AccountId: 011433970860
ContactId: 18f1f5a7-4bc6-4c77-8ade-c274c3c7382f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1361520 ms
Total Talk Time (AGENT): 398635 ms
Total Talk Time (CUSTOMER): 322079 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/18f1f5a7-4bc6-4c77-8ade-c274c3c7382f_20250528T15:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling on behalf of the provider, checking on claim status.
[AGENT][NEUTRAL] I can help you with claim status. [PII]. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] OK. My callback number is [PII] and my extension is [PII].
[AGENT][NEUTRAL] OK, and do you have the policy number?
[CUSTOMER][NEUTRAL] Yes. Uh, the patient policy number is 02440117.
[AGENT][NEUTRAL] OK, give me just a moment while I look that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK. The patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Uh yes, I have the data service. It is uh 212 of 2025. That is February 12 of 2025.
[AGENT][NEUTRAL] Let me look that up for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the total bill amount?
[CUSTOMER][NEUTRAL] The total charge amount is $698 698 dollars.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment while I look that up, OK?
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][NEUTRAL] And you said it was for $698?
[CUSTOMER][NEUTRAL] $698 yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, it looks like we received that claim. oh, go ahead.
[CUSTOMER][NEUTRAL] Actually, uh
[CUSTOMER][NEUTRAL] Uh yeah, I said to you, I have the 6 claims uh of the same patient with me.
[AGENT][NEUTRAL] You have 6 claims?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, um.
[AGENT][NEUTRAL] We can go through this one first and we'll go by each of them, uh, one at a time. Is that all right?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Right, for this first one.
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] Claim was processed on the same day, [PII].
[AGENT][NEUTRAL] Claim number is 35.
[AGENT][NEUTRAL] 91829.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] It looks like that claim.
[AGENT][NEGATIVE] Was denied.
[AGENT][NEGATIVE] It looks like it was a duplicate.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So let me see if I can find the one that, let me see if I can find the other one, OK?
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, here we go.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me find it.
[CUSTOMER][POSITIVE] OK. Take your time.
[AGENT][NEUTRAL] OK, for the date of service of [PII]?
[AGENT][NEUTRAL] We received that claim on [PII].
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 73949
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that paid?
[AGENT][NEGATIVE] And the claim was denied. It looks like office visits aren't covered by this policy.
[AGENT][NEUTRAL] And we need the insured's primary insurance. It looks like their primary insurance provided full benefits, so there was no benefits payable.
[AGENT][NEUTRAL] For this insurance. Looks like their primary insurance provided full benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, is this based on patient's plan?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] I mean, is this denial based on patient's plan or the provider's contract?
[AGENT][NEGATIVE] It was denied on their plan through us.
[AGENT][NEUTRAL] Uh, their primary insurance, um, their primary insurance paid it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Primary insurance pay the maximum, right?
[AGENT][NEUTRAL] Right, that's what it looks like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it, and now it is patient's responsibility. Is this do?
[AGENT][NEUTRAL] We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] So shall we move to the next one?
[AGENT][NEUTRAL] OK, and what's the next one?
[CUSTOMER][NEUTRAL] OK, before that, can I ask you if you submit any medical records, any regarding information, this will process or not or again it will get denied?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] I mean, if we submit any kind of medical records or submit an appeal, is this process again?
[AGENT][NEUTRAL] Um, yeah, we can go through the process again and check and see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Then can you please provide me the date of service information?
[AGENT][NEUTRAL] For which claim this claim?
[CUSTOMER][NEUTRAL] Uh, yeah, this one, same patient, same provider.
[AGENT][NEUTRAL] OK, I don't have the only one I have is that I can see is [PII]. If you know the claim number or the date of service, I can look it up. Oh, I, I don't know what the date of service is. Do you know what it is?
[CUSTOMER][NEUTRAL] No, no, I will say the date of [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The data of service is [PII] and total charge amount is $580.
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] Claim number 35.
[AGENT][NEUTRAL] 98963.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like it's the same denial reason, um, office visits are not covered and their primary insurance provided full benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then shall we move to the next one?
[AGENT][NEUTRAL] Yeah, what's the next date of service?
[CUSTOMER][NEUTRAL] That is [PII]. And the total charge amount is $320 320 dollars.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] I think same detail.
[AGENT][NEUTRAL] It is the same denial, but let me get you the information for that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, hold on one moment.
[AGENT][NEUTRAL] I think we got the wrong one.
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][NEUTRAL] OK, for this one it looks like we received the claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 8962.
[AGENT][NEGATIVE] And that one was denied because office visits aren't covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then shall we move to the next one?
[AGENT][NEUTRAL] OK, what's the next one?
[CUSTOMER][NEUTRAL] The date of service is [PII]. And the total charge amount is $6830 6830.
[AGENT][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] OK, it looks like.
