AccountId: 011433970860
ContactId: 362d1e5e-7d9c-4400-844b-bcc052d2c8f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 743659 ms
Total Talk Time (AGENT): 296928 ms
Total Talk Time (CUSTOMER): 230677 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/362d1e5e-7d9c-4400-844b-bcc052d2c8f2_20250203T19:46_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling to check on a claim.
[AGENT][NEUTRAL] I can certainly help with, with the claim. And what is that policy number, please?
[CUSTOMER][NEUTRAL] 023 02966 M. like Mike L. Lima 8.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The number is [PII].
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] Thank you. And what date of service are we looking for for [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the charge amount is 138855.32.
[AGENT][NEUTRAL] Thank you. It looks like your claim number on this is 3493503.
[AGENT][NEUTRAL] Uh, we receive your claim, um,
[AGENT][NEUTRAL] On uh the um
[AGENT][NEUTRAL] On the [PII], excuse me, the [PII], we processed it on the [PII]. Now we are, we are, um.
[AGENT][NEUTRAL] Ms. [PII] um secondary insurance. And so in order for us to process that, we need a copy of the explanation of benefits from her major medical.
[AGENT][NEUTRAL] And so we would require that.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] In order to finish processing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, you can
[CUSTOMER][NEUTRAL] All right. Um,
[CUSTOMER][NEUTRAL] Yes, go ahead, please.
[AGENT][NEUTRAL] I was just gonna say you can mail that to us, fax it to us. We have an online service center that you can send it to us, and we just need the explanation of benefits from her major medical in order to process the claim.
[CUSTOMER][NEUTRAL] But and uh while sending it, it is required to send the primary you be alone or you want us to file the claim once, uh, both the claim and the primary will be together.
[AGENT][NEUTRAL] Yes, yeah, we, we just need a copy of the EOB, you can just go ahead and send that, uh, in reference this, the claim number 349.
[AGENT][NEUTRAL] 3503 and if you will do that, then we can go ahead and get this processed and and uh and um finalized but we uh we do need that EOB.
[CUSTOMER][NEUTRAL] All right. Thank you. Uh, could you please help me, uh, with the mailing address for my documentation?
[AGENT][NEUTRAL] Yes, sir. Certainly, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. Thank you. Thank you so much for this information. And uh could you please help me with the timely filing limit?
[AGENT][NEUTRAL] There, there's no timely filing uh because we're the secondary insurance, so you can just send that in at any time.
[CUSTOMER][NEUTRAL] Uh, do you have a fax number?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 9423. Now, is this the only claim that we're looking for for Ms. [PII]? Is there any other dates of service that we need to look at or?
[CUSTOMER][NEUTRAL] May I know how many claims can I assist your call?
[AGENT][NEUTRAL] I can, I can do one more. What is, what is the next um
[AGENT][NEUTRAL] Is it for Ms. [PII] that we're looking up or is it for someone else?
[CUSTOMER][NEUTRAL] It's a different patient.
[AGENT][NEUTRAL] OK, yes, and what uh what date of service are we looking for for her again?
[CUSTOMER][NEUTRAL] Mhm. Just, uh, it's a different patient and just give me one moment.
[CUSTOMER][NEUTRAL] OK, I mean the total charge.
[CUSTOMER][NEUTRAL] All right, thank you. And uh may I know what information can I go with first?
[CUSTOMER][NEUTRAL] OK can I have your call reference number.
[AGENT][NEUTRAL] Yes, go, yeah, go ahead and give me the policy number. That would be fine.
[CUSTOMER][NEUTRAL] 231-222-4.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and you said that the uh policy number is 02312284?
[CUSTOMER][NEUTRAL] Uh, it's 0312224.
[AGENT][NEUTRAL] 24, OK, OK, thank you. Let me see.
[AGENT][NEUTRAL] Let me see if I can't find it by their name. It's not, uh, how do you spell the, the customer's last name, please?
[CUSTOMER][NEUTRAL] The first name is [PII] And you remembers last name [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm still just checking.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, what date of service are we looking for for [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Have you received anything from us on this because I'm not seeing that I've got that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, uh,
[CUSTOMER][NEUTRAL] I could see uh there was a fax sent.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right. And uh uh I do see your uh policy number. Could you please check with that?
