AccountId: 011433970860
ContactId: 1479cb41-806d-43ee-87a4-2fde9f857fa1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1047858 ms
Total Talk Time (AGENT): 195506 ms
Total Talk Time (CUSTOMER): 544134 ms
Interruptions: 8
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/1479cb41-806d-43ee-87a4-2fde9f857fa1_20250620T14:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, sir. Uh, this is [PII] calling from provider's office to know the claim status. Could you please help me with that?
[AGENT][POSITIVE] Happy to check on a claim for you today, [PII] What is the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the patient policy number I have uh
[CUSTOMER][NEUTRAL] 02473403 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Thank you. And then for documentation, do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Thank you. What is the patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Yeah, the date of service, uh, [PII].
[AGENT][NEUTRAL] Filled them out.
[CUSTOMER][NEUTRAL] $2,444 2444.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] We.
[AGENT][NEUTRAL] This claim was received [PII]. Claim was denied and processed on [PII]. The max benefit for the state of service has already been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] 3569847
[CUSTOMER][NEUTRAL] Mhm. OK. So it is 4 visits or as, uh, metro is 4 visits or else a dollar value?
[AGENT][NEUTRAL] Uh, no, it looks like it was dollar value. The outpatient benefit max for the date was $300 that was already met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm. For the same, uh, date of service is also, uh, it was met, is it?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you provide me the fax through UB?
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] I mean.
[CUSTOMER][NEUTRAL] 888
[CUSTOMER][NEUTRAL] 350
[CUSTOMER][NEUTRAL] 5470.
[AGENT][NEUTRAL] Do we need to mark attention to anybody on that?
[CUSTOMER][NEUTRAL] Uh, Max
[CUSTOMER][NEUTRAL] J as in John, or else you can uh uh put it the same uh American insurance life. May I know how many days it will be taken to uh to get the EOB?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, give it about 5 minutes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Is there anything else I can check on for you?
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Yeah, can you spell your name, please?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] First of last name is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I have more members. Could you provide that to?
[AGENT][NEUTRAL] You have another member that you need to check?
[CUSTOMER][NEUTRAL] Yes. And I need to know, uh, in how many days uh that uh you will be.
[CUSTOMER][NEGATIVE] Restricted after sending the fax.
[AGENT][NEUTRAL] The fax has been sent. It'll take about 5 minutes to get.
[CUSTOMER][NEUTRAL] OK. Only it was sent. It will take 5 minutes to get the fax, is it?
[AGENT][NEUTRAL] Yes, it's already been sent.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] What's the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, ma'am, just a moment.
[CUSTOMER][POSITIVE] I'm apologize for waiting you, uh, just a moment.
[CUSTOMER][NEUTRAL] they have.
[CUSTOMER][NEUTRAL] Yeah, yeah, ma'am. It's um 02566933.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII]'s uh date of birth, uh, [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Data service?
[CUSTOMER][NEUTRAL] Yeah, the date of service [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Filled them out.
[CUSTOMER][NEUTRAL] $1,692 1692.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have a different amount after the primary you paid?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, after the primary paid, uh, 47,750 is done.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Have the balance amount. That is the balance amount of the primary paid. And total charges is $1,692.
[CUSTOMER][NEUTRAL] March or Feb uh, we have sent it. Sorry, ma'am, uh interrupting between.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Claim
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][POSITIVE] Thank you for that. Yeah, OK.
[AGENT][NEUTRAL] Claim is processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of 477.50 in a single check.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] 47,760.
[CUSTOMER][NEUTRAL] 50 or 60, ma'am. 47,750.
[AGENT][NEUTRAL] $477.50 50.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so the allowed amount and the paid amount is the same, $477.50 is it?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh, no patient responsibility and the shingle check. And may I know it is, uh, paid through Ei or check?
[AGENT][NEUTRAL] A single check.
[CUSTOMER][NEUTRAL] OK. May I know the check number?
