AccountId: 011433970860
ContactId: 126705ee-48d1-4e6a-af77-efa3b0800eed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 986780 ms
Total Talk Time (AGENT): 244950 ms
Total Talk Time (CUSTOMER): 289933 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/126705ee-48d1-4e6a-af77-efa3b0800eed_20250307T15:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] from provider office. How are you doing?
[AGENT][POSITIVE] I'm good [PII], how are you?
[CUSTOMER][POSITIVE] Yeah, I'm doing perfect thanks for asking happy Friday.
[AGENT][POSITIVE] You too. How can I help?
[CUSTOMER][NEUTRAL] Uh, yeah, I have, uh, patience. I'm looking for some claim status.
[AGENT][NEUTRAL] OK, I'm happy to check on the claim status. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's 608-796.
[AGENT][NEUTRAL] All right, thank you for that. And then if I can get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Of course. Patient first name is [PII] Last name is uh [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you for that and then what's the date of service?
[CUSTOMER][NEUTRAL] The service, it's uh
[CUSTOMER][NEUTRAL] [PII]. And there are 4 data service for [PII].
[AGENT][NEUTRAL] OK, what's the bill amount for the state of service?
[CUSTOMER][NEUTRAL] Yeah, it's $348.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Maybe you
[AGENT][NEUTRAL] Alright, so we did receive this claim on [PII].
[AGENT][NEUTRAL] Uh, looks like there was a benefit payment sent in the amount of $70.
[AGENT][NEUTRAL] Claims processed on, uh-huh.
[CUSTOMER][NEUTRAL] Just a second, ma'am.
[CUSTOMER][POSITIVE] Yeah, uh, let me make a note. I'm so sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Paid amount is $70 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what's the claim number?
[AGENT][NEUTRAL] 356.
[AGENT][NEUTRAL] 896 8.
[CUSTOMER][NEUTRAL] OK. It was uh partially paid, right? Something was denied?
[AGENT][NEUTRAL] Uh, let's see. So it looks like procedure code 00274 was denied.
[CUSTOMER][NEUTRAL] 274 was denied.
[CUSTOMER][NEUTRAL] Do not do to.
[AGENT][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] It looks like the benefits were applied to the calendar year deductible, so that's why there was nothing paid out.
[CUSTOMER][NEUTRAL] OK, amount was paid.
[CUSTOMER][NEUTRAL] 2 hours deductible.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. And ma'am, the bid amount was $348. 0, let's see. Just a second.
[CUSTOMER][NEUTRAL] And ma'am, it was via check or uh EFT the payment?
[AGENT][NEUTRAL] Single check.
[CUSTOMER][NEUTRAL] Single check, the check number?
[AGENT][NEUTRAL] 202.
[AGENT][NEUTRAL] 9905.
[CUSTOMER][POSITIVE] Perfect. The amount of $70.
[CUSTOMER][NEUTRAL] OK. And when it was issued, ma'am?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And is it cash or still outstanding?
[AGENT][NEUTRAL] One moment.
[AGENT][POSITIVE] Check still shows outstanding.
[CUSTOMER][NEUTRAL] OK, not cash yet.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And ma'am, can you please send me the UB for this claim?
[AGENT][POSITIVE] Absolutely. What's a good fax number?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's uh
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Just to confirm, that was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Should we mark attention to anybody on this?
[CUSTOMER][NEUTRAL] Yeah, you can [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name
[AGENT][NEUTRAL] Alright, that is on its way. It should be there in about 5 minutes or so.
[CUSTOMER][POSITIVE] Perfect. Thank you. And ma'am, for the next date of service for [PII], shall we move on?
[AGENT][NEUTRAL] Mhm, that's the next stage of service.
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][NEUTRAL] And the bill out.
[CUSTOMER][NEUTRAL] Bill amount, it's uh $472.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] I apologize just for the bill amount again for that was how much? $236?
[CUSTOMER][NEUTRAL] No, ma'am. It's $472.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] Alright, so looks like we did receive this claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, there was a benefit payment sent.
[AGENT][NEUTRAL] And the amount of $60 in a single check.
[CUSTOMER][NEUTRAL] OK. Uh, claim number.
[AGENT][NEUTRAL] Uh, claim number is going to be 356-89.
[AGENT][NEUTRAL] 71
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Single check, check number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let me grab that for you, one moment.
[AGENT][NEUTRAL] Check number is going to be 202.
[AGENT][NEUTRAL] 9906.
