AccountId: 011433970860
ContactId: 245bb301-9796-42f2-b614-c1ee1e8f82cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1604540 ms
Total Talk Time (AGENT): 564987 ms
Total Talk Time (CUSTOMER): 279417 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/245bb301-9796-42f2-b614-c1ee1e8f82cc_20250106T14:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, hi, my name is [PII] calling from the office to check on claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Oh my God.
[CUSTOMER][NEUTRAL] To 6 claims.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] It's 02446.
[CUSTOMER][NEUTRAL] 653 8.
[AGENT][NEUTRAL] 024466538.
[CUSTOMER][NEUTRAL] No, it's 02446538.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And the date of birth is uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Does this number have multiple dates of service or just one?
[CUSTOMER][NEUTRAL] Uh, sorry.
[AGENT][NEUTRAL] Do you have multiple dates of service for this member or just one date of service?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEGATIVE] And the total charge is $802 even.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So $802.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's uh you, you're asking the rendering provider, right?
[AGENT][NEUTRAL] Yes, the provider's name.
[AGENT][NEUTRAL] The facility?
[CUSTOMER][POSITIVE] It's uh Mandy.
[CUSTOMER][NEUTRAL] Oh yeah, the facility name is MUSC physicians.
[AGENT][NEUTRAL] OK, so we only have one claim for this data service, but it's a different total bill and provider, so we don't have a claim on file for um [PII] for for this number for you.
[CUSTOMER][NEUTRAL] For the total charge $802 right?
[AGENT][NEUTRAL] Correct. There's no claim on file with that total bill.
[AGENT][NEUTRAL] Or your provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] May I know the patient effective date?
[AGENT][NEUTRAL] Yes, hold on one moment.
[AGENT][NEUTRAL] The policy is still active and has been effective since [PII].
[AGENT][NEUTRAL] I'm sorry. Hold on one moment.
[AGENT][NEUTRAL] Hold on one moment. I didn't switch over.
[AGENT][NEUTRAL] OK, yes, that was correct. It's been active since [PII] and still active.
[CUSTOMER][POSITIVE] Perfect. And may I know the pay ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] Perfect. And may I know the time limit for the submit the claim?
[AGENT][NEUTRAL] Um, so there's no timely filing limit as long as the policy was active on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] OK. And may I know the
[CUSTOMER][NEUTRAL] Mailing address.
[AGENT][NEUTRAL] Mhm. It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the conference number?
[AGENT][NEUTRAL] For the whole call, the call reference number will be my name and today's date, and that's [PII] my [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK. Shall we move on the next claim?
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] I'm ready for the the policy number whenever you are.
[CUSTOMER][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEUTRAL] The policy is 02.
[CUSTOMER][NEUTRAL] 446-531
[CUSTOMER][NEUTRAL] And the patient name is it's [PII].
[AGENT][NEUTRAL] Uh, hold on one moment, let me pull up the policy.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill?
[CUSTOMER][NEUTRAL] It's [PII]. The total charge is $480 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I'm also showing no claim on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] Another patient due date.
[AGENT][NEUTRAL] Yes, hold on one moment.
[AGENT][NEUTRAL] The policy has been active since [PII].
[AGENT][NEUTRAL] And it's still active.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And on the next one.
[AGENT][NEUTRAL] Um, hold on one moment. I'm just noting this policy.
[AGENT][NEUTRAL] OK, and the next one?
[CUSTOMER][NEUTRAL] Yeah, the member is um.
[CUSTOMER][NEUTRAL] 2446538
[AGENT][NEUTRAL] OK, so this is the same as the first one, so there is multiple data service. Is it a different member?
[AGENT][NEUTRAL] Or it's still
[CUSTOMER][NEUTRAL] Oh, yeah.
[AGENT][NEUTRAL] OK, and which member is it for this claim?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I think it's uh before I, yeah, I.
[CUSTOMER][NEUTRAL] Uh, and the patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and the data service.
[CUSTOMER][NEUTRAL] And the date was.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the total charge is $423.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And again, all the information provided is a verification of benefits, not a guarantee of payment. Let me see if this is the total, yeah.
[AGENT][NEUTRAL] You said $423 or $425 for the total bill?
[CUSTOMER][NEUTRAL] $425 even.