[AGENT][NEUTRAL] 204-577-5
[CUSTOMER][NEUTRAL] Mhm. May I know the issue date, check issue date?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. When it was clear, may I not cleared it.
[AGENT][POSITIVE] It's not cleared, still shows outstanding.
[CUSTOMER][NEUTRAL] May I know how many days it will be took for clear?
[CUSTOMER][NEUTRAL] Please check.
[AGENT][NEUTRAL] If the check hasn't cleared in 30 days, then we can reissue it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] 3603839
[CUSTOMER][NEUTRAL] Mhm. May I know the last four digits of patient account number? Yes.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] I don't have a patient account number. I just have their policy number.
[CUSTOMER][NEUTRAL] OK. And can you provide me the call reference number?
[AGENT][NEUTRAL] That is my name with today's date.
[CUSTOMER][NEUTRAL] For.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, can you spell your name, please, ma'am?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], first of last insured.
[AGENT][NEUTRAL] T like Tango.
[CUSTOMER][POSITIVE] OK. Thank you so much for valuable information, ma'am. And before going to that, I have one or more 2 members. Could you provide if it is possible?
[AGENT][NEUTRAL] I need to notate this 11 moment.
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Go ahead with the next member ID when you're ready.
[CUSTOMER][NEUTRAL] Yeah, ma'am. Uh I was checking this. Just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm apologize for waiting you, ma'am. Just a moment. Our system is too slow. Wait a moment.
[CUSTOMER][NEUTRAL] Almost it was done. Just a moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, the the, the member ID starts with 008424349.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It doesn't come up as a valid member ID. Do you have their name or social?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah I have the name. Uh, could you please check with the name.
[AGENT][NEUTRAL] The last name?
[CUSTOMER][NEUTRAL] Last name, [PII], sorry, [PII].
[CUSTOMER][NEUTRAL] Give me the, um, apologize for that. Uh, I repeat once again. The last name begins with [PII].
[CUSTOMER][NEUTRAL] [PII]. And the first name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[CUSTOMER][NEUTRAL] They.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Not finding a member's policy under that uh name. Do you have a claim number or anything?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm, OK, just a moment. I was checking, I will check you for that.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] No, ma'am, I don't have one. We have to send, we send a claim on [PII]. Uh, could you please check your rejection bucket if it is possible.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] I don't even see a member's policy, so I would be unable to check a claim without a policy. I'm not seeing a policy under that name.
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Uh, I repeat once again, uh, uh, the member ID, uh, member ID starts with 008424349.
[CUSTOMER][NEUTRAL] Uh, the, the patient, uh, full name with the middle name also I will provide you. The middle name is, uh, after, uh, first name, the middle name, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] That member ID does not pull up anything and I cannot find anything under that name.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK, ma'am, no problem. Uh, can you provide me a clear mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. May I know the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801. OK. Just a moment.
[CUSTOMER][NEUTRAL] So claim not on file, is it? Or else patient are unable to, uh, patient is not, not able to find.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] is it, ma'am?
[AGENT][NEUTRAL] [PII], yes.
[CUSTOMER][NEUTRAL] Uh-huh. OK, may I know the TFL for this number?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Timely filing limit to send the claim.
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] OK, is there an amplifying limit?
[AGENT][NEUTRAL] 180 days.
[CUSTOMER][NEUTRAL] AFL
[CUSTOMER][NEUTRAL] All 80 days from?
[AGENT][NEUTRAL] Decision date.
[CUSTOMER][NEUTRAL] Decision date.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, ma'am. Uh just a moment.
[CUSTOMER][NEUTRAL] OK, ma'am. No problem. Thank you for valuable information, ma'am. So we have to send the claim again, uh, is it? Because uh we have send it on uh [PII] with the total charge amount of $384 but you are saying that uh the patient is unable to pull up. So no problem. I will send again the claim. Is it OK?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you, ma'am. Thank you so much for valuable information. Take care. Bye-bye.
[AGENT][NEUTRAL] Bye bye.