AccountId: 011433970860
ContactId: 353e227f-2e16-4536-a4f5-33702e966617
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 702770 ms
Total Talk Time (AGENT): 281784 ms
Total Talk Time (CUSTOMER): 191904 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/353e227f-2e16-4536-a4f5-33702e966617_20250624T20:53_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] I do have 2 claims.
[AGENT][NEUTRAL] Are they for the same patient or for different patients?
[CUSTOMER][NEUTRAL] Uh, this is for different patient.
[AGENT][NEUTRAL] OK, [PII], so I can help you and you will use my name along with today's date as each of your call reference numbers. Also, any information that is provided 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 once I provide you the claim number.
[AGENT][NEUTRAL] You can print those yourself by going to our portal which is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your first patient's policy number?
[AGENT][NEUTRAL] Oh, first off, [PII], oh wait, [PII], uh, I'm so sorry. What is your callback number?
[CUSTOMER][NEUTRAL] Yeah, the policy number will be 02.
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And the first member's policy number?
[CUSTOMER][NEUTRAL] 02506178
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Oh yeah, [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Any
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Yeah. The total.
[AGENT][NEUTRAL] But the data service.
[CUSTOMER][NEUTRAL] Sorry, the date of service is, yeah, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And charges will be $20,270 and even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you did say [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I, and the total bill amount you said is $20,270. Is that correct?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes. Yes.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] OK, so we do not have a claim on file at this time for this data service and that billed amount.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, one moment.
[CUSTOMER][NEUTRAL] Could you please check uh for this amount that is $19,942 even?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so I share the claim this claim that for that billed amount that was received on 4-22-25 and it was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3593451.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This claim is the remark on this claim states insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Uh, so the claim is denied for primary UB, right?
[AGENT][NEUTRAL] It shows on here insured's primary insurance provided full benefits, no benefits are payable.
[CUSTOMER][NEUTRAL] OK, could you please once again repeat me the date?
[AGENT][NEUTRAL] Insured's primary insurance.
[CUSTOMER][NEUTRAL] No, I'm asking for the received date.
[AGENT][NEUTRAL] The date that you gave me.
[CUSTOMER][NEUTRAL] No. Uh, when the claim has been received, could you please once again repeat me the received date of that claim? You told that is April something.
[AGENT][NEUTRAL] I did. I gave you the received date and the process date.
[AGENT][NEUTRAL] The received date was [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK. Uh, for this, we have already sent the primary UB. Um, could you please check on that?
[AGENT][NEUTRAL] Yes ma'am, that's the last information that I have.
[AGENT][NEUTRAL] What I just provided you is the most recent information that's all of the information that I have.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But we have recently sent you the primary UV that is on [PII]. Um, so you need uh time to process.
[AGENT][NEUTRAL] OK, as of now.
[AGENT][NEUTRAL] As of now, this was the this is the latest review that has been done.
[AGENT][NEGATIVE] There has not been anything reviewed and processed in the last several days for this state of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I have the timely filing limit?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Are you able to hear me OK?
[CUSTOMER][NEUTRAL] Yeah, I can barely hear you. Now, it is OK.
[AGENT][NEUTRAL] I said there is, yes, ma'am. I, there is.
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] OK, thanks for that. And shall we move on to the next claim?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And what is your next patient's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the patient policy number will be 01648436.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name will be [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] [PII] will be the date of uh service and the total charges will be $6,391 and e[PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] It will go through nightly processing tonight.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 361-6520.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And the benefit to be paid shows $2,063.00.
[CUSTOMER][NEUTRAL] So it has been paid or it has to be paid?
[AGENT][NEUTRAL] It has to be paid.
[AGENT][NEUTRAL] It is scheduled to go through our nightly processing tonight, June.
[CUSTOMER][NEUTRAL] So it uh
[CUSTOMER][NEUTRAL] Sorry, could you please repeat that? Your voice is uh
[AGENT][NEUTRAL] Oh my [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] This claim is scheduled to go through nightly processing tonight.
[CUSTOMER][NEUTRAL] OK, it has been processing, right?
[AGENT][NEUTRAL] It has been processed. The check has not yet been issued. It will have to go through our overnight processing tonight. So I do not have a check number that I can provide for you at this time.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I have provided you the claim number and the benefit amount being paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please once again repeat me the claim number and the paid amount?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Claim number 3,616,520 benefit amount $2,063.00.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks for that. Uh, I, I want the process date.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] That will be that was going to be today as I explained the process date it will go through our processing tonight, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, no, one moment please um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And may I have your name and the call reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, I gave you my name and explained that the reference number would be my name in today's date.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You're welcome. And if that's all I can help you with, have, you have a nice day too, and thank you again for calling APL.
[CUSTOMER][POSITIVE] OK. Thank you, [PII], and have a good day. Mhm.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you and have a good day.
[AGENT][POSITIVE] You're welcome. You too. Bye bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Lovely. Bye-bye.