AccountId: 011433970860
ContactId: 35e885a3-28b0-4a45-aa98-6bce921333f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1021500 ms
Total Talk Time (AGENT): 355842 ms
Total Talk Time (CUSTOMER): 268906 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/35e885a3-28b0-4a45-aa98-6bce921333f4_20250304T13:40_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] Hey, [PII], it's [PII] calling from the provider office to know the claim status.
[AGENT][NEUTRAL] OK. Did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK [PII], and you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Yes, [PII], I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and how many claims, [PII], do you have to check status on today?
[AGENT][NEUTRAL] [PII], how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] Are they for the same patient?
[CUSTOMER][NEUTRAL] I have 3 claims.
[AGENT][NEUTRAL] Are they for the same patient?
[CUSTOMER][NEUTRAL] No, no, it's different. No.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So you have one date of service for 3 different patients. Is that correct?
[CUSTOMER][NEUTRAL] No, everything is different. date of service and patient also.
[AGENT][NEUTRAL] Yes, sir, but do you have one claim for each person that you're calling about?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, yes sir, I can help you with that. So first off, [PII], for all of them you will use my name that I gave you along with today's date as your call reference number.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Secondly, any information that I do provide for you will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claim on file and you need a copy of the explanation of benefits, you may print that by going to our portal which is at [PII] to print those.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All right. And what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 02185094 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And what is the first name? That's the last name. What is the first name?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name [PII]
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Not according to our records. Yes, sir, that's not the information according to our records.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, OK. Just wait a second. I'll cross-check this.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Check with this name, [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the bill amount is $34,0057 even.
[AGENT][NEUTRAL] OK, so first off, you have an incorrect policy number. The policy number you gave me, [PII], is an old policy number that termed in [PII].
[AGENT][NEUTRAL] The correct policy number that you should have, which would have been active for your data service is 02337110 with an effective date of [PII].
[AGENT][NEUTRAL] And give me just a moment to get all of that policy information pulled up and so I can check to see if we received and processed the claim under the correct policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so the claim was received and processed under the correct policy number.
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] Claim number is 353-2407.
[AGENT][NEUTRAL] And the reason for the denial, [PII], is because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] As per checking in our system, we have already sent you the primary EOB.
[CUSTOMER][NEUTRAL] Let me provide you the date.
[CUSTOMER][NEUTRAL] We have sent you the primary on [PII].
[AGENT][NEGATIVE] OK, that was not received.
[CUSTOMER][NEUTRAL] OK, I didn't receive it. OK.
[AGENT][NEUTRAL] How did you send it?
[CUSTOMER][NEUTRAL] Via fax
[AGENT][NEGATIVE] No, so we did not receive that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can you just cross-check with the fax number. It's [PII].
[AGENT][NEUTRAL] That is correct. And did you put it to the attention of anyone or any department?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so you would need to put it to attention claims.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][POSITIVE] OK, thank you so much. Can you just spell your name?
[AGENT][POSITIVE] You're welcome. And
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else?
[CUSTOMER][NEUTRAL] Just wait a second. I'll, I'll, no, I'll provide you another patient.
[AGENT][NEUTRAL] OK. I'm not ready yet, but give me just a moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What do we got
[AGENT][NEUTRAL] OK. And the next policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 02263082 M as in Mike L as in Lima 7.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And what is gonna be the date of service before we even get to the member?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] OK, so the policy number you gave me is not active for that data service. Let me see if there's another one.
[AGENT][NEUTRAL] So you also have the incorrect policy number for the state, for this number. So just one moment.
[AGENT][NEUTRAL] OK, and any information as I stated before, would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The name, the name and date of birth is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] First thing, second name.
[AGENT][NEUTRAL] What's the first name?
[CUSTOMER][NEUTRAL] The first name is, just wait a second, it's [PII].
[AGENT][NEUTRAL] Spell it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII]. It's
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] How do, how is it spelled? Because it's not just an [PII] [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What is the correct spelling of the name?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the last name?
[CUSTOMER][POSITIVE] It's great. It's [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So the correct policy number that you need to have for this number?
[AGENT][NEUTRAL] It's going to be 0254.
[AGENT][NEUTRAL] 9553 with an effective date of [PII].
[AGENT][NEUTRAL] And again, what is the date of service [PII] and total bill amount?
[CUSTOMER][NEUTRAL] The date of service is.
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is 21,000.
[CUSTOMER][NEUTRAL] $248 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 0984.
[AGENT][NEUTRAL] And this claim was also denied [PII], because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] We have send you already the primary UB free time.
[AGENT][NEGATIVE] We are not receiving that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Again, are you putting it to attention claims department?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] It has not been received.
[CUSTOMER][NEUTRAL] Uh, OK, so we will send you once again.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there any other information, [PII] you need on this number?
[CUSTOMER][NEUTRAL] No, I'll provide you another member. Let me know when you will be ready.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK. And the next member's policy number?
[CUSTOMER][NEUTRAL] I leave.
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] 1070427
[AGENT][NEUTRAL] OK, and your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Name is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm date of service, I mean, I'm sorry, date of birth.
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][POSITIVE] Thank you. Data service and total bill amount.
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $46,688 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was also received. The received date was [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The claim number is 355-0927.
[AGENT][NEGATIVE] And this claim was also denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, and this also we have already sent you the primary U be full time.
[AGENT][NEUTRAL] OK, I don't know what maybe if there is an issue with your end. If you have sent it 4 times and we have not received it, it may also be mailed to us, but as of now we have not received the primary insurance EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] We'll send you once again.
[AGENT][NEUTRAL] And it would be the same fax number that I gave you earlier, [PII].
[CUSTOMER][NEUTRAL] account number.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for your help.
[AGENT][POSITIVE] Well, you're welcome. Is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Well, you're very welcome, [PII], and thank you for calling APO. I hope that you have a wonderful day.
[CUSTOMER][NEUTRAL] So mutual.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Yes, sir. Thank you. Bye-bye.