AccountId: 011433970860
ContactId: 2e4f9bfa-90a7-4a83-b5e9-8c7996736aee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 601619 ms
Total Talk Time (AGENT): 211631 ms
Total Talk Time (CUSTOMER): 178792 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/2e4f9bfa-90a7-4a83-b5e9-8c7996736aee_20250520T19:28_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], my name is [PII]. I'm calling on behalf of Veritas Health Group, um, in regards to one of your mem a claim for one of your members. Are you able to assist?
[AGENT][NEUTRAL] Sure. Can I get you to spell your name for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have the uh policy number?
[CUSTOMER][NEUTRAL] 01673474
[AGENT][NEUTRAL] I have 01673474.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment while I look that up for you.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, so it's [PII], and it's [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] So yes, um, the, well the day well I'm calling because we sent it but uh we haven't heard anything back from you, but the data service is 26 of 24.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look that up.
[CUSTOMER][NEUTRAL] I actually have 32 other dates as well.
[AGENT][NEUTRAL] OK. What are the others?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII] that's actually have more than that.
[CUSTOMER][NEUTRAL] Um, [PII] or [PII].
[CUSTOMER][NEUTRAL] Those are the 4 dates we're looking at.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me start with the first one. You said [PII], correct?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me see here.
[AGENT][NEUTRAL] OK, for the for this one, that's on the [PII], would you like the claim number?
[CUSTOMER][NEUTRAL] Yes, and is it possible that I can get the ELB faxed to me or emailed?
[CUSTOMER][NEGATIVE] Because we haven't received anything.
[AGENT][POSITIVE] Sure, I can fax them all to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Um, so I, with that being said, I won't need the claim ID.
[AGENT][NEUTRAL] You won't need the claim ID?
[CUSTOMER][NEUTRAL] No ma'am, if we, if you're gonna fax it over I can get it from there.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like for that one we received the claim on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] It looks like that was denied because all payable benefits were applied to the policy deductible.
[AGENT][NEUTRAL] And the insurance, the insured primary insurance, um.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Provided the full benefits, so there was no benefits payable, um.
[AGENT][NEUTRAL] Did you just want me to fax the EOB for all of them, or? I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] So there was a $50 copay.
[CUSTOMER][NEUTRAL] If you, there was a $50 copay that the um primary did not pay.
[CUSTOMER][NEUTRAL] Which will say on the claim to see if you all would pay it for the patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It also looks like for this one.
[AGENT][NEUTRAL] Correct. So it looks like $250 was applied towards the deductible.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so it's still owed as the patient's balance?
[AGENT][NEUTRAL] Right, and then there was one more um denial that just showed that the receipt of reference of this claim is acknowledged. However, in order for us to process this claim further, we need the EOB that matches the claim information. It looks like we got the incorrect EOB for this.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, and it'll say that on the, on what I, uh, faxed you as well.
[CUSTOMER][NEUTRAL] OK, OK, I will wait for that so I could take a look, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that was for 26.
[AGENT][NEUTRAL] And did you want me to fax you the EOB for all of them?
[CUSTOMER][POSITIVE] Yes ma'am, if you have one for all, I would really appreciate it because we don't have anything for either.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, um, I'll, I'll continue to look them up for you. I just wanted to make sure that you did want it for all of them.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Yes ma'am please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the next date of service I have is [PII], correct?
[CUSTOMER][POSITIVE] Yes, yes, ma'am, correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not showing one for [PII].
[AGENT][NEUTRAL] So I can't give you that one.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And we don't do timely filing, so you can still file for that claim.
[CUSTOMER][NEUTRAL] OK, so no claims submitted.
[CUSTOMER][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Do you have a, let me ask you a question, um, do you receive claims electronically?
[AGENT][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] Hm.
[AGENT][POSITIVE] Yes, we can go through fax. You can upload them through an online portal account or you can even send them in through the mail.
[AGENT][POSITIVE] Whichever one is easiest for you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is your payer ID still 00010?
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801 OK I don't know why they had no.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And then um did you want our fax number or uh.
[AGENT][NEUTRAL] The website to get in to get the online account? or do you have that?
[CUSTOMER][NEUTRAL] Um, just your fax nu[PII] would be fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 [PII].
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][NEUTRAL] OK, and the next date of service I have is [PII], and I'm also not showing a claim for that one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And same with the last one, of [PII].
[CUSTOMER][NEUTRAL] OK, so no claims on file for those, but you do have the claim for 26224?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yes, ma'am, and I'll send you that EOB in just a moment.
[CUSTOMER][NEUTRAL] Ok, um, it is.
[CUSTOMER][NEUTRAL] Alright, and I can give you our fax number whenever you're ready.
[AGENT][POSITIVE] All right. Whenever you're ready, I'm ready.
[CUSTOMER][NEUTRAL] Alright, it's gonna be 803.
[CUSTOMER][NEUTRAL] 765.
[CUSTOMER][NEUTRAL] 1732.
[AGENT][NEUTRAL] I have [PII], correct?
[CUSTOMER][POSITIVE] Yes ma'am, that's correct.
[AGENT][NEUTRAL] OK, I'll go ahead and send you that. Um, give me about 5 to 10 minutes to get that sent over. Is there any other thing, anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, no, ma'am, if I could just get a reference ID for this call.
[AGENT][NEUTRAL] OK, we don't do reference numbers, but you can use my name and last initial in today's date. So [PII], the letter [PII], and today's date.
[CUSTOMER][POSITIVE] Alright, thank you, [PII]. You take care and I look forward to those um faxes here soon.
[AGENT][POSITIVE] Great. Thank you so much for calling APL and have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] OK.