[AGENT][NEUTRAL] Yes, and, and what is that?
[CUSTOMER][NEUTRAL] Uh, whether it's right for the patient?
[AGENT][NEUTRAL] Yes, and what is that please?
[CUSTOMER][NEUTRAL] 02457.
[CUSTOMER][NEUTRAL] Uh yes, it's 02457148.
[AGENT][NEUTRAL] Yes, that's what I'm looking up right now and I, and I just don't see that claim. Um, I realized that you probably faxed it to us and I, I don't know why we don't have it, but if you don't mind faxing it to us again.
[CUSTOMER][NEGATIVE] Uh no.
[CUSTOMER][NEUTRAL] Uh, before that, uh, I could see there was a correspondence receipt. I'll go with the claim number of that.
[AGENT][NEUTRAL] Yeah, let's try that then. What is that, please.
[CUSTOMER][NEUTRAL] 3, uh-huh, it's 346.
[CUSTOMER][NEUTRAL] 3078.
[AGENT][NEUTRAL] OK, thank you. I'm wondering if I didn't get the date of service wrong, let me just check here.
[AGENT][NEUTRAL] OK. Hang on just a second.
[AGENT][NEUTRAL] OK, OK, um, so [PII], OK, I'm sorry. I, I was putting [PII]. I'm sorry. Um, your, your claim number is 3463078. Um, it does look like we received that. Let me just see. Uh, it looks like we received that on the [PII]. It's processed on the [PII]. Now, the policy doesn't cover um kinesiology or speech therapy.
[AGENT][NEUTRAL] So this, uh,
[AGENT][NEUTRAL] This claim was not um.
[AGENT][NEUTRAL] Covered.
[AGENT][NEUTRAL] Because the policy doesn't cover this type of, of treatment.
[CUSTOMER][NEUTRAL] Oh, could you
[CUSTOMER][NEUTRAL] Uh, is that is not covered, uh, for the therapy?
[AGENT][NEUTRAL] It doesn't cover speech therapy or kinesiology.
[CUSTOMER][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] Thank you so much. Is the whole claim is denying for the same reason?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] All right. And on this claim, are you able to help me uh faxing the copy of EOB?
[AGENT][NEUTRAL] Uh, yes, you can do that. It's uh [PII]. Now, uh, [PII], if you're going to send this again, you need to send it in as an appeal, um, because it's, uh, because the denial is, is because this isn't covered. So if you're wanting to, if you're wanting to have it reviewed, it you have to send it in as an appeal because we've already gotten the EOB on it. We don't need it. You can send us another one if you want.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Um, but, uh, that it was denied because those services aren't covered under his policy, but we can always review it if you want to. So if you send it in to us again, I would send it in as a.
[CUSTOMER][NEUTRAL] It as
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Online, and this is non-covered as per the patient plan?
[AGENT][POSITIVE] That's correct. Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And uh may I know all the total charges is completely will be uh the patient's responsibility?
[AGENT][NEUTRAL] Well, I can't, I can't really tell you that. Uh, the only thing I can tell you is that that our policy won't cover it. It's, it's always possible, because we are a secondary insurance, it's always possible that they have another, another, uh, secondary insurance. Sometimes people have to, um, so I would, I would refer you back to the insured, but I, I, I can't tell you that, that they're responsible for the charges. I can just tell you that, that we won't pay them.
[CUSTOMER][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] Uh, are you able to fax a copy of COB to us?
[AGENT][NEUTRAL] Yes, what is your fax number?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Thank you for holding. The fax number will be 844902.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 3804. OK. OK, I will go ahead and send that to you.
[CUSTOMER][POSITIVE] Alright, thank you so much.
[AGENT][NEUTRAL] OK. Well, thank you for contacting APL. I should be seeing that fax. Yes, uh-huh, mhm.
[CUSTOMER][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] Uh, may I know the reference number for our call today?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that in today's date as our reference.
[CUSTOMER][POSITIVE] Thank you. Thank you so much for your assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thanks for contacting API.