AccountId: 011433970860
ContactId: 13ea2894-8c22-43d1-9138-b4b5f615970d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406420 ms
Total Talk Time (AGENT): 171974 ms
Total Talk Time (CUSTOMER): 90121 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/13ea2894-8c22-43d1-9138-b4b5f615970d_20250214T13:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] You have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Um, I do have two clients for the same member. Uh, it's for the different data service.
[AGENT][NEUTRAL] OK, yes, [PII], I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII] with no extension.
[AGENT][NEUTRAL] OK, thank you, and [PII], you will use my name that I gave you along with today's date as each of your call reference numbers. Also, any information that I provide for you on the claims will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file, [PII], and you need a copy of the EOB, you may print that from our portal by going to secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your patient's policy number?
[CUSTOMER][NEUTRAL] It's 02449773.
[AGENT][NEUTRAL] 497-73, is that correct? Or the last few numbers? OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is your first date of service for him and total bill amount please?
[CUSTOMER][NEUTRAL] Um, it's for [PII] and total charge is $216 even 216.
[AGENT][POSITIVE] 216. Thank you.
[CUSTOMER][NEUTRAL] And also, uh, my next data service is, uh, the same data service. It's for the different amount. OK, OK, yeah.
[AGENT][NEUTRAL] OK, just
[AGENT][NEUTRAL] OK, so just one moment, we have to do them one at a time, [PII].
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] OK, so [PII], this claim was received.
[AGENT][NEUTRAL] The received date on the claim was [PII]. It was also processed the same date.
[AGENT][NEUTRAL] The claim number is going to be 3553775.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] And the reason for the denial is that we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK. Uh, it is a CO be updated, right? OK.
[AGENT][NEUTRAL] Mhm, we need to have the primary insurance company's explanation of benefits sent.
[CUSTOMER][NEUTRAL] OK. Uh, may I get the time if I give me to this information?
[AGENT][NEGATIVE] There is no timely filing?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] And what is your, mhm.
[CUSTOMER][NEUTRAL] And is there, uh, previously it was uh updated uh from the member. Is there anything?
[AGENT][NEUTRAL] I'm sorry. Is there what?
[CUSTOMER][NEUTRAL] Last name?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, you need the primary insurance information, right? Uh, may I know who is the primary for the member?
[AGENT][NEUTRAL] We need to
[AGENT][NEUTRAL] According to the records for our employer, just one moment while it's loading, it's Aetna.
[CUSTOMER][NEUTRAL] OK, fine. Thank you so much. Um, uh, may I move to the next, uh, bill amount? It's for the same it's for the different bill amount.
[AGENT][POSITIVE] That is correct. You can go ahead.
[CUSTOMER][NEUTRAL] OK. Uh, it's $362 even, $362.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, for 362, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, there is no claim on file for the member for that data service and build out.
[CUSTOMER][NEUTRAL] Um, it's $407. Do you have that?
[AGENT][NEUTRAL] You get
[AGENT][NEUTRAL] You gave me 362.
[CUSTOMER][NEUTRAL] Um, just a moment. I'll check it.
[AGENT][NEUTRAL] Which one is the
[CUSTOMER][NEUTRAL] It's $407 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That was received on [PII], processed and denied on [PII].
[AGENT][NEUTRAL] The claim number for this claim is going to be 3553769.
[AGENT][NEUTRAL] This claim was also denied?
[AGENT][NEUTRAL] And one moment.
[AGENT][NEUTRAL] Uh, there are 2 denial remarks on this particular claim. One of them is office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] And the other one is that we need the primary insurance company's explanation of benefits.
[CUSTOMER][POSITIVE] OK, fine. Thank you so much. Can I get your name one more time?
[AGENT][NEUTRAL] You will.
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][NEUTRAL] OK. The code reference number is your name and today's date. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK. Thanks very much. Have a good day. Bye-bye.
[AGENT][POSITIVE] You're very welcome, [PII], and thank you again for calling APL. I hope you have a nice day as well.