AccountId: 011433970860
ContactId: 1cd86d8d-ff8b-4c04-aefb-7be438874cec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 3538129 ms
Total Talk Time (AGENT): 532066 ms
Total Talk Time (CUSTOMER): 818009 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/1cd86d8d-ff8b-4c04-aefb-7be438874cec_20250225T18:01_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good good afternoon. My name is [PII]. My insurance is R as in Romeo. So I would like to check the status of the claim. Would you be able to help me with that?
[AGENT][NEUTRAL] Sure, Ms. [PII], may I have a callback number just in case we get disconnected and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yeah, sure. The facility is mostly clinic as well the callback number. It is [PII]. And uh before that, can I have your names well with the last initial for documentation purpose?
[AGENT][NEUTRAL] Um, sure. Um, how do you spell the name of the clinic? I'm sorry, I didn't get that.
[CUSTOMER][NEUTRAL] No issues. It's Mercy, M as in Mama, E as in Echo, R as in Romeo, C as in Charlie, Y as in Yankee, and clinic, Mercy Clinic.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, thank you. My name is [PII], that's [PII], last initial [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you so much, sir.
[AGENT][NEUTRAL] You're welcome. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure. So it is 02304504.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient's first name is [PII]. Last name is [PII]. As for the date of birth, it's [PII].
[AGENT][NEUTRAL] Thank you, Miss [PII]. OK, um, so it looks like this policy is managed by Web TPA uh for claim status you will have to contact Web TPA. I can go ahead and transfer you over.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, before that, I have a few more clients with me. Can you be able to check me with that?
[AGENT][NEUTRAL] Is it for the same member or different member?
[CUSTOMER][NEUTRAL] It's going to be for the different members.
[AGENT][NEUTRAL] OK, let me go ahead and make a note on this one because I cannot help you with this one. OK, one moment.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] OK, no issue.
[AGENT][NEUTRAL] So you need the phone number for future?
[CUSTOMER][POSITIVE] And uh can I also have the, mm mhm mhm. Yes, I do.
[AGENT][NEUTRAL] It's OK, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9458.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII]. Thank you so much.
[AGENT][NEUTRAL] You're welcome, one moment.
[CUSTOMER][POSITIVE] OK, no issues. Take your time.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and what is the next policy number?
[CUSTOMER][NEUTRAL] Next policy number it is 01742617.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the uh date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The service number [PII] with the bill amount of $210 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] That was [PII], correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, so it looks like this claim was processed twice. The most recent one was a duplicate, and then the original one was processed and pay $125.70.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. And uh may I know uh what was the pay to address?
[AGENT][NEUTRAL] OK bear with me, let me pull that information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment. I'm still waiting for the image to pull up.
[CUSTOMER][POSITIVE] No issues. You can take your time.
[CUSTOMER][NEGATIVE] You lying.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me check and see because it looks like it's been reissued.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] 24 let me see about that one.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Let me do a research on this one. Do you mind holding for me?
[CUSTOMER][POSITIVE] Mhm. OK, no issues. You can take your time. You are on hold.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding, Ms. [PII]. Can you verify the correct address for the payment?
[CUSTOMER][NEUTRAL] Yes, sure, I can. So the correct way to address is uh
[CUSTOMER][NEUTRAL] Give me a moment. OK. It is [PII].
[AGENT][NEUTRAL] Oh, OK. That's totally different from [PII]. Uh, we're gonna need a W9 to change that. We cannot change that address unless we have a W-9.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Actually, uh, for the same patient and the different date of service. I have already faxed the uh 99 form. I think it was uh like uh last uh last week. Can you check that?
[AGENT][NEUTRAL] What is that claim, other claim number?
[CUSTOMER][NEUTRAL] So that takes uh supper.
[CUSTOMER][NEUTRAL] Uh, the claim number. Give me a minute. Uh, let me
[CUSTOMER][NEUTRAL] Go it here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, ma'am. And it's all I'm uh looking for the claim here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] To.
[CUSTOMER][NEUTRAL] Uh, so, actually, I was not able to find out the exact claim, but it is for the same tax ID I can uh confirm that here.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] One moment. I'll have to search for that. Um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me put you on hold again. I'll have to search for that W9 and see if I can find it, OK? One moment.
[CUSTOMER][POSITIVE] OK, no issues.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding, Ms. [PII]. OK, so I went ahead and send the request for this check to be reissued. I don't, I see that it's been voided but it has not been reissued, OK? That's why it took so long. So I went ahead and sent the request for that to be sent to the [PII] address.
[CUSTOMER][NEUTRAL] I, yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. So the address has been updated, right?
[AGENT][NEUTRAL] Correct, yes, we received the update on um the last time [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great. Thank you so much for that update. Uh, so, uh, as the address has been updated, you will send the request for the reissue of check, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. Um, give me a minute.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And uh how long it will take to get processed?
