AccountId: 011433970860
ContactId: 296fed19-5573-46b6-9a8b-04494a37bbd9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 678349 ms
Total Talk Time (AGENT): 236530 ms
Total Talk Time (CUSTOMER): 290129 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/296fed19-5573-46b6-9a8b-04494a37bbd9_20250625T20:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider's office for the claims status. Can you please help?
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, I can help you with that, [PII] and what is your callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you and how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] I have up to 2 to 3 claims.
[AGENT][NEUTRAL] You have 2 claims or 3 claims?
[CUSTOMER][NEUTRAL] Uh, 2 claims.
[AGENT][NEUTRAL] Are they for the same patient or different patients?
[CUSTOMER][NEUTRAL] Different member.
[AGENT][NEUTRAL] OK, so [PII] you're gonna use my name that I gave you along with today's date as each call reference number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Also, any information.
[CUSTOMER][NEUTRAL] If you don't mind, can you?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] Yeah. Can you spell that?
[AGENT][NEUTRAL] [PII] I.
[AGENT][NEUTRAL] And also, yes, ma'am, any information that's provided for you on the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][POSITIVE] Got it. Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And lastly, if we do have the claims on file and you need a copy of the explanation of benefits, once I have given you the claim number, you can go to our portal and print them yourself.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And our portal website.
[AGENT][NEUTRAL] Is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and what is the first member's policy number, please?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Allow me a moment, please.
[CUSTOMER][NEUTRAL] Yeah, it is 01829142. M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you one moment please.
[CUSTOMER][NEUTRAL] Um-hum.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] What is your
[CUSTOMER][NEUTRAL] Patient's first name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And the date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] Date of service is [PII] with the billed amount $8,648 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Man
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm, one moment.
[AGENT][NEUTRAL] So this claim was received. It was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 359-6805.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the denial remark states inpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, one moment, please.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] You don't have right.
[CUSTOMER][POSITIVE] Uh hello. I'm so sorry for the delay, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, uh, upon checking on my end, uh, the claim was denied as, uh, explanation of benefits needed. So we have submitted a primary EOB.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am, but there was another claim that was received with all the required documentation that was processed before your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you.
[CUSTOMER][NEUTRAL] Uh, can you, uh, repeat the claim number once again for me?
[AGENT][NEUTRAL] The claim number is 359-6805.
[CUSTOMER][POSITIVE] Got it, ma'am. Thank you.
[AGENT][NEUTRAL] You're welcome. And is there any other information that you need on this number before we move to your next patient?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. One moment.
[CUSTOMER][POSITIVE] Uh, thank you so much for patiently waiting, ma'am. May I know, uh, when did the, uh, patient last met?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It was received prior to your claim from another provider, so I can't provide you any additional information on that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] So you don't have any other information right now?
[AGENT][NEUTRAL] No, I can't provide you any additional information on the other claim that was processed because it's for a different provider.
[CUSTOMER][NEUTRAL] OK. Uh, uh, uh, can I provide you the claim number?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can see the one that was denied needing the primary insurance explanation of benefits, and that claim was reviewed in February.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] That's 3558921.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] When did you receive? Yes, yes.
[AGENT][NEUTRAL] Yes, that claim was that under that claim number, that claim was received [PII] and processed and denied on [PII].
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEGATIVE] And it it is denied as primary will be yeah.
[AGENT][NEUTRAL] With the denial
[AGENT][NEUTRAL] Correct. And then we did not receive the primary EOB?
[AGENT][NEUTRAL] Until
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] But in the meantime, we received another claim with complete information that was processed.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] And that's all of the information, [PII]. I can provide you on that.
[CUSTOMER][NEUTRAL] Uh, may I know how can we submit a primary will be to you?
[AGENT][NEUTRAL] We have already received the primary EOB.
[AGENT][NEUTRAL] Which is on the claim number that I gave you that was denied as the inpatient benefit maximum has been met for this calendar year. That was the first claim number that I gave you.
[CUSTOMER][NEUTRAL] OK, can you please provide the further information?
[AGENT][NEUTRAL] There is no further information?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I've provided you all of the information on both of your claims.
[CUSTOMER][NEUTRAL] OK. Thank you. Uh, one moment.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Can we please move on to the next screen?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, and the next member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 002545829.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Member's first name is [PII] and the last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, so there is something about the, the policy number that you gave me that is not correct, because you said 002545829. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEGATIVE] That is not the correct policy number.
[CUSTOMER][NEUTRAL] Mm let me double check and provide you the information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm. All right. uh.
[CUSTOMER][NEUTRAL] Yeah, I don't have any other information, ma'am. Also, no other claims, so we can wrap up the call.
[AGENT][POSITIVE] OK, well, if that is all that I can help you with today, [PII]. It was my pleasure in speaking to you and thank you for calling APL. I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thank you.