AccountId: 011433970860
ContactId: 1b77300e-9baa-4d42-82af-74cfe8091b74
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1214050 ms
Total Talk Time (AGENT): 327167 ms
Total Talk Time (CUSTOMER): 204857 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/2025/05/09/1b77300e-9baa-4d42-82af-74cfe8091b74_20250509T20:38_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Uh hello, this is [PII] calling from Pre office to check on a claim.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim. Can I please get your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Sure. The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. Patient's first name is [PII]. Last name is [PII]. Date of birth is [PII]. And the policy number is 0250.
[CUSTOMER][NEUTRAL] 7709 M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then um what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII], with the amount of
[CUSTOMER][NEUTRAL] Uh, $50 even.
[AGENT][NEUTRAL] OK, and what are the charges after the primary insurance paid?
[CUSTOMER][NEUTRAL] Uh, it's $50.
[AGENT][NEUTRAL] OK, what were the charges before the primary paid?
[CUSTOMER][NEUTRAL] Uh, it is $326.
[AGENT][NEUTRAL] OK, and the name of the facility, please?
[CUSTOMER][NEUTRAL] It is Caincare.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, [PII], while I look up this claim and I'll be right back sir.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII], could that claim possibly be under a different name?
[CUSTOMER][NEUTRAL] Uh, like the, uh, facility name?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, it is MD Non Medical Center.
[AGENT][POSITIVE] OK good I think I found it.
[AGENT][NEUTRAL] Alright, let's see, 30869. It's gonna be give me just one more second, get the rest of the information.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I have the claim information ready for you. The claim number is 357.
[AGENT][NEUTRAL] 05.
[AGENT][NEUTRAL] 91.
[AGENT][NEUTRAL] The claim was paid $50.
[AGENT][NEUTRAL] With check number 203.
[AGENT][NEUTRAL] 086 9.
[AGENT][NEUTRAL] And the check did clear the bank on [PII].
[CUSTOMER][NEUTRAL] OK. Got it.
[CUSTOMER][NEUTRAL] Just a second. It's a single payment?
[AGENT][NEUTRAL] Yes, a single payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Uh, cleared on [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] OK. May I have the claim receipt date?
[AGENT][NEUTRAL] Yes, let me go over to that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] May, may I have the pay to address for this?
[AGENT][NEUTRAL] Yes sir, let me look up that check real quick.
[AGENT][NEUTRAL] It went to [PII].
[CUSTOMER][NEUTRAL] Yeah, I got it. Yeah, I do have 2 more claims to check. Could you have also.
[AGENT][NEUTRAL] Yes, is it for the same member or a different one?
[CUSTOMER][NEUTRAL] A different one.
[AGENT][NEUTRAL] OK, what's the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number is 2, 02188916.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, number 8. 1st name is [PII], last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull that one up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then what is the data service for this one and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, data services.
[CUSTOMER][NEUTRAL] 26 2025 with the bill amount of $340.
[AGENT][NEUTRAL] OK. And then the charges after the primary?
[CUSTOMER][NEUTRAL] Uh, $50.
[AGENT][NEUTRAL] OK, and is it for the same facility MD now?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, alright, brief hold again. I'm gonna look this one up. I'll be right back with you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEGATIVE] No. Nope, that's wrong. Go over here.
[AGENT][NEUTRAL] $50.
[AGENT][NEUTRAL] 357.
[AGENT][NEUTRAL] 0292.
[AGENT][NEUTRAL] 203-054-0.
[AGENT][NEUTRAL] 3 1425.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you, [PII], for holding for me. I've got this one ready for you now too. Uh, the claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 357-0292.
[AGENT][NEUTRAL] The claim was paid $50.
[AGENT][NEUTRAL] With check number 203-0540.
[AGENT][NEUTRAL] And the check cleared the bank on [PII].
[AGENT][NEUTRAL] And a single check.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Uh, yeah. May I have the claim number once again?
[AGENT][NEUTRAL] Yes, that is 357.
[AGENT][NEUTRAL] 0292.
[CUSTOMER][NEUTRAL] OK. Yeah, the checking number is 2,030,540. Is that correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, I got it. Yeah, I do have one last thing to check.
[AGENT][NEUTRAL] OK. And what is the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, uh,
[CUSTOMER][NEUTRAL] Like I have the policy number 19145.
[CUSTOMER][NEUTRAL] And my first name is [PII], last name is.
[CUSTOMER][NEUTRAL] Her [PII] date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what was that um policy number again?
[CUSTOMER][NEUTRAL] Uh, like it's 19145.
[AGENT][NEUTRAL] OK, that doesn't look like a good policy number for our company. Um, and you said the name was [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, that's a very common name. Do you have the social?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what is that please?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what was the middle two digits? I've got [PII]?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII]. Yes, that is correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if I can find her.
[CUSTOMER][NEUTRAL] Like it's a follow-up call, uh.
[CUSTOMER][NEUTRAL] We have sent uh the EOB by fax to you guys. Could you check if you guys received it or not?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and then what is the date of service for this one?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] It is $376.
[AGENT][NEUTRAL] And the charges after primary?
[CUSTOMER][NEUTRAL] Uh, $207.
[AGENT][NEUTRAL] OK, and is it for also for MD now?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK. OK, quick hold. I'm gonna check it for you. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh, that
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you for holding for me, [PII].
[AGENT][NEUTRAL] When did you send in the explanation of benefits for this one?
[CUSTOMER][NEUTRAL] Oh, yes.
[CUSTOMER][NEUTRAL] It was in on [PII].
[AGENT][NEUTRAL] And it was it sent by mail?
[CUSTOMER][NEUTRAL] The facts
[AGENT][NEUTRAL] Facts, OK.
[AGENT][NEUTRAL] Because at this time, um, looking at the claim, the claim number is 354-9292.
[AGENT][NEUTRAL] I showed that it
[AGENT][NEUTRAL] The remark on the claim.
[AGENT][NEUTRAL] It it and let me read the full thing to you.
[AGENT][NEUTRAL] It says benefits are payable only if your medical, your major medical.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The insurance provider provides benefits. If this claim is later paid by your major medical insurance,
[AGENT][NEUTRAL] Please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Yeah, like the, uh, like primary insurance never paid the claim. Uh, that's why the claim, uh, like the balance was sent to the second insured.
[AGENT][NEUTRAL] OK, so the way that our insurance works is the major medical has to pay. If they don't pay, then we don't pay.
[CUSTOMER][NEUTRAL] So is the patient responsibility for this?
[AGENT][NEUTRAL] We can't give patient responsibility we let the provider determine that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, uh, do you guys fax the UV?
[AGENT][NEUTRAL] Yes, I can fax it to you. What's your fax number?
[CUSTOMER][NEUTRAL] Yeah. It is 833.
[AGENT][NEUTRAL] 833 and then what's after that?
[CUSTOMER][NEUTRAL] Yeah, it is 833648.
[CUSTOMER][NEUTRAL] 483 2.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get that fax ready for you, [PII] and I'll be right back.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Ah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII] for holding for me. That fax is on its way to you now.
[CUSTOMER][POSITIVE] Yeah, thank you so much your name and the call reference number?
[AGENT][NEUTRAL] Yes, you can use my name [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] Yeah. Thank you, [PII]. Have a good day. Thank you so much.
[AGENT][POSITIVE] You're welcome. You have a wonderful weekend, [PII].
[AGENT][POSITIVE] Thank you for calling APL.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.