[AGENT][NEUTRAL] 24 to 48 business hours.
[CUSTOMER][POSITIVE] OK. Uh, 24 to 48 business hours. OK. Thank you so much for that and we can uh check the update uh like uh after 7 days, right?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][POSITIVE] Mhm. OK. Thank you so much for that. Give me a minute. Yeah. And uh I do have uh some more clients with me, so would you be able to assist me with that too?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, yes, bear with me, let me finalize this one because I'm still working on some other information that I need to put in, OK?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no issues, sir. You can take your time.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK. Mm.
[AGENT][NEUTRAL] Let me finalize the note.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] How much, how many more uh claims do you have, Miss [PII]?
[CUSTOMER][NEUTRAL] I would have like 8 claims including the next claim which we are going to see.
[AGENT][NEUTRAL] OK, uh, bear with me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No issue. So you can totally take your time.
[CUSTOMER][POSITIVE] No issues.
[AGENT][NEUTRAL] OK, yeah, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And how was your weekend, uh, so?
[AGENT][POSITIVE] It's good, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] Mhm. I'm sorry?
[AGENT][NEUTRAL] What's the next policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] OK. So in the next policy number is 02061534.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Member's name is [PII] and date of birth is [PII].
[AGENT][NEGATIVE] OK, this one is through Web TPA so this one is not with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK great thank you so much then uh.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] What's the next one?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It is 081-863718.
[AGENT][NEUTRAL] Um, that's too many numbers to be one of our policy numbers. That's not our number.
[CUSTOMER][NEUTRAL] It's not a number. Let me check the member's ID card here. Give me a moment.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. I don't have any ID card here, but it shows it's from the um how do you say American Public Life, which is the ID of [PII]. Can you uh check with the patient's name and date of birth?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, what is the spelling of the last name?
[CUSTOMER][NEUTRAL] Uh yes, sure. It is [PII].
[AGENT][NEUTRAL] And what's the spelling of the first name?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, so the first name is [PII]. The first, the last name is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Now, uh uh you said uh before [PII], you said it is [PII], right? No, actually, it is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's [PII].
[CUSTOMER][NEUTRAL] Uh-huh, yeah.
[AGENT][NEUTRAL] OK, so it's [PII]
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's the date of birth.
[CUSTOMER][NEUTRAL] Date of birth, yes. Give me a moment. It is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And what is the day of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service is [PII]. The bill amount is $2,0006 even.
[AGENT][NEUTRAL] And that was [PII].
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so it looks like we processed, we received the claim [PII], processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied, the denial reason is the outpatient maximum for the date of service has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, so, uh, the claim was processed on [PII] or [PII].
[AGENT][NEUTRAL] Um, let me go back to it.
[AGENT][NEUTRAL] It was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and you said it was denied as benefit met maximum, right?
[AGENT][NEUTRAL] Outpatient benefits for the calendar year has been met, so it's maxed out.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Outpatient.
[CUSTOMER][NEUTRAL] For the calendar year, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm. And may I know what is the, um, I mean, uh total uh amount of units can be billed for the outpatient services or the, what is the total benefit for the calendar year?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment because this is a canceled policy, so it'll be a minute to find that information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. No.
[CUSTOMER][POSITIVE] Mhm. OK. Totally fine. You can take your time. No issues.
[AGENT][NEUTRAL] 5000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] 5000. OK, great. And may I know when was the last time the patient has met the uh calendar year outpatient benefit?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] We can now release that information.
[CUSTOMER][NEUTRAL] Mhm. OK, fine. And can I have the claim number?
[AGENT][NEUTRAL] Yes, that's 318.
[CUSTOMER][NEGATIVE] There's a claim which got denied. Mhm.
[AGENT][NEUTRAL] Mhm. 318-330-8.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, great. Thank you so much. And uh so, actually, I don't have any EOB with me. Is there any possibilities that you could fax me the EOB?
[AGENT][NEUTRAL] Uh, yeah, it's gonna be a minute. I'll have to fax it right now. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] 440.
[CUSTOMER][NEUTRAL] [PII] and the attention is my name with my last initial.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] OK what's the next policy number?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, ma'am and it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So the next policy ID is 01792144.
[AGENT][NEUTRAL] Let me have that one more time.
[CUSTOMER][NEUTRAL] Mhm. It is 01792144.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Member's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The service, it is now [PII] with the amount of $129 even.
[AGENT][NEUTRAL] That was in [PII].
[CUSTOMER][POSITIVE] Mhm. Yes, correct.
[AGENT][NEUTRAL] OK, and Miss [PII], you can check claim status online through our website at [PII] just in case for future, OK? Let me see.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Thank you for that information. And I do have tried to pull up the claim status in the uh uh portal since it's our past two years, I was not able to pull up that claim. That's why I made a call.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, we received the claim [PII]. We processed the claim [PII], and the claim was denied stating office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So office visits are not covered as per the policy, right? Mhm.
