AccountId: 011433970860
ContactId: 2ea239c7-f505-4014-996e-34ccfc733d3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2799860 ms
Total Talk Time (AGENT): 650226 ms
Total Talk Time (CUSTOMER): 1101703 ms
Interruptions: 20
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/2ea239c7-f505-4014-996e-34ccfc733d3f_20250501T20:07_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for the provider to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So may I know, can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] Sure, I can assist you with calling me Mr. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's [PII]. No extension it's a direct line.
[AGENT][NEUTRAL] That was [PII]. What is the middle numbers?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you. And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] The name of the facility is Sangina Valley Walking Clinic.
[CUSTOMER][NEUTRAL] And um.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, the patient's policy number is 022-06070.
[AGENT][NEUTRAL] OK, thank you. One moment, let me pull this information.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let me, uh, just maybe the last time that we start, I don't know.
[CUSTOMER][NEUTRAL] Like I just say like at this time the two people that I like.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The date of birth will be [PII].
[AGENT][NEUTRAL] OK. Thank you, Mr. [PII]. All right, um, Mr. [PII], this particular policy is managed by Web TPA so I will have to transfer over to Web TPA for claim status. I can give you their number.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] That's going
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you can provide me the the number.
[AGENT][NEUTRAL] OK, the number to web TPA is 18669759458.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] 9759458.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes. Again, that's 18669759458. Do you need me to transfer you over?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, so
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, no, I have more claims with me. Could you please assist me with, assist me with that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, bear with me just a second, let me make a note on this 11 moment.
[CUSTOMER][NEUTRAL] It's a
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] EPA.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, what's the next policy?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's 01673475.
[AGENT][NEUTRAL] 73405
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 475.
[AGENT][NEUTRAL] 475. OK.
[CUSTOMER][NEUTRAL] $100.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the amount will be 120. OK, give me a minute. The amount will be different. The amount will be $280 even.
[AGENT][NEUTRAL] OK, and that's [PII], correct?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] All right, let me see if I can find this claim. For future, you can check claim status online through our website at [PII] and that's just optional. And let me see if this is your claim. One moment, let me pull this EV.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 110415.
[CUSTOMER][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 5259989.
[CUSTOMER][NEUTRAL] Yeah, it is uh it, right? Could you please repeat that?
[AGENT][NEUTRAL] OK, I'm still waiting on the EB. One moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] All right. It looks like we processed the claim on [PII].
[CUSTOMER][NEUTRAL] sure that
[CUSTOMER][NEUTRAL] So it also.
[AGENT][NEUTRAL] And all payable benefits was applied towards the calendar year deductible of the policy.
[CUSTOMER][NEUTRAL] OK, what's the received date of the member uh of the claim?
[AGENT][NEUTRAL] OK, let me get the received date that's not on the it'll be one moment.
[CUSTOMER][NEGATIVE] sorry.
[AGENT][NEUTRAL] OK. It was received on [PII], processed [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah uh.
[CUSTOMER][NEUTRAL] OK, [PII]. OK, bear with me just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] not
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm, and could you please tell me the, what is the annual deductible amount?
[AGENT][NEUTRAL] Mhm. Sure, let me get that for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And before the annual deductible amount, could you please tell me the process amount towards the deductible?
[AGENT][NEUTRAL] The amount that was supplied, uh, let me add this one moment.
[CUSTOMER][NEUTRAL] Yeah I I
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] but it's gonna
[CUSTOMER][NEUTRAL] This.
[AGENT][NEUTRAL] OK. $128.20 was applied towards the deductible.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And on the calendar year deductible amount is 2000.
[CUSTOMER][NEUTRAL] And how much patient me?
[AGENT][NEUTRAL] As of today, one moment, let me see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so as of today for [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah this.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 5
[AGENT][NEUTRAL] $1,863.02.
[CUSTOMER][NEUTRAL] $1,863.
[AGENT][NEUTRAL] In 2 cents.
[CUSTOMER][NEUTRAL] OK. Was it an in-network deductible or out network deductible?
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Was it in network deductible or out network deductible?
