAL] OK. Uh, actually, I'm calling for procedure code 76856, which is not paid.
[AGENT][NEUTRAL] Yes ma'am, on the claim number you have, it was not because we had not received the primary EOB.
[AGENT][NEUTRAL] There has been a benefit issued for that code in the amount of $148.03.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The total amount on this claim paid $500.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Just give me a minute. Let me check.
[CUSTOMER][NEUTRAL] Just give me a minute, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, actually, yeah. Hello.
[AGENT][NEUTRAL] Yes, ma'am. I'm having trouble hearing you though, [PII], there's some noise in the background where you're located.
[CUSTOMER][NEUTRAL] 5
[AGENT][NEGATIVE] It's making it difficult for me to hear you.
[CUSTOMER][POSITIVE] Sorry for that.
[CUSTOMER][NEUTRAL] Actually, I'm calling from the procedure code 76856.
[AGENT][NEUTRAL] Yes, ma'am, and I just gave you the information on that code.
[CUSTOMER][NEUTRAL] OK, you didn't just save for this one. But we submitted with the pri.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yes, ma'am, and I gave you a new claim number.
[AGENT][NEUTRAL] And explained that it was processed under the new claim number and I explained that on that code 148 dollars.03 cents was paid. The total amount paid once we received the primary EOB was $500 and I gave you the check number.
[CUSTOMER][NEUTRAL] OK, can we proceed with the next claim.
[AGENT][NEUTRAL] Let me finish my note on this claim, just one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It was.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] The next member's policy number, please?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Sure. Next member ID would be 01557746. Mike Lima number 8.
[AGENT][NEGATIVE] OK, again, I'm sorry, the background noise, the people that are talking in, in the background where you're located, it's making it very difficult for me to understand you.
[CUSTOMER][NEUTRAL] Oh my [PII], you too.
[CUSTOMER][NEUTRAL] OK. Member ID will be 01557746. Mike Lima number 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date, uh, excuse me, your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. [PII] now, date of birth is [PII].
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] What you like
[AGENT][NEUTRAL] And the day of the service and total bill amount, please?
[CUSTOMER][NEUTRAL] Sure, [PII], with the total charge $660.70.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received. Do you already have the claim number on this claim?
[AGENT][NEUTRAL] Right. The claim was received on 4-14-25. It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] The claim number is 3589583.
[AGENT][NEUTRAL] And the reason for the denial on this claim?
[AGENT][NEUTRAL] State that
[AGENT][NEGATIVE] The service was, excuse me, these services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK. Can you provide me the effective date and date?
[AGENT][NEUTRAL] Effective date was [PII] and it turned [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need any other information on this policy, [PII]?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] I just give a moment.
[CUSTOMER][NEUTRAL] And now can I provide my, uh, shall want next claim.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you. One moment please.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. And the next member's policy number, please?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] That's our payer ID. That's our electronic payer ID. That's not a policy number.
[CUSTOMER][NEUTRAL] Uh, I don't have the policy ID number.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can't look in that's our electronic payer ID so I can't look that information up with that.
[CUSTOMER][NEUTRAL] Uh, can you help me with?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What other information do you have?
[CUSTOMER][NEUTRAL] I have patient name, date of birth.
[AGENT][NEUTRAL] OK, I can't search by the date of birth. I can try by the name.
[AGENT][NEUTRAL] What's the last name?
[CUSTOMER][NEUTRAL] Sure. Name is.
[CUSTOMER][NEUTRAL] [PII]. First name is [PII]. Last name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I will need for you to spell the names and I'm gonna, I, I'm stating again, [PII], the noise in the background is preventing me from understanding you.
[CUSTOMER][NEUTRAL] Yo, you
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] The people that are talking in the background with each other, it's making it very difficult for me to understand you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Sorry about that.
[AGENT][NEUTRAL] Is there any way that you
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] I'm sorry for that.
[CUSTOMER][NEUTRAL] Patient last name is spell out, it would be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What state does she live in?
[CUSTOMER][NEUTRAL] Yeah sure.
