AccountId: 011433970860
ContactId: 1c529726-1809-4e67-b47b-80a9ce4b18be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2084219 ms
Total Talk Time (AGENT): 549006 ms
Total Talk Time (CUSTOMER): 398939 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/1c529726-1809-4e67-b47b-80a9ce4b18be_20250218T13:55_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm [PII] calling from provider office to check claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] Uh, just a second, let me check.
[CUSTOMER][NEUTRAL] I have 5 claims.
[AGENT][NEUTRAL] May I have the first member's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, the member ID is 0163 consecutive 961 ML7.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, uh, the patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service or the total and the total bill for the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] D of service uh.
[CUSTOMER][NEUTRAL] Yeah, the date of service is on [PII] and the bill amount is $312 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And so for [PII] for [PII], I'm not showing a claim on file.
[CUSTOMER][NEUTRAL] OK. Let me check.
[CUSTOMER][NEUTRAL] OK, we can resubmit once again.
[AGENT][NEUTRAL] But you know what, hold on one.
[AGENT][NEUTRAL] Hold on one moment because there's actually
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Another policy here. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the policy number that was active on the data service is 2473136.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Under that policy number, there is a claim for [PII]. Um, we received it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is 352-8961.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], I'm sorry, the claim was denied and I'm waiting for the denial reason now. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, kinology, speech, and occupational therapy are not covered benefits under this policy, so it wasn't a covered, um, service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it, uh.
[AGENT][NEUTRAL] OK, and what's the next member's policy number?
[CUSTOMER][NEUTRAL] Mhm. Uh, may I get the call reference on that car?
[AGENT][NEUTRAL] The call reference number for the call reference number for the entire call will be my name and today's date, and that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] But clean, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. And the next member ID is 02413470 ML8.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the date of service is on [PII], and the bill amount is $2180 even.
[AGENT][NEUTRAL] And that's [PII] $2180.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so I'm showing we received this claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 357, I'm sorry, 3548358.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I proceed the next claim num uh next member ID?
[AGENT][NEUTRAL] Um, hold on one moment, I'm noting the policy. I'll let you know as soon as I'm finished.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and this may I get the number, uh, sorry, EOB through fax?
[AGENT][NEUTRAL] Uh, hold on one moment. Let me finish noting this.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] What's a good fax number for you?
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] Uh, the fax number, uh.
[CUSTOMER][NEUTRAL] [PII] and attention is Bonnie [PII]
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] OK, while I'm waiting for the fax to come up, what's the next member's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next
[CUSTOMER][NEUTRAL] 02478718 ML 8.
[AGENT][NEUTRAL] 02478718.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] 18
[CUSTOMER][NEUTRAL] Yeah, 18 ML 8.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yeah, the date of service is on [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The bill amount is $4380 even.
[AGENT][NEUTRAL] Thank you. Hold on one moment. And this is for [PII], correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim number is 352-9240.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider, a total of $211.01.
[AGENT][NEUTRAL] Did you need the checking information?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, so the check, it was a single check in the amount of $211.01. Check number 2013436.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Oh yeah, it was issued on [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it cleared on [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you fax the UOB?
[AGENT][NEUTRAL] Yes, would you like it faxed to the same um fax number as the other client?
[CUSTOMER][NEUTRAL] Yeah. Uh, is there any patient responsibility?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility, um, because we're not the major medical insurance company.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment while I get the um explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] How long it takes to receive?
[AGENT][POSITIVE] Um, I can't really give you a time that you'll receive it. We usually say when faxes are sent to give it at least an hour. If you haven't received it by the end of day today, then you can give us a call back and we'll be more than happy to resend it.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][POSITIVE] I just got the confirmation that the first fax went through successfully, so you should be seeing it shortly.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The next number policy number.
[CUSTOMER][NEUTRAL] 02161356 ML 8.
[AGENT][NEUTRAL] 021 61356.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Oh yeah, 021-61356 ML 8 yeah.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. The patient name is.
[CUSTOMER][NEUTRAL] [PII] and the date of birth is on [PII].
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the
[AGENT][NEUTRAL] Data service and the total bill for the member?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The date of service, [PII] and the amount, $1,149 even.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the um facility on the claim?
[CUSTOMER][NEUTRAL] Yeah, Holy Cross Hospital.
[AGENT][NEUTRAL] Are you needing the original claim or the duplicate?
[CUSTOMER][NEUTRAL] Oh itli?
