AccountId: 011433970860
ContactId: 13e6aec3-1d94-4826-b356-87358c533448
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553780 ms
Total Talk Time (AGENT): 189707 ms
Total Talk Time (CUSTOMER): 270162 ms
Interruptions: 8
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/13e6aec3-1d94-4826-b356-87358c533448_20250416T17:14_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, yes, my name is [PII], and I was calling from a provider's office just to, just to confirm, um, a denied claim.
[AGENT][NEUTRAL] OK, [PII], you're needing to verify the.
[CUSTOMER][NEUTRAL] Uh, well, the denial reason, yes, ma'am. I'm sorry.
[AGENT][NEUTRAL] OK, you're needing to verify what the denial is on the claim, is that correct?
[CUSTOMER][NEUTRAL] Yeah, just to confirm that the the now said the patient max the benefits, but if we have some other notes in the account, so just wanna make sure that she matched the benefits and that's basically it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that, [PII]. Sure. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Um, I have 0213, I'm sorry, 02131561.
[AGENT][NEUTRAL] Please.
[AGENT][NEUTRAL] OK, thank you. Give me a moment please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK, [PII], any information that I do provide would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Uh, this one is for um.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] And what is that data service and total bill amount please?
[CUSTOMER][NEUTRAL] Um, that is going to be for, let me go back to it.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, it's gonna be, it's gonna be [PII] for $315.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And you said, uh maybe I misheard you. Data service [PII]?
[CUSTOMER][NEUTRAL] Um, the day of service is, yes, [PII].
[AGENT][NEUTRAL] And you said the bill amount is $315?
[CUSTOMER][NEUTRAL] Um, yes, or it may have came through as $235. I know we built it on [PII].
[AGENT][NEUTRAL] OK, what's the claim number you have because I don't see a claim for that either one of those billed amounts.
[CUSTOMER][NEUTRAL] To you guys.
[AGENT][NEUTRAL] With APL.
[CUSTOMER][NEUTRAL] Do you have a claim for that date of service?
[AGENT][NEUTRAL] Not for either one of those billed amounts.
[CUSTOMER][NEUTRAL] OK, so you don't even have that data service for the patient.
[AGENT][NEUTRAL] No, ma'am, not with that information. Uh-huh.
[CUSTOMER][NEUTRAL] The reason why I'm asking is because it doesn't help me like eliminate um if that claim went through. I see. OK. um well, we don't have that.
[AGENT][NEUTRAL] Because you said you had a denial benefit for Max, so I was just wondering, you should have a claim number if it shows the benefits for not paying because.
[CUSTOMER][NEUTRAL] Let me look at this um.
[CUSTOMER][NEUTRAL] Let me go to the transaction on, um, let me see 821.
[CUSTOMER][NEUTRAL] Let's see, let me open this up, this one.
[AGENT][NEUTRAL] I don't, I don't have.
[CUSTOMER][NEUTRAL] OK, do the, um, I just wanna make sure this is the right patient um thing. Do you guys come, when you send the EOBs, do it come back health log logistics?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, it would come as American public life. I don't even know what that other is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Never heard that before.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Let me see if we have the health insurance. Hold on.
[CUSTOMER][NEUTRAL] Do you guys take your claims electronically? I'm gonna just check the clearing house real quick.
[AGENT][NEUTRAL] Mhm. We, we do. Our payer ID is 60801.
[CUSTOMER][NEUTRAL] OK, let me check this clear house real quick. Um, 8:19. That is so weird. 8 224, um, this is before.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Let me see what we got. We, it looked like we build it.
[CUSTOMER][NEUTRAL] This one is 8:21. Let me get 8:21.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 821.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] I'm trying to see cause it looks like we built it, but
[CUSTOMER][NEUTRAL] I like they deleted it. an account number. Let me pull one more ELB real quick. Let me just see if this one because I have it in.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah, sure. Yeah, cause.
[AGENT][NEUTRAL] Yeah, because with the supplemental policy, I don't have a claim for that data service.
[AGENT][NEUTRAL] Matching any of that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see this one is coming from.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Let me go to the one that shows 98.
[CUSTOMER][NEUTRAL] That's so weird cause it looks like we billed it to you guys and, and honestly this, this is probably what the problem is, um, health insurance, let me see that EOB. This one is for August.
[CUSTOMER][NEUTRAL] OK. What I'm gonna do is I'm gonna check.
[CUSTOMER][NEUTRAL] The EOBs like go through each one cause it's showing that we don't have the EOB from you guys. We have the, let me see what this label says. It says benefits Max.
[AGENT][NEUTRAL] That would explain because we don't have a claim. Yeah, we don't have a claim, so I don't know if that's, but we don't have a claim for this data service.
[CUSTOMER][NEUTRAL] Question, do you guys like check numbers or anything come in like TZ that's not yours?
[AGENT][NEUTRAL] No, no, that's not us.
[CUSTOMER][NEUTRAL] OK, or EQ?
[AGENT][NEUTRAL] Uh uh.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][POSITIVE] The claim number. OK. OK, perfect. Well, not even gonna bother. Well, thank you so much for your time.
[AGENT][NEUTRAL] So if you're gonna be, well, that's OK if you're gonna, well, you're welcome and you know, there's no timely filing with APL so if you're gonna be filing the claim with us, just make sure um to include a copy of the primary insurance company's explanation of benefits because we will have to have that as well.
[AGENT][NEUTRAL] And then once we have.
[CUSTOMER][NEUTRAL] That you'll be with it, OK.
[AGENT][NEUTRAL] Uh-huh, we do have to have a copy of the primary insurance explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And then once we have processed our claim, [PII], we do have a portal that you should be able to check claim status in for us and our website for that.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] I secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me put that in.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Well, is there anything else I could help you with?
[CUSTOMER][NEUTRAL] OK, and let me just make sure we got your billing.
[AGENT][NEUTRAL] Address?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let me make sure that we have the OK, so the payer ID number.
[AGENT][NEUTRAL] For the supplemental policy.
[CUSTOMER][NEUTRAL] To submit the claims with you guys is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] OK, 60801 and that's OK. Now for this patient the policy is still active like we can we can submit correct the claims of claims to you guys, right? A secondary with the primary information.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] With the primary EOB along with the claim. Uh-huh.
[CUSTOMER][NEUTRAL] OK, um, and.
[CUSTOMER][NEUTRAL] And um lastly, the ID number I verified, was that the correct number? Like that's a, a correct number?
[AGENT][NEUTRAL] 2131561. Yes, that is the policy number with APL. Yes, ma'am.
[CUSTOMER][NEUTRAL] 1561.
[CUSTOMER][POSITIVE] OK, I'll let them know you guys don't have any claims on file, but thank you so much for your time. I appreciate that.
[AGENT][POSITIVE] Oh, well, you're welcome, [PII]. So is there anything else that I could help you with today?
[AGENT][NEUTRAL] The moment.
[CUSTOMER][POSITIVE] Nope, that is it. Nope, that's it. Thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome so it's my pleasure in helping you today and thank you for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you