[AGENT][NEUTRAL] Oh, this one is not in network or out of network. It's outpatient deductible. We are the secondary. So the outpatient deductible is 2000.
[CUSTOMER][NEUTRAL] I'll tell you.
[CUSTOMER][NEUTRAL] OK. And to which address you guys mailed the copy of your?
[AGENT][NEUTRAL] OK, this was sent to.
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK. And what, could you please verify me the patient's account number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go back to that page, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, that is 1219173, V [PII] in Victor 5499.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And could you please help me with the claim number as well?
[AGENT][NEUTRAL] Yes, that's 3576853.
[CUSTOMER][NEUTRAL] March 219 3.
[CUSTOMER][NEUTRAL] OK. It's 3576853.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And could you please fax me the copy of your?
[AGENT][NEUTRAL] That's the fax number?
[CUSTOMER][NEUTRAL] The fax number is [PII] in attention to the patient's account number.
[AGENT][NEUTRAL] OK, let me repeat this back to you. [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Yeah, I don't mind.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Mr. [PII]. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] OK, and how much time you will receive the copy of your be?
[AGENT][NEUTRAL] A few minutes.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment as.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And could you please uh tell me the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's name.
[CUSTOMER][NEUTRAL] Uh, your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Could you please spell the name once again?
[CUSTOMER][NEUTRAL] I have.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and today's date, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And so the, so I have one more claim with the same member. Should you, uh, could I, uh, should I tell you the date of service?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] The data service is [PII].
[CUSTOMER][NEUTRAL] And the amount, yeah, and the amount is $358 even.
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and it's gonna be the same, um, we apply all benefit amount towards the calendar year deductible.
[CUSTOMER][NEUTRAL] one thing
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And how much was, could you please tell me the claim received date and process date?
[AGENT][NEUTRAL] Mm one moment.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, it was received [PII], process [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] And the amount?
[AGENT][NEUTRAL] Let me get this together one moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] We applied $160.25 towards the deductible.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] OK, and the annual amount will be the same and patient med will be the same?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and it was outpatient, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and could you please tell me to which charges you guys mail the copy of UB.
[AGENT][NEUTRAL] Give me one moment, let me put the image.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so this one was sent to.
[AGENT][NEUTRAL] The same address?
[CUSTOMER][NEUTRAL] OK. And could you please
[CUSTOMER][NEUTRAL] Verify me the patient's account number.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, let me go to that page, one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] That's 121-7958 V as in [PII].
[CUSTOMER][NEUTRAL] And what will be the claim number?
[AGENT][NEUTRAL] 35768662
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] For this one as well, could you please send me the copy of EUB to attention to the patients are.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, I'll send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] OK. And could you please assist with a few more claims I have on file. You, uh,
[AGENT][NEUTRAL] Uh, I'm sorry?
[CUSTOMER][NEUTRAL] So we move to the next one?
[AGENT][NEUTRAL] You say you have, how many more? You, you have a few more claims on the file. How many more do you have?
[CUSTOMER][NEUTRAL] I have a few more claims on the file.
[CUSTOMER][NEUTRAL] If you
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 73457 claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, bear with me just a second. I'll have to send a note out.
[AGENT][NEUTRAL] OK, I have a question, Mr. [PII]. So we don't have uh this long wait in between them. Are you gonna need faxes for all of them or no?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, I don't know. I will need a fax, need a fax of all of them. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I need to check.
[CUSTOMER][NEUTRAL] I don't think so. I need a fax for all of them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so, um, what I'm gonna do, I'm gonna just open them and leave them open, and then in the end I can fax them, but you'll have to give me time to fax them again, OK? Um, so, so we can go a little bit faster because if I have to, uh, pause every time to send in a fax, it takes a little bit longer, OK? So bear with me just a second. Mhm.
[CUSTOMER][NEUTRAL] United.
[CUSTOMER][NEUTRAL] Of course. OK, yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, what's the next policy?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so the next policy ID will be, bear with me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 2500293
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Name will be [PII]. First name will be [PII], and the last name is [PII]. And the date of birth will be [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The rate of service is [PII] and the amount will be $276 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] of
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] It was [PII], correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I don't have that claim on file for this number.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so the claim is not on file.
