AccountId: 011433970860
ContactId: 31892e8d-d8f8-48bf-9bae-c577e7806815
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 867559 ms
Total Talk Time (AGENT): 306959 ms
Total Talk Time (CUSTOMER): 460028 ms
Interruptions: 19
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/31892e8d-d8f8-48bf-9bae-c577e7806815_20250305T14:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, good morning, [PII]. Myself, [PII], and I'm calling from provider office to check the claims.
[AGENT][NEUTRAL] OK [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes, [PII], I can help you with that and what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you and [PII], how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] 11.
[CUSTOMER][NEUTRAL] Two claims.
[AGENT][NEUTRAL] OK, are these claims for this?
[CUSTOMER][NEUTRAL] And the same provider. Sorry?
[AGENT][NEUTRAL] OK, are they for different patients or for the same patients in multiple dates of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, both are different, different data services that different patients.
[AGENT][NEUTRAL] OK, so, OK, so [PII], you will use my name that I gave you along with today's date as your call reference number for each one.
[CUSTOMER][NEUTRAL] OK right.
[AGENT][NEUTRAL] Also, any information that I provide for you today will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of the explanation of benefits, you may print those by going to our portal and our portal website is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Can you spell your name?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] And I.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] And what is your first patient's policy number please?
[CUSTOMER][NEUTRAL] Before doing that, can I request you to please let me have your last name initial? I got your name as [PII].
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] That is correct. And what is yours? S [PII].
[CUSTOMER][NEGATIVE] [PII].
[CUSTOMER][NEUTRAL] My, OK, myself, uh, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You need the first policy details, right?
[AGENT][NEUTRAL] The first, yes, policy number for your first patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Number ID I have 24,824,480.
[AGENT][POSITIVE] That's a great number. There's another number on the ID card.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] 95
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1.
[CUSTOMER][POSITIVE] Yeah I can.
[CUSTOMER][NEUTRAL] Do you want to do a name search since I found that's the ID I have.
[AGENT][NEUTRAL] So you do not have a copy of the ID card?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I do think, but it's not found up as of now.
[CUSTOMER][NEUTRAL] That's why I'm requesting you to please do a name search.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What is the last name of your patient?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Policy last I have [PII] India Golf Uniform [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] First one I have I am [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Delivery EKG with the L.
[AGENT][NEUTRAL] So you said that you do not have the ID card, is that correct?
[CUSTOMER][NEUTRAL] Yes. A [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII] and date of birth [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] last year.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] And any information that I do provide as I stated before, [PII], will be a verification of benefits and not a guarantee of payment. What is the patient's name again, full name and date of birth?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh date of birth is [PII]. Full name, I have [PII]
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] $82.
[CUSTOMER][NEUTRAL] [PII] and the bill amount $50.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Before that, uh, can I request you to please help me out with the policy ID?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] 258-022-1.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Thank you. I have a date of service [PII].
[AGENT][NEUTRAL] Uh-huh, total of, excuse me, total bill amount, please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] $114 even 114.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Or can I have number plan?
[CUSTOMER][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you did say 122 of 2025, is that correct?
[CUSTOMER][NEUTRAL] 92.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so just one moment please.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] 25016184033233.
[AGENT][NEUTRAL] OK, so this claim was received. The received date on this claim was [PII].
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 356-477-2.
[CUSTOMER][NEUTRAL] different.
[AGENT][NEUTRAL] And the reason for the denial is that office visits are not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] You mean general office visit uh coverage is not on this policy?
[AGENT][NEUTRAL] That is correct under the member's plan, office visits are not covered.
[CUSTOMER][NEUTRAL] OK, may I request you to please explain me about the member plan. What's the plan name, plan type?
[AGENT][NEUTRAL] This is a supplemental policy and the name of the plan is Medlink.
[CUSTOMER][NEUTRAL] 51289.
[AGENT][NEUTRAL] that
[CUSTOMER][NEUTRAL] supplemental med policy, right, or gap policy you mentioned?