[AGENT][NEUTRAL] We received that claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] It was processed.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] The claim number is 360.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] 3454.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like that was paid.
[AGENT][NEUTRAL] We paid a total of $407.83.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So full amount paid.
[AGENT][NEUTRAL] Yes, it looks like we paid.
[CUSTOMER][NEUTRAL] Can you please tell me the
[AGENT][NEUTRAL] Oh, it looks like we only paid $407.83 towards that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, can you please tell me the mode of payment details?
[AGENT][NEUTRAL] OK, it looks like it was sent through check.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Check number?
[AGENT][NEUTRAL] 204.
[AGENT][NEUTRAL] 5484.
[AGENT][POSITIVE] The check is outstanding.
[AGENT][NEUTRAL] It looks like there's an issue date.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Issue date is [PII].
[AGENT][NEUTRAL] Right, the issue date is [PII].
[CUSTOMER][NEUTRAL] OK. Is it a bulk amount or single?
[AGENT][NEUTRAL] Single?
[CUSTOMER][NEUTRAL] Single of 407.
[AGENT][NEUTRAL] And 83 cents.
[CUSTOMER][NEUTRAL] OK. Thank you. And uh if it is issued on [PII] today, right?
[AGENT][NEUTRAL] Yes, and it looks like it has not cleared, so no one's cashed the check yet.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] Not cleared.
[CUSTOMER][NEUTRAL] OK. Uh, what is the turnaround time to reach the check?
[AGENT][NEUTRAL] Um, did you want us to reissue the check? You'll have to wait 30 days.
[CUSTOMER][NEUTRAL] 30 days.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, reissue, we will get the check. Is this canceled?
[AGENT][NEUTRAL] Um, it looks like we sent the check on the [PII] to [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So they'll want to look for that.
[CUSTOMER][NEUTRAL] Let me check on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, that is the correct address.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So, shall we move to the next one?
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the next date of service?
[CUSTOMER][NEUTRAL] That is [PII] and total charge amount is $423.
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It looks like we received that claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. Claim number, please.
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 3451.
[AGENT][NEUTRAL] It looks like we paid $60 towards this.
[CUSTOMER][NEUTRAL] OK. And mode of payment?
[AGENT][NEUTRAL] It will also be a check.
[CUSTOMER][NEUTRAL] Check number please.
[AGENT][NEUTRAL] Check number is 204.
[AGENT][NEUTRAL] 5482.
[CUSTOMER][NEUTRAL] Is it uh uh pay today?
[AGENT][NEUTRAL] It looks like the check is outstanding. It's the same as the last check. It was issued on [PII] to [PII].
[AGENT][NEUTRAL] And no one has cashed that check yet.
[AGENT][NEUTRAL] And it's a single payment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Thank you. Then I have one more date of service of this patient that is [PII] and total charge amount is $423.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm not showing a claim for that date of service.
[CUSTOMER][NEUTRAL] Mm, I will say once more that [PII]. Let me check if there is any claim number or something I have.
[CUSTOMER][NEUTRAL] No no claim number.
[AGENT][NEUTRAL] Yeah it looks like we haven't received that yet um did you need the fax number?
[CUSTOMER][NEUTRAL] OK. Let me check that when we have submitted, or we have submitted it on [PII].
[AGENT][NEUTRAL] Did you send it through mail?
[CUSTOMER][NEUTRAL] Mm, let me.
[CUSTOMER][NEUTRAL] Yes, it, it is send it through electronic payment, electronic.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, I'm not seeing it for that date of service um do you want our fax number just in case?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK, it's 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] And whom should I put attention to?
[AGENT][NEUTRAL] Attention claims department.
[CUSTOMER][NEUTRAL] OK. Uh, let me confirm the mailing address. Is that [PII].
[AGENT][NEUTRAL] I
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK. Can you please uh check this patient uh eligibility?
[AGENT][NEUTRAL] Their eligibility, give me just a moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like this policy has an effective date of [PII].
[AGENT][NEUTRAL] And it is currently active.
[CUSTOMER][NEUTRAL] And do you know the termination date?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] I mean, uh policy termination date?
[AGENT][NEUTRAL] Um, it's still active.
[CUSTOMER][NEUTRAL] OK. So, uh, can you please tell me your good name?
[AGENT][NEUTRAL] Um, my name is [PII], last initial [PII]
[CUSTOMER][POSITIVE] OK. And [PII], thank you for your valuable assistance. Can you please provide me the call reference number?
[AGENT][NEUTRAL] So we don't have call reference numbers, but you can use my name and last initial in today's date, so [PII] in today's date.
[CUSTOMER][POSITIVE] OK. So, thank you so much, [PII]. Thank you for your valuable assistance and have a great day.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you, bye bye.
[AGENT][NEUTRAL] Bye.