AccountId: 011433970860
ContactId: 1ec96b7c-b019-448d-ad49-025c38c9fbba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1776579 ms
Total Talk Time (AGENT): 296980 ms
Total Talk Time (CUSTOMER): 419246 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/1ec96b7c-b019-448d-ad49-025c38c9fbba_20250402T14:46_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII] calling from provider's office to check up on a claim status. Also, this call has been recorded for quality assurance sharing purposes. Are you OK with that?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your name was
[CUSTOMER][NEUTRAL] It's [PII], spelled as [PII]. Initial to my last name would be [PII].
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] And I can help you. You say claim status, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And your call back number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yeah, it would be 02250224.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Member's name would be [PII] No [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] It's [PII], total charge $905 even.
[AGENT][NEUTRAL] Uh, looks like we received that 324 25.
[AGENT][NEUTRAL] Process 3 25 25.
[AGENT][NEUTRAL] And that was
[AGENT][NEUTRAL] Uh, service is not covered when performed in doctor's office or clinic.
[CUSTOMER][NEUTRAL] Uh, can you just explain me that like.
[AGENT][NEUTRAL] It's not a covered service.
[CUSTOMER][NEUTRAL] What's the exact denial.
[CUSTOMER][NEUTRAL] Uh, why is the dinner is not covered?
[AGENT][NEUTRAL] Because of the place of service.
[CUSTOMER][NEUTRAL] Because of the place of service.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEGATIVE] But we have received payment for another date of service.
[CUSTOMER][NEUTRAL] And there is also the same place of service.
[AGENT][NEUTRAL] Uh, so the
[CUSTOMER][NEUTRAL] Which is [PII].
[AGENT][NEUTRAL] For the same patient?
[CUSTOMER][NEUTRAL] Yeah, for this patient.
[AGENT][NEUTRAL] For what day of service?
[CUSTOMER][NEUTRAL] It was actually from [PII], uh, [PII].
[AGENT][NEUTRAL] And it was the same CPT code?
[CUSTOMER][NEUTRAL] Mm yes 76,830.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] You are
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] You are at home.
[AGENT][NEUTRAL] OK, I don't know why something was paid in the past, but according to the policy currently, treatment in the doctor's office is not covered.
[CUSTOMER][NEUTRAL] Uh, OK, just give me a moment.
[CUSTOMER][NEUTRAL] You want to say it is denied as non-covered as per members current plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, sure, no problem. Uh, can you help me with the claim number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 358-036-1.
[CUSTOMER][NEUTRAL] Thank you. Can we move to the next number?
[AGENT][NEUTRAL] Sure. How many claims do you have?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh, yeah, just give me a moment.
[CUSTOMER][POSITIVE] Anyway, I got my people.
[CUSTOMER][NEUTRAL] 7 more claims.
[AGENT][NEUTRAL] OK, do you have access to the Internet?
[CUSTOMER][NEUTRAL] Uh yeah.
[AGENT][NEUTRAL] OK, have, have you, were, are you able to get onto our portal because you can pull EOBs and immediately.
[CUSTOMER][NEUTRAL] Yeah I have tried on that but I didn't found any that's why I'm calling for the claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and the policy ID of the next patient?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] It would be 02.
[CUSTOMER][NEUTRAL] 3 consecutive 4.
[CUSTOMER][NEUTRAL] 753.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima. 8.
[AGENT][NEUTRAL] The patient name and date of birth?
[CUSTOMER][NEUTRAL] Members's name.
[CUSTOMER][NEUTRAL] Is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And date of service?
[CUSTOMER][NEUTRAL] It's [PII] total charge $500 even.
[AGENT][NEUTRAL] Uh, it looks like we made a payment of $150.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When it was?
[AGENT][NEUTRAL] And that was.
[AGENT][NEUTRAL] No it was received 8-16-2024 paid 821-2024.
[CUSTOMER][NEUTRAL] Can you just help me with the pay to address?
[CUSTOMER][NEUTRAL] On which address you have made the payment?
[AGENT][NEUTRAL] Uh yes uh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, that's the correct address actually.
[CUSTOMER][NEUTRAL] Um, actually we didn't receive any payment that's why I'm asking for this. Uh, can you, uh, if possible, can you send me the paid EOB?
[AGENT][NEUTRAL] Yes, to what's your fax number?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Thank you. Yeah, it's [PII].
[CUSTOMER][NEUTRAL] And please give attention to my name [PII]. Last name initial [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How much time it will take to get this?
[AGENT][NEUTRAL] Uh, I'll fax it after I'm off the call.
[AGENT][NEUTRAL] So that after after we get done with the all of the claim statuses just about 5 minutes.
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you help me with the claim number for this one as well?
[AGENT][NEUTRAL] 349-5141.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Can we move to the next member?
[AGENT][NEUTRAL] OK, and the number?
[CUSTOMER][NEUTRAL] It would be.
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 19355
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And date of service?
[CUSTOMER][NEUTRAL] It's [PII] total charge $500 even.
[AGENT][NEUTRAL] Uh, this 71-2024.
[AGENT][NEGATIVE] And that was denied.
[AGENT][NEUTRAL] 78 [PII].
