AccountId: 011433970860
ContactId: 33bc6b3f-bcbe-4077-b818-3bebd8f32352
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 487359 ms
Total Talk Time (AGENT): 175215 ms
Total Talk Time (CUSTOMER): 193603 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/33bc6b3f-bcbe-4077-b818-3bebd8f32352_20250129T13:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], this is [PII] and I'm calling from the provider's office for a claim status. Could you please help me with that?
[AGENT][NEUTRAL] OK, well, you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII] and there's no extension for that.
[AGENT][NEUTRAL] OK, and again, the phone number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Go.
[CUSTOMER][POSITIVE] Yes, please. You got it.
[AGENT][NEUTRAL] OK, thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, fine.
[CUSTOMER][NEUTRAL] The policy is, it's 0250.
[CUSTOMER][NEUTRAL] 99
[CUSTOMER][NEUTRAL] 81.
[AGENT][NEUTRAL] OK, thank you. Give me a couple of moments in order to get the member's information pulled up, please.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is
[CUSTOMER][NEUTRAL] Uh, it's, uh, one moment. It's [PII].
[CUSTOMER][NEUTRAL] stuff.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK. Did you get the name? It's.
[AGENT][NEUTRAL] And her date of
[AGENT][NEUTRAL] I did. I need her date of birth. Mhm.
[CUSTOMER][NEUTRAL] OK. The date of birth?
[CUSTOMER][NEUTRAL] OK. The date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for her, please.
[CUSTOMER][NEUTRAL] OK. The date of service is on [PII] and uh the total amount is $133.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Can you send the letters or.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] did you also do uh uh the price for the.
[CUSTOMER][NEUTRAL] number or uh.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 867-7.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And give me just one.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No you don't need any.
[CUSTOMER][NEUTRAL] Get
[CUSTOMER][NEUTRAL] So what is?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the, the remark, the denial remark on this claim, [PII] reads as follows.
[AGENT][NEUTRAL] Um, we have received the primary insurance explanation of benefits that was submitted with the claim. However, the explanation of benefits received does not list the amounts applied to the deductible, co-pay, or co-insurance. Please submit a a more detailed explanation of benefits that shows these amounts for further consideration of the claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So we are in need of a detailed explanation of benefits.
[CUSTOMER][NEUTRAL] OK, so you, one moment.
[AGENT][NEUTRAL] Showing the amounts applied to the deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK. So, this is the UV which we sent to you. The UV doesn't show any
[AGENT][NEGATIVE] It was not detailed.
[CUSTOMER][NEUTRAL] Amount related to patient responsibility, right? Yes.
[AGENT][NEUTRAL] We need a detailed explanation of benefits. The one we received did not show.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Details. It did not show any amounts supplied to the deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I see, sir. I will send that. Uh, could you please give me the mailing address and the fax number so that we could send that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mailing address is the same as claims. What do you show for the mailing address for claims?
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The mailing address is, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. [PII], right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. OK. Could you please give me
[CUSTOMER][NEUTRAL] Fax number as well?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942-3 attention claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. Uh, what else do you need to receive? Do you need only the primary?
[CUSTOMER][NEUTRAL] Insurance explanation of benefits or any other things?
[AGENT][NEUTRAL] No, sir. We need a detailed primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if you need a copy of this explanation of benefits for our company with that remark on it, you can print that Roy by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. I get that. Uh, thank you so much for all that information. And uh yeah, that's why, OK. Could you please give me the
[AGENT][POSITIVE] Hey, you're welcome.
[CUSTOMER][NEUTRAL] Call reference number?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][POSITIVE] OK, [PII], thank you so much for that.
[AGENT][POSITIVE] Yes, you're very welcome. So again, if that's all I can help you with today, thank you again for calling APL and I hope you have a very nice day.
[CUSTOMER][NEGATIVE] Oh, I can't help
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][POSITIVE] Thank you.