AccountId: 011433970860
ContactId: 272dc14f-d791-495b-b81b-88c15e6b88ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 683169 ms
Total Talk Time (AGENT): 284625 ms
Total Talk Time (CUSTOMER): 195546 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/272dc14f-d791-495b-b81b-88c15e6b88ab_20250410T17:52_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office and looking on a claim status. Can you help me?
[AGENT][POSITIVE] Sure, 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] Uh, 2 claims.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, the contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, 02559264.
[AGENT][NEUTRAL] Thank you for that, 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] Yeah, it's [PII]. Date of birth, [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 and total bills?
[CUSTOMER][NEUTRAL] It's [PII] for $338 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Integrated dermatology of South Miami.
[AGENT][NEUTRAL] And is it $338 or $383?
[CUSTOMER][NEUTRAL] Sorry, yeah, 383.
[AGENT][NEUTRAL] OK, so I'm sure we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 1183.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $108.49.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you need that check information?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so it was a single check.
[AGENT][NEUTRAL] In the amount of $108.49.
[AGENT][NEUTRAL] Check number 20264, I'm sorry, 2026943.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was issued on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was mailed to [PII].
[CUSTOMER][NEUTRAL] OK. And may I know the cash date?
[AGENT][POSITIVE] Um, so I'm still showing that this check is outstanding, so I can send it over to our representative and have her check on the check. If it has been cleared, uh, we'll provide a copy of the clear check. If it's not, um, we'll go ahead and um get it reissued for you.
[CUSTOMER][NEUTRAL] OK. Actually, can you reissue the check to the, uh, can you mention if the, uh, this check has not been cashed? Can you request to reissue the check to the address which was on the claim form on [PII]?
[CUSTOMER][NEUTRAL] I think that address is different from this address.
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm just waiting for the document to populate here. Hold on one moment.
[CUSTOMER][NEUTRAL] OK, no.
[AGENT][NEUTRAL] OK, so you're saying that it should be.
[AGENT][NEUTRAL] Sent to the [PII] because we sent it to the billing address.
[AGENT][NEUTRAL] If you
[CUSTOMER][NEUTRAL] Yeah, actually it's uh
[CUSTOMER][NEUTRAL] To be [PII].
[AGENT][NEUTRAL] OK, so then we'll need to correct the claim and in your billing section, you need to put the address that it needs to go to for billing.
[CUSTOMER][NEUTRAL] Yeah, actually, on the claim on the [PII], it was on the same uh address which was [PII].
[AGENT][NEUTRAL] OK, so there may be another copy because the one we received in that's in [PII], it says [PII] and then it says [PII]. But in [PII], it says our integrated dermatology of South Miami [PII].
[AGENT][NEUTRAL] So if that's in fact not the billing address, we'll just need to correct the claim with the [PII] in the billing address.
[AGENT][NEUTRAL] Box.
[CUSTOMER][NEUTRAL] OK. OK. So, no, before that, uh, can you raise a check whether this one is not cashed or not?
[CUSTOMER][NEUTRAL] Before submitting the corrected claim, we just want to know whether it is cashed or not.
[AGENT][NEUTRAL] So, um, we've already went over that in our system it's showing that it's not, um, it's still outstanding, so it has not been cashed.
[AGENT][NEUTRAL] If you would like, I can send it over to our representative so that she can check on the check, and if it in fact has not been cashed, which is what it's showing in our system, we can go ahead and reissue it, but the problem now is you're saying that the address is incorrect. So you'll need to submit a corrected claim with the correct address for billing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, actually, this address is also, we are getting the payment on this address as well. Uh, but on the safer side, I have, uh, I have just verified that uh this address, which was the alternate address is on file from your end.
[CUSTOMER][NEUTRAL] Now, you can send this claim back for uh review for verifying the guest.
[AGENT][NEUTRAL] So you're saying that it's OK to send it?
[AGENT][NEUTRAL] To the [PII]. OK. So I'll send it to um the representative to go ahead and check on it and reissue if needed. And then did you want to move on to the next one?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, and how many days we need to allow for this one?
[AGENT][NEUTRAL] Um, 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK. And uh is there any specific ticket number or document number?
[AGENT][NEUTRAL] No, there's no um doc or ticket number. The call reference number for the entire call will be my name and today's date, and that's [PII] First initial of my last name is [PII].
[CUSTOMER][NEUTRAL] Call reference your name and today. OK. And shall I provide you the next uh member ID?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, the next member ID is 02507926 ML8.
[AGENT][NEUTRAL] 02507926
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] 02507926 ML 8.
[AGENT][POSITIVE] OK, yes, that's correct. 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] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. 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 date of service and the total bill for this number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] For $410 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And would the provider be the same on this claim or would it be a different provider?
[CUSTOMER][NEUTRAL] Same provider.
[AGENT][NEUTRAL] Alright, so I'm showing received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3555625.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] As for the patient's plan, it's not covered?
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] Right, not covered
[CUSTOMER][NEUTRAL] And it's a patient responsibility.
[AGENT][NEUTRAL] So we don't determine the patient responsibility because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Can you fax me the EOB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and did you need the explanation of benefits for the other claim also or just this one here?
[CUSTOMER][NEUTRAL] No, both the claims. Thank you for asking.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're welcome. Well, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, that's all, [PII]. So call reference will be your name and today's date, [PII] and today's date.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information you provided me on this.
[AGENT][POSITIVE] You're very welcome.
[AGENT][POSITIVE] You're welcome, [PII]. Well, thanks for calling APL and I hope you have a great day as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You too as well. Thank you. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.