AccountId: 011433970860
ContactId: 36788097-b486-467c-b1df-b8208a398332
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 626479 ms
Total Talk Time (AGENT): 193514 ms
Total Talk Time (CUSTOMER): 199339 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/36788097-b486-467c-b1df-b8208a398332_20250212T13:39_UTC.wav
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[AGENT][POSITIVE] Thanks for calling API. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, and this is [PII] here calling on behalf of provider's office and this for checking claims.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with claim status. First, can I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] And that's [PII] and the callback number is [PII].
[AGENT][NEUTRAL] OK. Please spell your name one more time.
[CUSTOMER][NEUTRAL] Yeah, that's [PII].
[AGENT][NEUTRAL] OK. Thank you for it. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Yes, and the number, uh, policy number is 0182.
[CUSTOMER][NEUTRAL] 8757.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] And the patient name is [PII] and the last name is [PII] and the birth date is on [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] And that's on [PII] and the claim is for 200 and
[CUSTOMER][NEUTRAL] $32 even.
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] OK, thanks for your patience. We received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 349-9002.
[AGENT][NEUTRAL] And the claim um denied because under this policy, there's a $1000 deductible that needs to be met um before benefits pay out.
[AGENT][NEUTRAL] And the amount of $139.71 went to the $1000 deductible.
[CUSTOMER][NEUTRAL] OK, just process towards the patient's deductable, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the patient responsibility. One moment, let me check. So $139 was paid process towards the patient's deductible.
[AGENT][NEUTRAL] $139.71.
[CUSTOMER][NEUTRAL] 71 cents. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for that information.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] And uh uh upon checking here, uh, the claim is not denied for lack of information, right?
[AGENT][NEUTRAL] It was denied because um the, well, it, it paid out but the um payment went towards the deductible, the $1000 deductible.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Thank you for that information. And uh so the total deductible amount for the euros 1000, right? And how much it was me so far?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] For the date of service?
[AGENT][NEUTRAL] Um, the, uh, the amount that the claim paid out.
[CUSTOMER][NEUTRAL] OK. It's just met 139, right? For the year of [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Thank you for that information. And for this, can you please send us your through fax?
[AGENT][NEUTRAL] Yes, what's your fax number?
[CUSTOMER][NEUTRAL] Yeah. Let me confirm the fax number one more moment. And how many, like, how many minutes has it will take to reach us while you send the OB?
[AGENT][NEUTRAL] About 10 minutes.
[CUSTOMER][NEUTRAL] Oh, OK. So, the fax number is [PII].
[AGENT][NEUTRAL] OK, so that's attention, your name, um [PII]. OK. And that's [PII]?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] That's perfectly right.
[AGENT][NEUTRAL] OK. You should receive it, [PII], in about 10 minutes. I just sent it. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Uh, I do a next claim, and how many claims do I have the call?
[AGENT][NEUTRAL] I can handle 2 more. Is it, are they for the same number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, oh yeah, same patient here and the next service date is on.
[CUSTOMER][NEUTRAL] [PII] for $125 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, please repeat that date of service.
[CUSTOMER][NEUTRAL] Yeah, sure. [PII].
[CUSTOMER][NEUTRAL] And for charge amount of $125 even.
[AGENT][NEUTRAL] OK, we received that claim on [PII].
[AGENT][NEUTRAL] It processed on [PII].
[AGENT][NEUTRAL] The claim number is 3529794.
[AGENT][NEUTRAL] And that claim denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Office visits are not covered under the patient's policy or
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, whether the patient has uh
[CUSTOMER][NEUTRAL] In network or out of network benefits.
[AGENT][NEUTRAL] This is for secondary coverage. There's no network.
[CUSTOMER][NEUTRAL] Can I
[CUSTOMER][NEUTRAL] OK. So, like, I think the primary has processed the claim initially and you will not cover the
[CUSTOMER][NEUTRAL] Amount, uh, co-pay amount, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEGATIVE] The $25 will not be covered.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Thank you for that information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For this to be an option to build the patient.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Covered in the policy and you, OK. And can I have your bill for this also?
[AGENT][NEUTRAL] Yes, and one moment, please.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And adding to that, can I have your appeal family and the family?
[AGENT][NEUTRAL] Please repeat that question.
[CUSTOMER][NEUTRAL] Appeals timely filing limit and the credit claim timely filing limit.
[AGENT][NEUTRAL] There's no timely filing limit?
[CUSTOMER][NEUTRAL] Uh, for both, is like anytime we can send an appeal and credit the claim.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment, I'll get the last date of service from you in just a second. One moment, please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, thanks for your patience, [PII]. Now what's the last date of service?
[CUSTOMER][NEUTRAL] Yes, and uh this is for the different patient totally.
[AGENT][NEUTRAL] OK. I'm ready for that policy number.
[CUSTOMER][NEUTRAL] Yes. And the policy number is 02182458.
[AGENT][NEUTRAL] OK, and please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] And the patient's name is [PII] and the birth date is on [PII].
[AGENT][NEUTRAL] OK, thank you. Now I need the date of service and bill charges for his claim.
[CUSTOMER][NEUTRAL] And the service state is on.
[CUSTOMER][NEUTRAL] [PII] and we charge the amount of $227 even.
[AGENT][NEUTRAL] OK, we received this claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 349-8847 and this claim is denying because um office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] And as you stated is also as for the patient's policy, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK. And thank you. And for this also, can I have the UP?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] I'm sending it now and you should receive this in about 10 minutes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. And for a reference number, [PII], you can use my name and today's date. My name is [PII]. It's spelled [PII]
[CUSTOMER][NEUTRAL] Can you please spell it
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. And my last initial.
[CUSTOMER][NEUTRAL] OK, and your last name, Miss?
[AGENT][NEUTRAL] It's [PII] like [PII].
[CUSTOMER][POSITIVE] Thank you, ma'am. Have a great day. Take care. Bye-bye.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.