[AGENT][NEUTRAL] So we received the claim on. We received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is 3456004.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, they have mentioned that claim received on [PII]. Can you check with the duplicate one?
[AGENT][NEUTRAL] Mhm. It was denied as a duplicate. What questions did you have?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, uh, they have mentioned claim received and it's still in processing.
[AGENT][NEUTRAL] Um, so the claim number is 35, the duplicate is 3523051.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We received it on we received it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was denied on [PII] as a duplicate.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But hold on one second. It looks like we received this 3 times. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Go.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you again for holding. So, so we received this claim three times. So the second claim um was received on [PII]. The claim number is 3495214.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] On [PII], we paid out on the claim, a total of $275 to the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need the checking information?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So let's check number 186-9166. It was a single check in the amount of 275.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Check was issued on [PII].
[AGENT][POSITIVE] And this check is still outstanding, so I can send um a message to our representative to check on the check and if needed, we can reissue this as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] And just so that we can, um, by the time we move on to the next one, this note will be completed. Do you mind if I place you on just a brief hold so that I can send this over to the representative?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh no, not there.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, I know.
[AGENT][POSITIVE] Thank you so much for holding. So I've sent the request over to [PII] to check on the check for you. If the check has been cleared, we will provide a copy of the clear check for you. If it's still outstanding, we'll reissue. And what's the next member's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the next member ID is 02281478ML7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that and all the information again provided is a verification of benefits, not a guarantee of payment. May I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Can you change uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the date of service, OK. The date of service, uh, we do have two dates of service on this. One is uh [PII] and the bill amount of $471 even.
[AGENT][NEUTRAL] OK, and the next day of service?
[CUSTOMER][NEUTRAL] And the next one is uh [PII] and the billing amount is $471 a month.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold while I get the claims for you?
[CUSTOMER][NEUTRAL] Sure, I know.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, now wait a minute, go back.
[AGENT][POSITIVE] So that's just right.
[AGENT][NEUTRAL] If how long is what?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, I know.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So both claims were received and processed on the same day, um, which was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They were both processed on [PII]?
[AGENT][NEUTRAL] The [PII] claim.
[CUSTOMER][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII], right?
[AGENT][NEUTRAL] I said [PII]. OK, so [PII], they were both received and [PII], they were both processed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For the [PII].
[AGENT][NEUTRAL] Claim the policy or the claim number is 356-032-5.
[AGENT][NEUTRAL] For [PII].
[AGENT][NEUTRAL] The claim number is 356-032-2.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Both were paid a total of $55 each claim.
[CUSTOMER][NEUTRAL] $5. Uh what was the pay date?
[AGENT][NEUTRAL] Um, hold on one second, let me go back. So for the [PII], it was, well, they're both the same, [PII].
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Did you need the check numbers for either of the claims?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So for [PII], the check number is 2026422.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And for [PII], the um check number is 2026421.
[CUSTOMER][NEUTRAL] Got it. Uh, when was that, uh, check issued?
[AGENT][NEUTRAL] Again, [PII].
[CUSTOMER][NEUTRAL] 25.
[CUSTOMER][NEUTRAL] Got it, um.
[CUSTOMER][NEUTRAL] Uh, may I know the clear date of the check?
[AGENT][NEUTRAL] Um, they were just sent on [PII], so today is the [PII]. It's coming from [PII]. Um, it's still outstanding. You haven't received it yet.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] All right. And the next member's policy number when you're ready? 12345.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, Oklahoma.
[CUSTOMER][NEUTRAL] OK, I do have a last claim. Uh, can I proceed the next claim number, uh sorry, member ID? Yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, uh,
[CUSTOMER][NEUTRAL] The member ID is 1330836ML8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth?
[CUSTOMER][NEUTRAL] It's on [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] D of service is on [PII] and the bill amount is $3,252.75.
[AGENT][NEUTRAL] Alright, [PII] $3,252.75.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I'm sure we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My claim number is 352-228-5.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In October, on [PII], the claim was denied because the outpatient benefit for the calendar year has been used.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I get the claim number once again? I missed it.
[AGENT][NEUTRAL] The claim number is 352-228-5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. And the call reference number will be the same for all the calls, right?
[AGENT][NEUTRAL] Yes, it'll be my name and today's date.
[CUSTOMER][POSITIVE] OK, [PII]. That's it for today. Uh thank you for assisting me. Have a great day.
[AGENT][POSITIVE] You're very welcome and thank you for calling APL. I hope you have a great day as well.
[CUSTOMER][NEUTRAL] Yeah.