[AGENT][NEUTRAL] That is correct. Supplemental medical policy. It's a supplement to the primary insurance.
[CUSTOMER][NEUTRAL] Uh, mm, OK, uh, now what about the second day, do I have $35 with you to owing as a coinsurance or the copay from the primary. Should I need to bill a
[CUSTOMER][NEUTRAL] Patient responsibility towards the number for the 35 or towards an appeal for your insurance let me complete mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] We do not, we do not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Second is this a claim number I have 356-477-2.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Let me help you with the next policy to the same provider whenever you're ready.
[AGENT][NEUTRAL] OK, so that is all of the information that you need on this one, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, yeah, since that was been denied for uh you're not covering this, uh, payment, right?
[AGENT][NEUTRAL] Yes, sir, as I explained, this this claim was denied. Of visits are not covered under this policy. And what is your next policy number?
[CUSTOMER][POSITIVE] Thank you. That is what I.
[CUSTOMER][POSITIVE] Since there is nothing to deal additionally, I'm ready with the next call, OK.
[AGENT][NEUTRAL] OK, you need to give me just one moment.
[CUSTOMER][NEUTRAL] I have a 0255, but you are not able to hear, right?
[AGENT][NEUTRAL] OK [PII], you're gonna have to wait just a moment.
[AGENT][NEUTRAL] I ask you to please hold for just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The only tool to start.
[AGENT][NEGATIVE] I'm sorry, there's something in your background that is very loud and I can barely understand what you are saying to me.
[CUSTOMER][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have plans.
[AGENT][NEUTRAL] And what is the next patient's policy number?
[CUSTOMER][NEUTRAL] 02550778
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What's gonna help you.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Can I have paid amount claim of paid or?
[CUSTOMER][NEUTRAL] you have.
[CUSTOMER][NEUTRAL] 38,640.
[CUSTOMER][NEUTRAL] You should and how should I say.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your patient's name and date of birth on this one?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you and the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The amount is $114 even.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And now.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and again you said the data service is [PII], is that correct?
[CUSTOMER][NEUTRAL] Sorry, what was that? You break up in what's the date of service? [PII].
[AGENT][NEUTRAL] Yes, so we do not have a claim on file for this member for this data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For [PII], you may claim?
[CUSTOMER][NEUTRAL] 0538640.
[AGENT][NEUTRAL] 12:26, no claim on file.
[CUSTOMER][NEUTRAL] Thank you. It was being sent through fax from our end on [PII]. Would you mind to please verify the fax number if it's correct or wrong?
[AGENT][NEUTRAL] There is no claim. Yes, uh-huh. Go ahead.
[CUSTOMER][NEGATIVE] You do need to hear carefully from what I'm telling without hearing why you are giving me the answers.
[AGENT][NEUTRAL] I'm sorry, I didn't understand what you said, [PII].
[CUSTOMER][NEUTRAL] Fax number I have 877.
[CUSTOMER][NEUTRAL] That is what listen carefully 1st. [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] What's the mailing address to submit this?
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] Repeat it again.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] You know
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And when you do submit the claim to APO for review, we will also need a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] 2700756
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] What's the policy effective date?
[AGENT][NEUTRAL] The effective date on this policy is 3, excuse me, [PII] and it is active. No termination date.
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] Secondary insurance, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How about the timely filing limit to submit the claims?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] Payer ID electronic submissions.
[AGENT][NEUTRAL] I'm sorry, I didn't understand your question.
[CUSTOMER][NEUTRAL] Payer ID.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome and again. Yes.
[CUSTOMER][POSITIVE] Thanks for your assistance. We'll submit you again and they'll reach you for this call for further review, OK?
[AGENT][NEUTRAL] I'm sorry. I, could you repeat that again? I was not able to understand what you were saying.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's fine. Thanks for you.
[AGENT][POSITIVE] Well, you're very welcome, ma'am. If that's all I can help you with, thank you again for calling APL today, [PII] and I hope you have a nice day.