AccountId: 011433970860
ContactId: 1c2583f5-0a96-49cf-81c3-446db1a0e0d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1087160 ms
Total Talk Time (AGENT): 356200 ms
Total Talk Time (CUSTOMER): 437068 ms
Interruptions: 7
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/1c2583f5-0a96-49cf-81c3-446db1a0e0d8_20250204T14:47_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh yeah, very good morning. My name is [PII] and my initial is [PII], and I am calling from provider office. Hello.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Uh, I'm so sorry. You'll have to repeat what you said. There's some background noise where you're located that I was preventing me from understanding what you said.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. My name is [PII] and my initial is [PII].
[AGENT][NEUTRAL] Did you say [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And [PII], how can I help you today?
[CUSTOMER][NEUTRAL] I need your assistant to check the claims.
[AGENT][NEUTRAL] OK, you're needing claim status, is that correct?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Are you needing claim status, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Yeah, 2 claims for same patient, like 2 different data services to the same patient.
[AGENT][NEUTRAL] OK, and I can help you with this. So what is the member's policy number?
[CUSTOMER][NEUTRAL] I have the member policy ID as 1542679 M like Mary.
[CUSTOMER][NEUTRAL] Would you mind spell your name? I hadn't got you clearly.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Would you want to repeat that again? [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. OK. What's your initial?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As in Sierra.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient is [PII] and [PII] is the UOB.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the first date of service and total bill amount for her, [PII]? I mean, [PII], sorry.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, yeah, it's fine. [PII] is the date of service.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm. Total bill amount.
[CUSTOMER][NEUTRAL] And do you need the bill charge amount? mhm for a charge of $1968 even.
[AGENT][NEUTRAL] OK, thank you. Now there is no claim on file for this member under this policy number. This policy was not active for that data service.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me see if she has another policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She does, so let me give you the correct policy number that you should have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Continue.
[AGENT][NEUTRAL] 022 017887.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this policy has an effective date of [PII].
[AGENT][NEUTRAL] So just one moment, just mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] [PII] effective date I got out until now active or uh inactive.
[AGENT][NEUTRAL] It is still active.
[CUSTOMER][NEUTRAL] OK. That's secondary insurance, right?
[AGENT][POSITIVE] This is, that is correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK, and bear with me just a moment while I pull up some additional information up first.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And uh for a quick con OK con first you carry on, then I will ask my consent.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was received and processed under this correct policy number. It was received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 354-462-1.
[AGENT][NEUTRAL] And the reason for the denial state's office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] The supplemental plan, George does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just an office visit, right? Uh, you need an authorization or is there any denial for provider or why it is not covered? Or do you have any particular plan for this, uh, [PII] that doesn't have any office visit coverage? Do you have any specifications for that?
[AGENT][NEUTRAL] With
[AGENT][NEUTRAL] This policy that she has with our company, the supplemental policy does not cover office visits.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Give me a sec.
[CUSTOMER][NEUTRAL] Is there any chance that you can send me the UOB to my fax?
[AGENT][NEUTRAL] Do you have access to the internet, [PII]?
[CUSTOMER][NEUTRAL] Yes, I, I do have go ahead if it is online I can go ahead mhm.
[AGENT][NEUTRAL] OK, so we, mhm.
[AGENT][NEUTRAL] Yes sir, we have a portal that you now that you have the claim number you should be able to print that yourself. Uh, the website you go to for our portal is secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Am [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. Let me load this one sec.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Secure. A alpha [PII], right?
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] And is this website need any logins to get that EOBs?
[AGENT][NEUTRAL] It is a self-registration?
[AGENT][NEUTRAL] You would create your own username and password and then you should be able to access the EOB with that claim number that I gave you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Thank you so much for that information. And one last thing is, uh, can I get the patient policy details for this one in which the office visits are not covered? What's the member plan name?
[AGENT][POSITIVE] You're welcome. You're welcome.
[AGENT][NEUTRAL] Medlink.
[AGENT][NEUTRAL] M E D L I N K.
[CUSTOMER][NEUTRAL] Ned or me.
[AGENT][NEUTRAL] Medin, one word, supplemental.
[CUSTOMER][NEUTRAL] Mhm. OK. Got you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Supplemental meddling. And what's the type within that?
[AGENT][NEUTRAL] I'm sorry, what's the what?
[CUSTOMER][NEUTRAL] Plan type like HMO, PPO, or any other concerns specialization.
[AGENT][NEUTRAL] Neither. None of those, none of those. We're not a major medical insurance company. This is only a supplemental policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, however, uh, it was being told to be a user links or user logins, sir. Can I request you as a courtesy? Would you mind to send this UOB for this one, in the meantime?