[AGENT][NEUTRAL] When was it sent?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the claim was sent on [PII].
[AGENT][NEUTRAL] So it may be pending. Let me check the pending claims. One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is a place.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have another one for this one or it's just one?
[CUSTOMER][NEUTRAL] Just one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. Uh, so do you have a claim on file for $276 even?
[AGENT][NEUTRAL] I'm looking for it, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it, it was received on today.
[AGENT][NEUTRAL] So it's in line to be processed.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, you guys received the claim today.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], uh sorry, [PII].
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] And what will be the claim number?
[AGENT][NEUTRAL] No claims received today.
[CUSTOMER][NEUTRAL] So do you have any reference number, ticket number, anything like that?
[AGENT][NEGATIVE] Nothing. Just uh mm mm, we don't have nothing. We just received this today.
[CUSTOMER][NEUTRAL] Which you can give me.
[AGENT][NEUTRAL] So that's the only information I can give you. It was received today. It was imaged into the account today.
[AGENT][NEUTRAL] And then you can use my name in today's date as a reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What will be the normal claim processing time?
[AGENT][NEUTRAL] Up to 14 business days.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 1414.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the turnaround time?
[AGENT][NEUTRAL] That is the turnaround time. It's the same thing as process time.
[CUSTOMER][NEUTRAL] OK, and is there any delay in claim processing? No.
[CUSTOMER][NEUTRAL] You know
[AGENT][NEUTRAL] No, it's, it's just 14 working days.
[CUSTOMER][NEUTRAL] OK. And could you please tell me, do you require any additional information from the patient or the provider?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Do you require any additional information from the patient or the provider?
[AGENT][NEUTRAL] We're not gonna know until it's processed.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so you don't know.
[AGENT][NEUTRAL] No, we're not gonna know until its process. It's not been reviewed yet. It was just received an image, that's all we have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Shall we move to the next claim then?
[AGENT][NEUTRAL] Mhm, yes, go ahead.
[CUSTOMER][NEUTRAL] Yeah, bear with me. My system's thinking, bear with me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, the next member ID is 1554734 M [PII], L as in Lima, 8.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The first name of the member is [PII] and the last name is [PII], and the date of birth will be [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The date of service is.
[CUSTOMER][NEUTRAL] [PII] and the amount will be
[CUSTOMER][NEUTRAL] $278 even.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hey hi my name is [PII].
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] OK, was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Claim was denied. The denial reason is that the service was surrendered after coverage was terminated.
[CUSTOMER][NEUTRAL] And I.
[CUSTOMER][NEUTRAL] So the member is not uh active on the date of service, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, bear with me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So it's [PII]
[CUSTOMER][NEUTRAL] Could you please tell me member's policy effective date and the term date?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] I was expensive.
[AGENT][NEUTRAL] The effective date is on [PII], terminated [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 19. Do you, OK. Do you have any updates on when was the last COB offer updated coordination of benefits?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't, we don't coordinate any benefits, so that's through the major medical only.
[CUSTOMER][NEUTRAL] You'll be
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you see any other bill is listed for this patient?
[AGENT][NEUTRAL] There's no other policies with us.
[CUSTOMER][NEUTRAL] A little
[CUSTOMER][NEUTRAL] And could you please tell me the time you find to submit the corrected claim?
[AGENT][NEUTRAL] No familyly filing.
[CUSTOMER][NEUTRAL] Mailing address to to submit the credited claim.
[AGENT][NEUTRAL] It's the one in [PII], the [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Mhm. [PII] City, [PII].
[CUSTOMER][NEUTRAL] And the zip code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Like check check on.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] And time for him to submit an appeal.
[AGENT][NEUTRAL] The appeal is 180 days from the decision date.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh, 180 days from?
[AGENT][NEUTRAL] From the decision there.
[CUSTOMER][NEUTRAL] Decision day.
[AGENT][NEUTRAL] Yes, so basically from the process date.
[CUSTOMER][NEUTRAL] OK, so you.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I was just thinking what's the decision day.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what, OK, and what will be the mailing address to submit an appeal?