[CUSTOMER][NEUTRAL] State is [PII].
[AGENT][NEUTRAL] And her date of birth, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so the current policy number that you should have for this number?
[AGENT][NEUTRAL] It's 255.
[AGENT][NEUTRAL] 6494.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the data of service and total bill amount?
[CUSTOMER][NEUTRAL] Assured date of service is [PII], with total charge $500 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so I do see that the explanation benefits was received. It was received on [PII], the claim processed on [PII].
[AGENT][NEUTRAL] And it processed under a different claim number than originally when it was denied needing the explanation of benefits that claim number is going to be 357.
[AGENT][NEUTRAL] 931 6.
[AGENT][NEUTRAL] There has been a benefit issued on this in the amount of $193.19.
[AGENT][NEUTRAL] And that's on single check 203445-5.
[CUSTOMER][NEUTRAL] Uh yes. And it will also pay the amount, but I'm calling for the remaining balance. You paid only 193.
[CUSTOMER][NEUTRAL] Uh $193.19. But
[CUSTOMER][NEUTRAL] We submitted.
[AGENT][NEUTRAL] This policy only helps with co-pays, deductibles, and co-insurance amounts. I covered services.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But that
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] We submitted the deductible amount which is $306.81.
[CUSTOMER][NEUTRAL] Annually, you pay $193.19.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] No, I'll be happy to send this um.
[AGENT][NEUTRAL] Back for review again.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] Can you provide me the return on time?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Yeah, to process the claim.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm going to send the claim back for review.
[CUSTOMER][NEUTRAL] Sure. Can you provide me the turnaround time?
[AGENT][NEGATIVE] I didn't understand you.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] How much time it takes to process the claim?
[AGENT][NEUTRAL] You would need to allow at least 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 7 to 12 days, right?
[AGENT][NEUTRAL] 7 to 10 business days. We are not open on the weekend.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] But it's gonna take me a moment to complete this one.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and are you ready? I'll come back to complete this one to send the request to have that reviewed.
[AGENT][NEUTRAL] And how many more did you have? I'm sorry, [PII]. Yes, ma'am. How many more do you have?
[CUSTOMER][POSITIVE] Sure. Thank you so much.
[CUSTOMER][NEUTRAL] 4.
[AGENT][NEUTRAL] And the next policy number?
[CUSTOMER][NEUTRAL] Uh sure. It will be 01893411. Mike Lima number 8. Patient name is
[AGENT][NEUTRAL] OK, well this one is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you. And how can I help you with her today?
[CUSTOMER][NEUTRAL] Actually, uh,
[CUSTOMER][NEUTRAL] A procedure code.
[CUSTOMER][NEUTRAL] 76,830.
[CUSTOMER][NEGATIVE] It's not fair.
[AGENT][NEUTRAL] OK, so you have a question on the claim that's already been reviewed.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Actually
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] [PII] with the total charge, $905 even.
[AGENT][NEUTRAL] And one more time the data service.
[CUSTOMER][NEUTRAL] [PII] with the total charge $905 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the claim number?
[CUSTOMER][NEUTRAL] 35795005
[AGENT][NEUTRAL] OK, so have you received, so the only thing you need to know is about that one specific claim, is that correct? I mean one specific code?
[CUSTOMER][NEUTRAL] Uh-huh, no, for both one.
[CUSTOMER][NEUTRAL] Because we submitted the.
[AGENT][NEUTRAL] OK, there's 3 codes on that claim.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] OK, so what code are you asking about?
[CUSTOMER][NEUTRAL] Actually, we submitted the uh total deductible which is $530 and you only pay $101.
[AGENT][NEUTRAL] We paid $399 on 76641 and 101 on 76,830. Code 76856 was denied, and the reason for the denial states outpatient benefits for this calendar year has been met.
[CUSTOMER][NEUTRAL] Uh, for the procedure code 76856, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Can you provide me yearly?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, sorry?
[AGENT][NEUTRAL] I didn't understand what you said.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just one.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] This patient, uh, dinner forcal has been met, right?
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] They will be, uh they the uh max benefit reach for this one?
