AccountId: 011433970860
ContactId: 0d56e2ae-f153-437c-9da5-b8f99d7e2491
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 836539 ms
Total Talk Time (AGENT): 338370 ms
Total Talk Time (CUSTOMER): 234111 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/0d56e2ae-f153-437c-9da5-b8f99d7e2491_20250605T15:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office, and this call will be recorded for quality and training purposes. Would you like to continue.
[AGENT][NEUTRAL] OK, that's fine, [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Uh, so I was calling regarding a claim status.
[AGENT][NEUTRAL] OK, you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh, I have 4 claims for the same patient.
[AGENT][NEUTRAL] So you have 4 days of service for 1 member, is that correct?
[CUSTOMER][NEUTRAL] That's right, mhm.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII] and my extension is [PII].
[AGENT][NEUTRAL] Thank you and what is the member's policy number, [PII]?
[CUSTOMER][NEUTRAL] It is 206-599-998.
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] And can you spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] So much
[CUSTOMER][POSITIVE] And a gift for you.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it's Monday with sale and the date of birth is [PII].
[AGENT][NEUTRAL] OK, so on this policy number that you provided me, there is no one by that name or date of birth covered, and this policy is actually not active. This policy was in effect from [PII]. But again, there is no one by that name or date of birth. And again, give me the date of birth.
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[AGENT][NEUTRAL] OK. And again, the name?
[CUSTOMER][NEUTRAL] The first name is spelled as [PII] and the last name is [PII]
[AGENT][NEUTRAL] OK, so there is no, again, there is no one on this policy by that name and that date of birth.
[AGENT][NEUTRAL] Now give me just a moment to look at something.
[CUSTOMER][NEUTRAL] OK, uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh yes, sir.
[AGENT][NEUTRAL] I don't have anyone by that name.
[CUSTOMER][NEUTRAL] Uh, so, uh, what was the effective date you said it's from [PII].
[AGENT][NEUTRAL] 1 to [PII], but again, there was no one on that policy by that name and date of birth.
[CUSTOMER][NEUTRAL] Uh, but I have the insurance card with me.
[AGENT][NEUTRAL] Yes, sir. And [PII], [PII] is not the insured with that policy number?
[CUSTOMER][NEUTRAL] This patient.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm also looking at the ID card.
[CUSTOMER][NEUTRAL] Can you use this number?
[CUSTOMER][NEUTRAL] That is 02515489.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so one moment for me to get that information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And so that is the correct number for the patient that you're calling about?
[CUSTOMER][NEUTRAL] Um-hum.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And [PII], for all of the claims you will use my name and today's date as your call reference number. Also any information that is provided on any of the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And lastly, if the claims are on file and you need a copy of the explanation of benefits, once I provide you the claim number, you can print those yourself by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So what is the first
[CUSTOMER][NEUTRAL] Uh, actually I visited that site.
[CUSTOMER][NEUTRAL] Uh, I don't have the social security number, so that's why I've called you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir, but once I provide you the claim number, you should be able to access the explanation of benefits by using the claim number.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the first date of service and bill amount?
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] It is [PII]. Charge amount is $96 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] And the received date was [PII] and processed the same date.
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 0507.
[AGENT][NEGATIVE] And this claim was denied.
[AGENT][NEUTRAL] And the reason for the denial, Mark, is that we need the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] It states, please provide copies of your explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK, so where can I submit the.
[CUSTOMER][NEUTRAL] Primary UB is there any fax number mailing address?
[AGENT][NEUTRAL] You may fax that to [PII] attention claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm repeating the fax number it is [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the claim number is 355-0507.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much and.
[AGENT][NEUTRAL] You're welcome. And what is the next date of service and build them out?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Next state of services.
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $300 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was also received.
[AGENT][NEUTRAL] The received date was [PII], denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 354948[PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the reason for the denial is that office visits are not covered.
[AGENT][NEUTRAL] The member supplemental policy Mark does not cover office visits.
[CUSTOMER][NEUTRAL] OK, um, repeating the.
[CUSTOMER][NEUTRAL] Claim number again it is 3549 sorry it's 35494488, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, thank you so much and.
[AGENT][NEUTRAL] You're welcome. And then what is the next date of mhm.
[CUSTOMER][NEUTRAL] Next state of service.
[CUSTOMER][NEUTRAL] Can I provide you the next state of service?
[AGENT][NEUTRAL] Yes, the next day to service and total bill amount, please.
[CUSTOMER][NEUTRAL] Oh, it's [PII]. Total charge amount is $357 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This claim was also received?
[AGENT][NEUTRAL] This claim was received on [PII], denied on [PII].
[AGENT][NEUTRAL] Uh, the claim number, give me just one moment on it please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 356 9.
[AGENT][NEGATIVE] And this was also denied as office visits are not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Last.
[CUSTOMER][NEUTRAL] Last date of service is.
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $357 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and so for that data service, there is, um, well, let me just double check one thing for you.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] You know
[AGENT][NEUTRAL] And there is no claim on file for that billed amount for that data service.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] What is the timely filing for this?
[AGENT][NEUTRAL] There is no timely filing limit, and if you will be filing a claim with us, we must have a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK and uh.
[CUSTOMER][NEUTRAL] What will be the mailing address to submit the claim?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Can you repeat the ZIP code again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm repeating the mailing address again. It is [PII], right?
[AGENT][NEUTRAL] Yes, would you please repeat the [PII] that you said one more time?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for the information and
[AGENT][NEUTRAL] You're welcome. Um, yes, sir, and give me just one second, um, [PII], I do want to look at one thing, please.
[CUSTOMER][POSITIVE] Have a great day.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] know
[CUSTOMER][NEUTRAL] I'm the one.
[AGENT][NEUTRAL] On this last data service, just bear with me a second.
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] OK, so yes, I, I just was double checking with them, but we do not have a claim on file for that last data service. So is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, no, that's it. Thank you so much. Is there any chance you can fax me those EOBs?
[AGENT][NEUTRAL] Well, you're welcome, [PII].
[AGENT][NEUTRAL] Again, you can use the claim number that I gave you and print them directly from our portal.
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][POSITIVE] OK, that's it thank you so much have a great day thanks for the information.
[AGENT][POSITIVE] OK. Well, you're very welcome. Yes, you're welcome and thank you again for calling APL. I hope you have a nice day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well they.
[AGENT][NEUTRAL] Bye bye.