[AGENT][NEUTRAL] OK, so I'm showing we receiv[PII] the claim on [PII].
[AGENT][NEUTRAL] Claim number is 354.
[AGENT][NEUTRAL] 2001.
[AGENT][NEUTRAL] And actually, hold on one moment.
[CUSTOMER][NEUTRAL] Could you please tell me the claim number again?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So it looks like the insured submitted this claim, so I actually can't give claim status because the provider didn't submit it.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The insured, the patient.
[AGENT][NEUTRAL] Submitted this claim?
[AGENT][NEUTRAL] So I can't give the claim status because the provider didn't provide the claim, the insured did.
[AGENT][NEUTRAL] But let me see if the explanation of benefits went out to you. Hold on one moment. Usually it doesn't.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on, I, I need you to to work.
[AGENT][NEUTRAL] I'm gonna do this.
[AGENT][NEUTRAL] What is happening?
[AGENT][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] Please work.
[AGENT][POSITIVE] These work.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Come on on base.
[AGENT][NEGATIVE] Oh my god, it's not even opening?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh my God, let me try this one while I'm on the phone.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] saying 6 claims systems.
[AGENT][NEGATIVE] Not flowing.
[AGENT][NEGATIVE] Oh my God, I'm gonna have to close out lying.
[AGENT][NEUTRAL] Oh man.
[AGENT][NEGATIVE] Still ain't no guarantee it's gonna sync with on base.
[AGENT][NEUTRAL] Oh Lord.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] Alright I'm gonna have to wing it. Hello, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So I'm not seeing that an explanation of benefits went out to the provider, um, because the insured submitted the claim. So you can touch back with the insured on the decision of the claim they submitted.
[CUSTOMER][NEUTRAL] Uh, I don't understand that and, and.
[AGENT][NEUTRAL] I didn't give a reason, I didn't give a decision. The claim was submitted by the insured, so we can only give you the claim status for the claims that you submitted as the provider. We can't give you another claim status. So since the insured submitted it first, you can, you would have to reach out to the insured to see what the decision is because we cannot give that to you over the phone, you're not the insured.
[CUSTOMER][NEUTRAL] Uh, the claim was denied.
[AGENT][NEUTRAL] I did not give a decision. The insured submitted the claim.
[AGENT][NEUTRAL] So I cannot give you the claim status because you are the provider.
[CUSTOMER][NEUTRAL] Or we need to
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] So we need to submit the claim.
[AGENT][NEUTRAL] You can either submit a claim for processing a decision or you can reach out to the insured to see what the decision was for their claim.
[CUSTOMER][NEUTRAL] Yeah, uh, so you said you said that, uh, there is no claim on file or we need to resubmit the claim again.
[AGENT][NEUTRAL] OK, so there is a claim on file. It was the insured, the patient filed the claim, so it's the patient's claim.
[AGENT][NEUTRAL] We cannot give you claim status because you're the provider. So you can submit a claim as the provider and receive a decision or you can contact the insured and see what the decision was on the claim that they submitted.
[CUSTOMER][NEUTRAL] Yeah, uh, uh.
[CUSTOMER][NEUTRAL] Uh, do you have any contact number for this? Or we need to call, contact the patient?
[AGENT][NEUTRAL] The patient's information should be in your file.
[CUSTOMER][NEUTRAL] OK. OK. Shall we move on the next claim?
[AGENT][NEUTRAL] Hold on one moment, I'm noting this account. Hold on 1 2nd.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] It's 02446538.
[AGENT][NEUTRAL] OK, so how many claims do you have for the 6538 because I can stay in there, this is, I can stay in their policy. I don't have to keep exiting.
[CUSTOMER][NEUTRAL] I think.
[AGENT][NEUTRAL] Is it the same member one or um [PII] or [PII]?
[AGENT][NEUTRAL] Or it's a different member on their policy.
[CUSTOMER][NEUTRAL] Uh, but the patient names.
[CUSTOMER][NEUTRAL] Um, but it's a patient name is different.
[AGENT][NEUTRAL] OK, what's that patient's name?
[CUSTOMER][NEUTRAL] A.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill for her claim?
[CUSTOMER][NEUTRAL] [PII] and the total charge is $503 even.
[AGENT][NEUTRAL] OK, hold on one moment. Again, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[AGENT][NEUTRAL] 503.