[AGENT][NEUTRAL] Yes ma'am. I just, yes, that is the remark on this claim.
[CUSTOMER][NEUTRAL] OK. Uh, when was previously taken these services?
[AGENT][NEGATIVE] It was not partially was it maxed out on this particular claim.
[AGENT][NEUTRAL] Because we paid
[AGENT][NEUTRAL] On this claim?
[AGENT][NEUTRAL] But this, but it maxed out, yes, on the other two codes when we pay on that, it maxed out the benefits.
[CUSTOMER][NEUTRAL] Yeah, 10 $1 you pay.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I'm sorry, but I didn't get it.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The outpatient benefit maximum per calendar year is $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Per year, right?
[AGENT][NEUTRAL] Per calendar year for covered outpatient services, yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you pay.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Just one.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Uh, actually one next week.
[AGENT][NEUTRAL] OK, just a moment. I need to look at something on here one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] What was your date of service again? [PII], is that correct? [PII], OK.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Huh.
[AGENT][NEUTRAL] OK, and your next patient's policy number please oralli.
[CUSTOMER][NEUTRAL] Sure. It is 02298883. M I Lima number 8.
[AGENT][NEUTRAL] OK, 02298883. Is that what you said?
[CUSTOMER][NEUTRAL] M. [PII] number 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And are you needing claim status or what type of the, how, how can I help you with this particular claim today for this number?
[CUSTOMER][NEUTRAL] Uh, actually, we submitted primary you'll be on [PII]. Can you help me with it? Status of it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The service is [PII] with the total charge $500 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, it appears the explanation of benefits was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] Uh, the claim number is going to be 357.
[AGENT][NEUTRAL] 9189.
[AGENT][NEUTRAL] And this was denied with a remarks stating receipt.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Of the reference claim is acknowledged, however, in order for us to process this claim, we need the explanation of benefits that matches the claims information.
[AGENT][NEUTRAL] The explanation of benefits we received does not match the claims information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you provide me the fax number?
[AGENT][NEUTRAL] [PII] attention claims.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK. Can you provide me the timely filing limit?
[AGENT][NEUTRAL] There's no timely filing limit?
[CUSTOMER][NEUTRAL] OK. Uh, shall we move on next claim?
[AGENT][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] OK, and the next numbers policy number?
[CUSTOMER][NEUTRAL] Sure. 1458575.
[CUSTOMER][NEUTRAL] Mike Lima number 8.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] It is service in total bill amount.
[CUSTOMER][NEUTRAL] Date of service is [PII]. The total charge $500 even.
[AGENT][POSITIVE] OK, thank you
[AGENT][NEUTRAL] Hey, this claim was received on [PII] and it was processed and denied on [PII].
[AGENT][NEUTRAL] And the reason for the denial is that we are in need of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK. Can you confirm the claim number?
[AGENT][NEUTRAL] We only received the claim.
[AGENT][NEUTRAL] 358-042-2.
[CUSTOMER][NEUTRAL] 358-042-2, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And uh fax number would be the same.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, shall we move on next explain?
[AGENT][NEUTRAL] No, ma'am, not yet.
[CUSTOMER][NEUTRAL] I shall
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK, and the next policy number?
[CUSTOMER][NEUTRAL] 02145415
[CUSTOMER][NEUTRAL] Yeah [PII], yeah Lima.
[CUSTOMER][NEUTRAL] Number 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] The name is [PII].
[CUSTOMER][NEUTRAL] OK. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for her place.
[CUSTOMER][NEUTRAL] Sure. Date of service is [PII], with total charge $1700 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEGATIVE] It's processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3587802.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And this was also denied because
[AGENT][NEUTRAL] We're in need of the primary insurance company's explanation of benefits.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. And is there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] No thank you so much. Have a good day.
[AGENT][POSITIVE] OK. Well then, thank you for calling APL. Yes, ma'am, and I hope you have a nice day as well.
[CUSTOMER][POSITIVE] Yeah you too bye.
[AGENT][NEUTRAL] Ah, bye bye.