[CUSTOMER][POSITIVE] Perfect. $70 single.
[CUSTOMER][NEUTRAL] OK. Issued on
[AGENT][NEUTRAL] 227.
[CUSTOMER][NEUTRAL] February
[AGENT][NEUTRAL] 25.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Check still outstanding?
[AGENT][NEUTRAL] Uh, let me just verify that one moment.
[AGENT][POSITIVE] Check is still outstanding, yes.
[CUSTOMER][NEUTRAL] OK, still. And ma'am, uh, anything was denied in this claim?
[AGENT][NEUTRAL] Nothing was denied. It looks like that was the maximum benefit payment for those services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And ma'am, you before this claim.
[AGENT][NEUTRAL] Yep, it's on its way. It should be there in a few moments.
[CUSTOMER][NEUTRAL] Oh great. OK. For the next data search for [PII], it's uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the build them out?
[CUSTOMER][NEUTRAL] Bill amount, it's uh $1,066.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][POSITIVE] All right. Thank you for your patience on that. So it looks like
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Uh, we did receive this claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $205.
[CUSTOMER][POSITIVE] Perfect. Check number, sorry, claim number.
[AGENT][NEUTRAL] The claim number is 356-897-2.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mhm. Anything was denied or it was fully paid according to the allowed amount?
[AGENT][NEUTRAL] Yeah, I was paid for the allowed amount.
[CUSTOMER][POSITIVE] Perfect. And check number?
[AGENT][NEUTRAL] 202.
[AGENT][POSITIVE] 9903. Check is still outstanding.
[CUSTOMER][NEUTRAL] And it was single payment, ma'am?
[AGENT][NEUTRAL] Mhm. Single check.
[CUSTOMER][NEUTRAL] Um, just a second.
[CUSTOMER][NEUTRAL] Uh issue date was the same, uh, [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Perfect. Thank you. And you'll be sent?
[AGENT][NEUTRAL] Mhm, just send it.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. And ma'am, for the next day the service for plan, it's uh [PII].
[AGENT][NEUTRAL] OK, and the build amount?
[CUSTOMER][NEUTRAL] Yeah, bill amount is $67.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And date of service again to confirm was [PII].
[CUSTOMER][NEUTRAL] Right, ma'am.
[AGENT][NEUTRAL] Not showing any claims on file for that date of service for [PII].
[CUSTOMER][NEUTRAL] Oh, no claim on file for date of service.
[CUSTOMER][NEUTRAL] OK, just let me see.
[CUSTOMER][NEUTRAL] It was electronically sent.
[CUSTOMER][NEUTRAL] On [PII]. OK. And ma'am, the electronic payer ID it's uh 60801. Is it correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So we can uh resubmit the claim with electronically, right? uh uh on this pay ID.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Claim is on file, need to be resubmitted.
[CUSTOMER][POSITIVE] Perfect. Thank you so much, ma'am.
[CUSTOMER][NEUTRAL] OK, ma'am. Uh, there's the last patient we have, it's for
[CUSTOMER][NEUTRAL] I think it's a family member with [PII].
[CUSTOMER][NEUTRAL] And the one date of service for this. It's [PII].
[AGENT][NEUTRAL] OK, and what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII], same.
[CUSTOMER][NEUTRAL] I hope it is on file.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] No claims on file for [PII] for 11-2124.
[CUSTOMER][POSITIVE] Perfect. Thank you. And uh I think, ma'am, uh the claim that uh was received on [PII].
[CUSTOMER][NEUTRAL] Yeah, 25. They were sent via fax because they were uh previously sent electronically but uh insurance never received them. So, ma'am, uh what's the fax number? So I will uh go ahead and send these claims on fax.
[AGENT][NEUTRAL] Uh, the fax number is 877.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] 9423 perfect.
[CUSTOMER][POSITIVE] Thank you so much, ma'am. And
[CUSTOMER][NEUTRAL] Ma'am, how do you spell your name?
[AGENT][NEUTRAL] My name is spelled [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, [PII]. What's the reference number for this call?
[AGENT][NEUTRAL] Call reference is my name with my last initial and then today's date. The last initial to my name is [PII], and today's date is [PII].
[CUSTOMER][NEUTRAL] OK. As today's date.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Perfect. Thank you so much, [PII], for assisting. Have a wonderful day. Stay safe. I hope you enjoy your weekend.
[AGENT][POSITIVE] You too. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah. Bye-bye.