[AGENT][NEUTRAL] OK, and [PII], may I place you on a brief hold. We received a few claims for this day. I just have to figure out which one is yours.
[AGENT][NEUTRAL] Hold on one moment, OK? Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] September 611266. Is there any other one?
[AGENT][NEUTRAL] 264.
[AGENT][NEUTRAL] 2504264.
[AGENT][NEUTRAL] Anything else? No, that's it.
[AGENT][NEUTRAL] Oh, it's only them 3.
[AGENT][NEUTRAL] 503
[AGENT][NEUTRAL] Please don't all be 503. OK, thank you, Lord.
[AGENT][NEUTRAL] Just, oh, that's a dupe so it don't matter, no way. OK, so this 164 is the correct one.
[AGENT][NEUTRAL] Um, and then 343542611 is.
[AGENT][NEUTRAL] The do
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So we received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 350.
[AGENT][NEUTRAL] 42
[AGENT][NEUTRAL] 64
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] As office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Sorry, uh, I'm the reason.
[AGENT][NEUTRAL] So there's a, so there's multiple for this claim for um code 99214. It was denied because office visits are not covered by the policy.
[AGENT][NEUTRAL] For code 99393 and 99173.
[AGENT][NEUTRAL] The claim was denied.
[AGENT][NEUTRAL] Because the policy provides no benefits for the treatment of conditions other than a sickness or injury as defined by the policy.
[CUSTOMER][NEUTRAL] Bro.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK, may I know the uh patient plan type?
[AGENT][NEUTRAL] This is their meddling supplemental gap insurance policy?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] May I know the plan type
[AGENT][NEUTRAL] It's a Medin supplemental.
[CUSTOMER][NEUTRAL] Uh, it's a some more plan or PPO plan?
[AGENT][NEUTRAL] Neither. It's a it's a gap, it's a gap insurance, it's supplemental, so it's not major, it's secondary.
[CUSTOMER][NEUTRAL] Could you please tell me the date again?
[AGENT][NEUTRAL] OK, so the plan name is Medlink, M E D L I N K.
[AGENT][NEUTRAL] The type of plan that Metlink is is a supplemental gap insurance policy.
[AGENT][NEUTRAL] So it's a secondary insurance. This is not the primary insurance.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Could you please send a copy of your withdrawal fax number?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Uh it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 2174. my name is [PII].
[AGENT][NEUTRAL] And do I need to put attention, [PII]?
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I'll go ahead and fax that over to you and um
[AGENT][NEUTRAL] Was there anything else I could assist with this number?
[CUSTOMER][NEUTRAL] No, um, shall you move on the claim.
[AGENT][NEUTRAL] Is it the same policy number?
[CUSTOMER][NEUTRAL] No, it's a different one.
[AGENT][POSITIVE] OK, yes, I'm ready to, I'm just saving these notes. Yes, I'm ready for the next member.
[CUSTOMER][NEUTRAL] It's 02446557.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] And patient name is.
[CUSTOMER][NEUTRAL] [PII] and the date of birth, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of service and total bill?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] The total charges
[CUSTOMER][NEUTRAL] $222 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And um will it be the same provider?
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] Same facility, same USA physicians.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm shall we receive the claim on [PII]?
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 08
[AGENT][NEUTRAL] 22
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] It's the same plan type.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Could you please send a copy of your with your fax number?
[AGENT][NEUTRAL] Yes, I can see that you'll be copy. Sure, the same fax number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And the last member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's 0
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] 46548
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] And the patient name is uh [PII].
[CUSTOMER][NEUTRAL] And the date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of service and total bills?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEGATIVE] And the total charge is $179 even.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and hold on one moment while I locate the claim for you.
[AGENT][NEUTRAL] Alright, so I'm showing received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 349.
[AGENT][NEUTRAL] 1764.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] The same plan time, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Could you send a copy of your?
[AGENT][POSITIVE] Yes, I can send this one as well.
[AGENT][NEUTRAL] And was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That's it, my end.
[AGENT][POSITIVE] Alright, well, thank you so much for calling.
[CUSTOMER][POSITIVE] And thanks for assisting me. Have a great day.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Yeah, you too, bye.
[AGENT][NEUTRAL] Bye bye.