[CUSTOMER][NEUTRAL] If possible.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you for calling.
[CUSTOMER][NEUTRAL] No, [PII] for Whiskey I for India.
[CUSTOMER][NEUTRAL] 163962
[AGENT][NEUTRAL] It's still loading this information.
[CUSTOMER][NEUTRAL] Uh, please take your own time.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Does it need to be put to your attention, [PII]?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, once you're done, let me know. I have other concern to be for this.
[AGENT][NEUTRAL] I will.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] and often.
[CUSTOMER][NEUTRAL] 1967.
[AGENT][NEUTRAL] What is your fax number?
[CUSTOMER][NEUTRAL] I'm gonna have the
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 303
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Again, I'm gonna repeat that back. [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that has been sent to you.
[CUSTOMER][NEUTRAL] OK. And the concern is the secondary due for this claim, I have $25 as a patient responsibility from primary. Should I need to bill this to you with the patient or uh should I go with an appeal for the next POA?
[AGENT][NEUTRAL] We do not determine patient responsibility and if you're going to file an appeal it must be filed in writing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Within 180 days from the date of the denial, attention appeals department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Mm OK. Thank you.
[CUSTOMER][NEUTRAL] Uh, but you are strictly cover, uh, strictly concerning about this office visits are not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, give me a second. When can I expect your fax?
[AGENT][NEUTRAL] It's already been sent, so provided that your fax line is able to receive it, you should be receiving it soon. It will only make a certain number of attempts if the line is busy before it will time out and not try to send it again. So at that point, you would just need to print it from the portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK, as I mentioned to you, should I, uh, do I have, uh, like, uh, $25 payment? Can I bill to the patient in the other end?
[AGENT][NEUTRAL] OK, I have explained to you, [PII], we do not determine patient responsibility. That is up to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yeah, I do have that, but in reference to that, I have a query, uh, to ask, OK, uh, confirm the claim number I have taken right around 354-462-1, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[CUSTOMER][NEUTRAL] And is there any call reference to going to the next care service to the same patient?
[AGENT][NEUTRAL] My name and today's date will be your call reference number and I just did receive one, I did receive an error message stating your fax number is busy.
[CUSTOMER][NEUTRAL] I have ability.
[CUSTOMER][NEUTRAL] OK, I think it was been, but uh let me give you a try for the next one sec.
[AGENT][NEUTRAL] What is the next date of service?
[CUSTOMER][NEUTRAL] OK. Shall we move on with the next date of service? Mm thank you.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Next one I have [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yes, yes for a charge of $250 even.
[AGENT][NEUTRAL] Total build amount.
[AGENT][NEUTRAL] 250. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for that. Can you spell your name for me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Can I have the call this number of the differences? Can you please send the Ubi to?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] details.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so this claim was also received.
[CUSTOMER][NEUTRAL] So I
[AGENT][NEUTRAL] [PII] and it was processed and denied on the same date, [PII].
[AGENT][NEUTRAL] The claim number is 353-3932.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the reason for the denial is one of them is the same office visits are not covered by the above numbered policy.
[AGENT][NEGATIVE] And the other two codes were denied because the insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] OK. As for the previous one you got dinner for the office visit and these quotes have been processed, uh, the primary maximum, right?
[AGENT][NEUTRAL] Again, this policy does not cover office visits. That is correct.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And thank you. And this claim number I have 353-3932, right?
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you. And do you mind?
[AGENT][NEUTRAL] 353-393-2
[CUSTOMER][NEUTRAL] Yeah. Thank you, [PII]. Do you mind to send this COB also just for a try since you are having that issues.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] De
[CUSTOMER][NEUTRAL] 2501.
[CUSTOMER][NEUTRAL] 054371.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK, so this EOB has also been faxed to you, but again, uh, if they will not go through via fax, you will need to print them from the portal.
[CUSTOMER][POSITIVE] Thank you. I got that. Uh let me update that from my end also. And [PII], thanks for your assistance. Hope you have a good one. Bye.
[AGENT][POSITIVE] Yes sir, um, yes, if that's all I can help you with.
[CUSTOMER][NEUTRAL] Have you taken this one, the fax number, yeah. Uh, confirm that [PII], right?
[AGENT][NEUTRAL] That is correct. Yes, sir. That's where they have both been faxed to. Mhm.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Thanks. These are the details that this has been. Thanks, bye.
[AGENT][POSITIVE] OK. Well, you're very welcome and again, thank you for calling APL [PII]. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] You too. Take care. Bye.
[AGENT][POSITIVE] Uh-huh. You're welcome