[AGENT][NEUTRAL] Yeah, that was for.
[AGENT][NEUTRAL] We need a primary explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah, actually we have submitted that on [PII].
[AGENT][NEUTRAL] Um, I don't show we have it on file.
[AGENT][NEUTRAL] Oh wait, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You said it was for [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh looks like we made a payment of 28691.
[AGENT][NEUTRAL] And that was on.
[AGENT][NEUTRAL] 1216 24.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We have check number
[AGENT][NEUTRAL] Uh, check number is 2018614.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you send me the PD before this one as well?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Also help me with the claim number.
[AGENT][NEUTRAL] 3541181.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can we move to the next member if you're ready?
[AGENT][NEUTRAL] Yes, the number?
[CUSTOMER][NEUTRAL] Yeah, it's 023.
[CUSTOMER][NEUTRAL] 371-38 [PII] [PII].
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And date of service?
[CUSTOMER][NEUTRAL] [PII] total charge $500 even.
[AGENT][NEUTRAL] OK, looks like that one.
[AGENT][NEUTRAL] Yeah, we received that on.
[AGENT][NEUTRAL] 3 1425.
[AGENT][NEUTRAL] And that was denied on 3-19-25.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it looks like insurance insured's primary insurance provided full benefits, therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] Uh, can you just, uh, repeat that?
[AGENT][NEUTRAL] The insured's primary insurance provided full benefits.
[AGENT][NEGATIVE] There are no benefits payable.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Do you have primary insurance EOB?
[AGENT][NEUTRAL] Yeah, do you need me to pull it up or?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What was your question?
[CUSTOMER][NEUTRAL] Actually there is actually a patient's responsibility for $75.
[CUSTOMER][NEUTRAL] Which is processed by the primary insurance.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Who's
[AGENT][NEUTRAL] Um, it says the policy benefits for the listed dates of service have been paid directly to the provider of service.
[CUSTOMER][NEUTRAL] No, my actual question is primary insurance have already processed the claim and paid for $213 something and they have processed $75 towards patients responsibility as members copay.
[AGENT][NEUTRAL] So it looks like we paid on 319-2025 $75.
[CUSTOMER][NEUTRAL] You have paid.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, $319 for $75. Do you have payment details with you?
[AGENT][NEUTRAL] What do you need the check number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, is there any bulk amount or anything?
[AGENT][NEUTRAL] Any what?
[CUSTOMER][NEUTRAL] Bulk amount.
[AGENT][NEUTRAL] It's a single check.
[CUSTOMER][NEUTRAL] OK, can you help me with the claim number?
[AGENT][NEUTRAL] 3577421.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] 3577421
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can we move to the next number?
[AGENT][NEUTRAL] Uh, give me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] It's 0226.
[CUSTOMER][NEUTRAL] 0491 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Ma's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII] total charge $450 even $450.
[AGENT][NEUTRAL] Oh, it was received 5-17-2024, denied [PII] 2024.
[AGENT][NEUTRAL] And that was for.
[AGENT][NEUTRAL] Uh, we need the primary explanation of benefits.
[CUSTOMER][NEUTRAL] We have already submitted that.
[AGENT][NEUTRAL] For on what date?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What was the bill charges?
[CUSTOMER][NEUTRAL] $450 even $450.
[AGENT][NEUTRAL] OK, it was received 12-11-2024, [PII] [PII].
[AGENT][NEUTRAL] $200.56 that's check number 2018533.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, can you also send me the.
[CUSTOMER][NEUTRAL] Paid EO before this one?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you have the next policy number?
[CUSTOMER][NEUTRAL] Yeah, just give me a moment.
[CUSTOMER][NEUTRAL] The next
[CUSTOMER][NEUTRAL] The next policy number would be 017.
[CUSTOMER][NEUTRAL] 416.
[CUSTOMER][NEUTRAL] 06 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] My name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] State of service.
[CUSTOMER][NEUTRAL] Uh, it's [PII] total charge $450 even $450.
[AGENT][NEUTRAL] No, you see 1211 2024, 1216 2024.
[AGENT][NEUTRAL] Payment amount was 37138, 2018538.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you send me the PDO before this one as well?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Do you have the next policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 025.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 592
[CUSTOMER][NEUTRAL] 81
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima. 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And date of service?
[CUSTOMER][NEUTRAL] It's [PII]. Total charge $5,0088 even.
[AGENT][NEUTRAL] Uh, claim was received 224-25. It was denied 226-25.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] No benefits for the treatment of conditions other than a sickness or injury as defined by the policy you're covered.
[AGENT][NEUTRAL] So it is not a covered service.
[CUSTOMER][NEGATIVE] Non covered as for members plan.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sure, no problem. Thank you so much. Can you help me with the claim number?
[AGENT][NEUTRAL] Claim number is 356-857-3.
[CUSTOMER][NEUTRAL] And what would be the call reference number?
[AGENT][NEUTRAL] It'll be my name, [PII]. First initial last name [PII].
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for your help.
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you have a great day and I'll get those faxed to you in about 5 minutes. You should receive them.
[CUSTOMER][POSITIVE] OK bye bye take care.
[AGENT][POSITIVE] OK, bye-bye. Thank you. You too.