AccountId: 011433970860
ContactId: 0ea05f15-ef8b-4cd8-a2b4-674f2cb6882f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1221979 ms
Total Talk Time (AGENT): 258511 ms
Total Talk Time (CUSTOMER): 452227 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/0ea05f15-ef8b-4cd8-a2b4-674f2cb6882f_20250409T20:12_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh well, yeah, yes, hello. Good day, this is [PII] from within Health Provider Services. I'm calling in regards with the claim.
[AGENT][NEUTRAL] OK, I can help you with claim status. And what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] Uh well, yes, um, [PII], this is [PII], that will be [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, member ID, do you mean?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, hold on for a moment.
[CUSTOMER][NEUTRAL] Um, hold on.
[CUSTOMER][NEUTRAL] For the member ID number.
[AGENT][NEUTRAL] And I can also
[CUSTOMER][NEUTRAL] Oh yes. Um, it's Z for, yes, it's Z for Zulu, C for Charlie, V for Victor, 13 consecutive 010913920.
[AGENT][NEUTRAL] Um, that's not one of our numbers. Um, do you have a social security number for the patient or a last name?
[CUSTOMER][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] That's not one of our policy numbers, um, or member IDs do you?
[CUSTOMER][POSITIVE] Oh yes, I'm so sorry. Yes, the, um, I have the member ID. I'm so sorry that is for um.
[CUSTOMER][NEUTRAL] Blue Cross Blue Shield of South Carolina. Yes, I have here for American Public. It's 023343778.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] Date of birth, uh yes, for the patient's name, that will be [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] Uh, got a different year.
[AGENT][NEUTRAL] I've got the same day.
[CUSTOMER][NEUTRAL] Uh, no, it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you were needing benefits or claim status?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, claims.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Claims, OK.
[AGENT][NEUTRAL] And what was the date of service?
[CUSTOMER][NEUTRAL] Um, hold on, let me check.
[CUSTOMER][NEUTRAL] Um, I just wanted to confirm for all claims in, um, CMD are on file for this one.
[CUSTOMER][NEUTRAL] And I just wanted to find out um the status of the claim.
[AGENT][NEUTRAL] OK. For what date?
[CUSTOMER][NEUTRAL] Um, hold on.
[CUSTOMER][NEUTRAL] Actually there is a multiple day of service. Hold on for a moment.
[CUSTOMER][NEUTRAL] Yes, for date of service, um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that bill charges?
[CUSTOMER][NEUTRAL] Um, for 2200 bills, uh, [PII], it's a date range.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And who is the provider?
[CUSTOMER][NEUTRAL] Um, within health provider services.
[AGENT][NEUTRAL] Um, I, I don't show a claim for that bill charges.
[CUSTOMER][NEUTRAL] For 3200?
[AGENT][NEUTRAL] I've got a claim, let me see.
[AGENT][NEUTRAL] Um, let me place you on a brief hold if you don't mind.
[CUSTOMER][NEUTRAL] OK, sure, thank you. You are on hold.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] 391
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] 529
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so sorry about that. Um, let's see, so I didn't see those bill charges, but let me pull up the claim. Hold on one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Sorry, my system's running just a bit slow. OK, and what were the total bills again? I'm so sorry.
[CUSTOMER][NEUTRAL] It's 2200 bales.
[AGENT][NEUTRAL] OK, I do see that.
[CUSTOMER][POSITIVE] Well, I'm for this one.
[AGENT][NEUTRAL] Uh, it looks
[CUSTOMER][NEUTRAL] Um, we sent primary, uh, yes, um, we sent the, we sent you the primary co-insurance and deductible that you need to pay for this one.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] So I just wanted to follow up with you first, mhm.
[AGENT][NEUTRAL] Yes, so
[AGENT][NEUTRAL] Looks like we made a payment of $291.51.
[CUSTOMER][NEUTRAL] OK, $291.51. OK, so I'll just get that payment information. Let me check, hold on.
[CUSTOMER][NEUTRAL] Hold on for a moment.
[AGENT][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Well, actually there is a multiple date of service for this one. I mean for these patients that needs to follow up.
[AGENT][NEUTRAL] OK, do you want the information for this particular claim first, or?
[CUSTOMER][NEUTRAL] Oh yes, yes, hold on, um.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] OK, so this claim was already processed and paid, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Processing payment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, OK. First, can I have the claim number?
[AGENT][NEUTRAL] Same number is 3583916.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That's all?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, how about the allowed amount for this claim?
[AGENT][NEUTRAL] Uh, we, we paid 291 51.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] And um OK so the allowed amount is 291.51 and the paid amount is 291 and 51 also how about the uh there's no patient responsibility, right?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility. This is a secondary plan.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh yes, yes, I'm sorry, um, how about the payment number?
[AGENT][NEUTRAL] The check number?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Number 203-6688.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, again for the check number 36688 right?
[AGENT][NEUTRAL] Yes, 203-6688, yes.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK, how, um, is, is this a bulk payment?
[AGENT][NEUTRAL] No, it's single.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, how about the payment date, uh, the clear date and the the, the payment date?
[AGENT][NEUTRAL] that is
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. How about the clear date?
[AGENT][NEUTRAL] I don't show a clear date yet. It was only a week ago.
[CUSTOMER][NEUTRAL] OK, so this uh processed on [PII].
[CUSTOMER][NEUTRAL] OK, um, can I ask a complete remit to be faxed?
[AGENT][NEUTRAL] Yes, your facts.
[CUSTOMER][NEUTRAL] OK, that would be [PII].
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So then other date of service that'll be.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] It's also a date range for [PII] for 2200 bills.
[AGENT][NEUTRAL] Uh, looks like that was received for 1-2025 paid for 22025.