[AGENT][NEUTRAL] The same as the claims.
[CUSTOMER][NEUTRAL] OK, is there any specific form for a nappy?
[AGENT][NEUTRAL] No, just a letter indicating what you're applying the decision.
[CUSTOMER][NEUTRAL] What will be the claim number?
[AGENT][NEUTRAL] OK, that is 358-078-3.
[CUSTOMER][NEUTRAL] It uh.
[CUSTOMER][NEUTRAL] 358-078-3. Am I right?
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] OK. Call reference number will be your name and today's date. OK. Shall we move to the next claim?
[AGENT][NEUTRAL] Yes. Go ahead.
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] It takes time to fetch the details.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the member ID will be [PII]. [PII].
[AGENT][NEUTRAL] OK. Name and date of birth?
[CUSTOMER][NEUTRAL] The member's first name is [PII].
[CUSTOMER][NEUTRAL] And the last name will be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The date of birth will be [PII], [PII].
[AGENT][NEUTRAL] What's the date of birth?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. And what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and the amount will be $300 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No it's [PII], correct?
[CUSTOMER][NEUTRAL] That was
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So we're talking.
[AGENT][NEUTRAL] What was the claim sent to us?
[CUSTOMER][NEUTRAL] What's the
[CUSTOMER][NEUTRAL] The claim was sent to you guys.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] OK, now.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] She's still working.
[CUSTOMER][NEUTRAL] It's 6 months.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm waiting on the system.
[AGENT][NEUTRAL] I'm waiting on the system.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I just.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, so it looks like we processed this claim and send a benefit amount of $50 to the provider.
[CUSTOMER][NEUTRAL] Well I.
[CUSTOMER][NEUTRAL] So the claim has been paid?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. When was the claim received date?
[AGENT][NEUTRAL] OK, that is.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII], process [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And paid
[AGENT][NEUTRAL] You pay $50 which is the maximum for that office visit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, I'm asking about the date.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, same as the process date.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and you guys paid $15 even. Am I right?
[AGENT][NEUTRAL] 50, 50, 50, yes.
[CUSTOMER][NEUTRAL] 5050. OK, sorry for that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there will be no members responsibility because allowed and paid the same.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And what will be
[CUSTOMER][NEUTRAL] How was the payment done via check or EFT?
[AGENT][NEUTRAL] Checks, single checks, paper checks.
[CUSTOMER][NEUTRAL] Number.
[AGENT][NEUTRAL] It's 203-359-9.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please verify me the payment's mailing address for this one?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this one went to [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and could you please help me with the claim number?
[AGENT][NEUTRAL] Sure, that's 357-6964.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] And could you please verify me the payment uh patient's account number?
[AGENT][NEUTRAL] Mhm. Let me go to that page.
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, that's um patients account 497-09, V as in Victor, 23652.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and could you please help me with the payment cash clear date?
[AGENT][NEUTRAL] Oh OK, I'll have to search that, bear with me.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Yeah. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding, um, Mr. [PII]. OK, so the check cleared on [PII].
[CUSTOMER][NEUTRAL] OK, and could you please send me the copy of your, the same fax number which I gave you before and in attention to the patient's account number.
[AGENT][NEUTRAL] OK, I'm gonna hold to this one to the end of the calls, OK?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So, um, let me just put it here. One moment. So I'm just sending this one, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And how much time we will receive the copy of your be? Uh, no, this was, this is the last claim.
[AGENT][NEUTRAL] Alright, so what's the next policy?
[AGENT][NEUTRAL] Once I send it.
[AGENT][NEUTRAL] Oh, that's the last person.
[CUSTOMER][NEUTRAL] This is the last game I have.
[AGENT][NEUTRAL] Oh, OK, um, bear with me.
[CUSTOMER][NEUTRAL] Hi, this is the last person I have.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] and how much time we will receive?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's just usually a few minutes. Um, let me go ahead and try to send it right now. One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, he should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, thank you for helping with me with the claims, and I love the partnership and have a great day.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling APL. bye-bye.
[CUSTOMER][NEUTRAL] Yeah bye bye.
[AGENT][POSITIVE] Nice.