[AGENT][NEUTRAL] Correct, on the member's plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. And uh
[CUSTOMER][NEUTRAL] Can I have the claim number for this claim as well?
[AGENT][NEUTRAL] 324-6600.
[CUSTOMER][POSITIVE] 324-6600. Great. Thank you so much for that. And uh I would like to request you to fax these claim this claims UB as well.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment, I have to do it right now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] here
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm gonna put you on a brief hold. One moment.
[CUSTOMER][POSITIVE] Mhm. No issues. Take your time. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, uh, what's the next policy number?
[CUSTOMER][NEUTRAL] Yes, uh, give me a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, we have just completed L, right. Yeah. Then, uh, the next policy number is 01792144.
[AGENT][NEUTRAL] It's the same one?
[CUSTOMER][NEUTRAL] No, it's a different mall.
[AGENT][NEUTRAL] Mm, it pulled it, it pulled the same one. What's the date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] That's for [PII] now.
[CUSTOMER][NEUTRAL] Mhm. Uh, the amount, right? $184 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what is the um,
[AGENT][NEUTRAL] Native service.
[CUSTOMER][NEUTRAL] It is service number [PII].
[AGENT][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think it's under the same family, I think so.
[AGENT][NEUTRAL] Yeah, it's the same family. Mhm. One moment.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][POSITIVE] No issues.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, this one was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Denied office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, can you tell me the review and process data again because uh I have gotten deleted here.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] [PII]. Thank you so much for the information. And you said it was denied for the same reason, right? Of visit will not be covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that information and can I also have the claim number?
[AGENT][NEUTRAL] Yes, that is 324-1239.
[CUSTOMER][NEUTRAL] Thank you so much. And uh for the same patient, I do have a different date of service as well. And uh I would like to request you to send the both of these UV through the fax as well.
[AGENT][NEUTRAL] What's the next date of service?
[CUSTOMER][NEUTRAL] The next date of service is [PII].
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] Total charge, it's $129 even.
[CUSTOMER][NEUTRAL] And they got
[AGENT][NEUTRAL] OK, we received this claim [PII], processed [PII].
[AGENT][NEUTRAL] And it was the same denial reason office visits are not covered by the policy.
[AGENT][NEUTRAL] Hello, you still there?
[CUSTOMER][NEUTRAL] Yes, I'm uh there.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm sorry, I was booking the, uh, yeah, my muted. I'm sorry for that. And uh I was uh asking that what is the claim number for this claim?
[AGENT][NEUTRAL] 325-735-1.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] 7351. Great. Thank you so much. And uh for the same uh like uh member ID I do have one more patient with me. Can you uh also help me to check the status for this claim as well?
[AGENT][NEUTRAL] Um, what is the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Member's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 5
[AGENT][NEUTRAL] So you will receive [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] that one.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, this is not in one moment.
[CUSTOMER][POSITIVE] Mhm. No issues. Take your time.
[AGENT][NEUTRAL] yeah
[AGENT][NEUTRAL] What is the date of service again?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] not
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hang on
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEGATIVE] I never go back
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] I want to go down.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So now, this one, yes, it was received and processed on the same date. It was the night office visits are not covered. The claim number is 3257435.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] 7435. Great. Thank you so much. And I would like to request you to send all three UV through the uh fax number uh with the attention of my name with my last initial.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And how many more we got, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh, we have 2 more.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah, I just.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] What's the next policy number.
[CUSTOMER][NEUTRAL] Next policy number it is 02340540.
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] Name [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, this one is Web TPA. What's the next policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Next policy number, yeah, give me a minute. I'm pulling up this here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for your patience and the next um member ID is 932134.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] Name is uh [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] D of service is [PII] with the amount of $217 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] In a in a.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, we received the claim on [PII], processed [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was um process indicating that all payable benefits were applied towards the policy deductible.
[CUSTOMER][NEUTRAL] OK, yeah. And may I know, uh, why it was processed to its deductible? If the deductible has not it been me before the date of service?
[AGENT][NEUTRAL] Yes, the policy has a calendar year deductible of 250 that needs to be met before we process and pay claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. $250 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm. per calendar year. And may I know uh how much was the deductible covered as before the date of service?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Before that date of service, I'm not gonna have that amount because that was an old claim. I can tell you how much we apply from your claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][POSITIVE] OK, no issues. Thank you so much for that information. Can I have the claim number?
[AGENT][NEUTRAL] Sure, that is 3241025.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] 1025. Great. Thank you so much. And I would like to request you to send this claim you as well.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Wait, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For yeah, for today's call, I have got enough information for me. So can I have the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for the information. Actually, I have got enough information for me. Thank you so much and have a great day.
[AGENT][POSITIVE] You as well thank you for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye bye.