[AGENT][NEUTRAL] And we paid $320.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] Um, first, can I have the claim number?
[AGENT][NEUTRAL] Claim number 3583963.
[CUSTOMER][NEUTRAL] OK, how about uh the allowed amount for this one? It's $320?
[AGENT][NEUTRAL] We paid 320.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] 320.
[CUSTOMER][NEUTRAL] $320.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] $320 no patient responsibility amount. How about the payment number for this one?
[AGENT][NEUTRAL] 20366997 single check.
[CUSTOMER][NEUTRAL] Um, 20366997, right?
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][POSITIVE] And, and yes, uh, I, I also, I'm so sorry, the payment date.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I is it also
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[CUSTOMER][NEUTRAL] And can I also ask a complete remit to be faxed?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for that. And another date of service [PII] for 2200 bills.
[CUSTOMER][NEUTRAL] Oh, yeah, [PII], not [PII].
[CUSTOMER][NEUTRAL] And yes, um.
[AGENT][NEUTRAL] No, it was received on the
[CUSTOMER][NEUTRAL] Is it also processing fee?
[AGENT][NEUTRAL] Yes, [PII] 2025 received 42 2025 paid.
[AGENT][NEUTRAL] We paid 320.
[AGENT][NEUTRAL] And are you ready for the check number?
[CUSTOMER][NEUTRAL] Um, hold on.
[CUSTOMER][NEUTRAL] 20 yes, um, for the check.
[CUSTOMER][NEUTRAL] Payment number, yes, yes, please.
[AGENT][NEUTRAL] 2036696.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the payment date is [PII] also. How about the claim number?
[AGENT][NEUTRAL] 3583961.
[CUSTOMER][NEUTRAL] OK, and also the.
[CUSTOMER][NEUTRAL] Um, can I request a complete remit to be faxed also?
[AGENT][NEUTRAL] Yes, do you have access to our online portal?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, do you want to sign up for that? You can pull EOBs immediately.
[CUSTOMER][NEUTRAL] Um, it's OK because actually the um.
[CUSTOMER][NEUTRAL] We don't have access for that. Um, let's proceed to another date of service, um, [PII] for 1100 bills.
[AGENT][NEUTRAL] And how many more claims do you have?
[CUSTOMER][NEUTRAL] Um, 12.
[CUSTOMER][NEUTRAL] 10
[CUSTOMER][NEUTRAL] Date of service.
[AGENT][NEUTRAL] You don't have, you don't have access to the internet?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yes, um, how about the [PII]? Is it already processed and paid?
[AGENT][NEUTRAL] Yes, receive same day 4-1-2025, paid 42-2025, paid 160.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, how about the claim number?
[AGENT][NEUTRAL] The claim number is.
[AGENT][NEUTRAL] 358-3955
[CUSTOMER][NEUTRAL] OK. Um, how about the payment number?
[AGENT][NEUTRAL] Um that is.
[AGENT][NEUTRAL] 2036694
[CUSTOMER][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] 2036694
[CUSTOMER][NEUTRAL] 669-4. OK.
[AGENT][NEUTRAL] Is this all for the same patient?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Oh yes, yes, can I ask also a complete room with the be?
[AGENT][NEUTRAL] OK, can you
[AGENT][POSITIVE] Yeah, can I get the, it'd probably be faster. I, if you give me the dates of service, then I can just fax you all of the EOBs.
[CUSTOMER][NEUTRAL] Oh yes, please. Thank you so much. But um I just wanted to make sure if this claim was already processed and paid.
[AGENT][NEUTRAL] Right, it was.
[CUSTOMER][NEUTRAL] OK, all the claims up until um date of service, [PII] for 1100 bill.
[AGENT][NEUTRAL] Right, so that's what I'm saying. If you give me the dates of service, I can fax you all of the EOBs that we have on file.
[AGENT][NEUTRAL] Instead of it's gonna include all of the information that we're going by over on the phone. So in order to expedite the process instead of just going through every single one, I can send you all of the EOBs and you can look through all of them. It has all of the information that we're talking about.
[CUSTOMER][POSITIVE] OK, sure. Thank you so much for.
[CUSTOMER][NEUTRAL] OK, sure, thank you. Um, yes, um, we're done with [PII], right? So let's proceed to [PII] for 1100 bill.
[AGENT][NEUTRAL] Right, that's what I'm saying.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], [PII]. OK, what's next?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, [PII] for 1100 bill. [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] for 1100 bill.
[CUSTOMER][NEUTRAL] [PII] for 1100 bill. [PII] for 1100 bill. [PII] for 1100 bill. [PII] for 1100 bill. [PII].
[CUSTOMER][NEUTRAL] [PII] for 1100 bill. [PII] for 1100 build. [PII] for 1100 build, [PII] for 1100 build, and for [PII] for 1100 bill.
[AGENT][NEUTRAL] OK, let me just repeat it back to you. [PII], [PII], [PII], [PII], [PII], [PII], [PII], [PII], [PII], [PII], [PII], [PII], [PII], and then the ones that we've discussed previously.
[CUSTOMER][POSITIVE] OK. Yeah, sure. Thank you so much for that.
[AGENT][NEUTRAL] OK, let me get your fax. [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh yes. Again, it's [PII]. But those claims were already uh processed and paid, right?
[AGENT][POSITIVE] Correct, so I'll send you all of the explanation of benefits.
[CUSTOMER][POSITIVE] OK, thank you so much for this and yes um [PII], lastly, can I have the reference number for this call?
[AGENT][NEUTRAL] Um, it's gonna be my name, which is [PII], and then first initial to last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][POSITIVE] Um, so sorry, [PII]. Thank you so much for that. So yes, I think we're all set here. Um, thank you for your time and have a great day. Bye.
[AGENT][POSITIVE] Great. Thank you for calling APL.