AccountId: 011433970860
ContactId: 2a4d5148-b00b-4041-8d28-b03cd8c0a97c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 813280 ms
Total Talk Time (AGENT): 192275 ms
Total Talk Time (CUSTOMER): 181211 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/2a4d5148-b00b-4041-8d28-b03cd8c0a97c_20250310T16:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for claim status.
[AGENT][NEUTRAL] OK [PII], I can help you with claim status. What is your callback number, sir?
[CUSTOMER][NEUTRAL] That is [PII]. And it's a direct line.
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient's name, [PII]. Date of birth [PII]. Policy number?
[CUSTOMER][NEUTRAL] 02446548
[AGENT][NEUTRAL] OK, I'm gonna put you.
[AGENT][NEUTRAL] Real quick, I'm going to look this up for us.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] All right, all right. Take your time.
[AGENT][NEUTRAL] OK, I have [PII] pulled up and what is the date of service?
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] That is going to be
[CUSTOMER][NEUTRAL] [PII] bill amount on $91 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $28.77.
[AGENT][POSITIVE] Thank you. And what is the name of the facility, please?
[CUSTOMER][NEUTRAL] That is going to be um USC physicians.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII] while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh, come on.
[AGENT][POSITIVE] Thank you for holding for me [PII]. I have the claim for you.
[CUSTOMER][NEUTRAL] Yeah. Yeah.
[AGENT][NEUTRAL] The claim number is 353-771-1.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The claim was received on [PII] and it was processed on [PII] and the claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK, stating that claim was received on [PII], denied on [PII] 5 years, office visits are not covered under the patient's plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, yes, yes. Actually, uh, not covered under the patient plan. Can I have the patient's plan type?
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] Uh, medin is a plan type, right? Can I have the plan name?
[AGENT][NEUTRAL] Medin
[CUSTOMER][NEUTRAL] And plan type was it it's some more PBO like like that.
[AGENT][NEUTRAL] No, there's no PPO.
[AGENT][NEUTRAL] It's a secondary.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] OK, secondary plan.
[CUSTOMER][NEUTRAL] Secondary plan, OK. Thank you. Middling plan name. OK. And um just to make sure the claim number that is 353-7711, right? Seven digits.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thank you. And can you please spell your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can I have the call reference for this, and will you be able to send this copy of then be through fax for me. That will be grateful if you do so.
[AGENT][NEUTRAL] Yes, um, can you please give me your fax number?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me [PII] that fax is on its way to you now and the call reference number is my name plus today's date.
[CUSTOMER][NEUTRAL] OK. Your name and today's date. I, I have one more claim. Shall we go with that next, next patient?
[AGENT][NEUTRAL] Yes, what is the next patient's name?
[AGENT][NEUTRAL] Date of birth and policy number.
[CUSTOMER][NEUTRAL] patients, um,
[CUSTOMER][NEUTRAL] That is [PII]. Date of birth [PII]. And the policy number here I have is 02439237.
[AGENT][NEUTRAL] OK, let me pull that one up real quick.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, I've got [PII] pulled up and what is her data service and charge amount before and after primary?
[CUSTOMER][NEUTRAL] Yes, the date of service here was going to be that uh
[CUSTOMER][NEUTRAL] One more quick second.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um, data service, [PII] and the total bill amount here was going to be, that is $650 even and the primary left $50 towards the secondary.
[AGENT][NEUTRAL] OK, and what is the name of the facility for this one?
[CUSTOMER][NEUTRAL] Yeah, may I see physicians as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, brief hold again [PII], while I look up this claim for us and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me [PII]. So looking on data service of [PII] in the amount of $650 original charge amount and.
[CUSTOMER][POSITIVE] Yes, I'm here for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] $50 for what's left after primary. I do not find a claim on file for that dollar amount.
[CUSTOMER][NEUTRAL] OK. You're stating that there is no claim on file for this bill amount in this case.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And I have one more bill amount for the same patient for the same data as I shall I give it? Can you please double check?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes sir, what is um the charge amount?
[CUSTOMER][NEUTRAL] That is going to be.
[CUSTOMER][NEUTRAL] $363. And in this case, also $50 left towards the secondary.
[AGENT][NEUTRAL] OK, brief hold again [PII]. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. This one is the same situation on data services 731-2024. There's not a claim on file for the dollar amount given.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, that's grateful. Can I have the same mailing address to resubmit the claim?
[AGENT][NEUTRAL] Yes, sir. It's APL claims and that's [PII].
[AGENT][NEUTRAL] And that's going to be [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Thank you. Can I have the payer ready to submit claims?
[AGENT][NEUTRAL] Yes, it's 60801.
[CUSTOMER][POSITIVE] Thank you. And um
[CUSTOMER][NEUTRAL] And can I know the timely filing limit to submit claims?
[AGENT][NEUTRAL] We don't have one.
[CUSTOMER][NEUTRAL] There is no time limit, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, thank you. And the call references your name and today's date. That is [PII]
[AGENT][POSITIVE] Yes, that's right.
[CUSTOMER][POSITIVE] Thank you, [PII] so sweet, uh, for your name on today's date. Thank you. Bye. Great day, take care. Have the week ahead. Bye.
[AGENT][POSITIVE] You have a wonderful week too [PII].
[AGENT][POSITIVE] Thank you for calling the PL bye bye sir.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye-bye. Bye-bye.