AccountId: 011433970860
ContactId: 378c6cb7-ba21-4aa8-a029-cad954154143
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1404770 ms
Total Talk Time (AGENT): 195603 ms
Total Talk Time (CUSTOMER): 349413 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/378c6cb7-ba21-4aa8-a029-cad954154143_20250611T14:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider's office regarding our clarification.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Oh, could you please repeat that?
[AGENT][NEUTRAL] Do you have a good callback number?
[CUSTOMER][NEUTRAL] Give me a minute.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And then do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The policy number is 018287557.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And do you have the claim number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The claim number is 352-574-3.
[AGENT][NEUTRAL] OK, it looks like we processed the claim and applied it towards the calendar year deductible.
[CUSTOMER][NEGATIVE] It is deductible, but we don't have to receive the updated EOB year. It was denied for claim service lack of information.
[AGENT][NEUTRAL] OK, do you need me to fax the EOB?
[CUSTOMER][NEUTRAL] Give me a minute. May I know how much is processed towards the deductible?
[AGENT][NEUTRAL] Uh, it looks like 231 84 and 517.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] 517.
[CUSTOMER][NEUTRAL] OK. Is that under the same claim number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a minute.
[CUSTOMER][NEUTRAL] May I know when it was processed? May I have the details for the payments?
[AGENT][NEUTRAL] Claim was received 10:31 24, processed 11-4-2024.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the total deductible amount for this member?
[AGENT][NEUTRAL] Their calendar year deductible is 1000.
[CUSTOMER][NEUTRAL] Your voice is breaking out. Could you please repeat that?
[AGENT][NEUTRAL] The calendar year deductible is 1000.
[CUSTOMER][NEUTRAL] OK. And uh how much is made for that year?
[AGENT][NEUTRAL] Uh, it looks like they've met. Hold on just a second.
[AGENT][NEUTRAL] 45563.
[CUSTOMER][POSITIVE] 63. Thank you so much. And you stated that 5.17 cents is for the CPT code 81025?
[AGENT][NEUTRAL] Uh, let me pull it back up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And for the CPT code 57454?
[AGENT][NEUTRAL] 231 8
[CUSTOMER][NEUTRAL] It is 231.8. OK.
[CUSTOMER][POSITIVE] Thank you so much for that details.
[CUSTOMER][POSITIVE] And the claim number, thank you so much. Could you please fax me a copy of your for the updated one?
[AGENT][NEUTRAL] Your fax number?
[CUSTOMER][NEUTRAL] Give me a minute.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] May I know how much
[CUSTOMER][NEUTRAL] Yes, go on.
[AGENT][NEUTRAL] Just repeating back the fax number [PII]. It just takes a few minutes.
[CUSTOMER][NEUTRAL] Yes, right.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] And I do also have a few more claims for different member. Could you please help me with that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said the same number?
[CUSTOMER][NEUTRAL] The member.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh just one moment.
[CUSTOMER][NEUTRAL] And may add the, OK.
[AGENT][NEUTRAL] OK, what was the next policy number?
[CUSTOMER][NEUTRAL] It is 01792084.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] State of service and bill charges?
[CUSTOMER][NEUTRAL] The date of service is [PII] with the charge amount of $420 even.
[AGENT][NEUTRAL] That was 9:27, 2024.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Did you have the claim number for this one?
[CUSTOMER][NEUTRAL] a minute.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] The claim number for this one is 352-065-5.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Uh it was received 1021, 24, processed 1022, 24.
[AGENT][NEUTRAL] Uh, we paid 6825.
[CUSTOMER][NEUTRAL] 1024.
[CUSTOMER][NEUTRAL] You paid for?
[AGENT][NEUTRAL] 8 68 25.
[CUSTOMER][NEUTRAL] 25.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's under the same claim number?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I have the payment details for this fund, whether it is the EFT or the check?
[AGENT][NEUTRAL] I will check [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know whether it is cashed?
[AGENT][NEUTRAL] Yes, it was cashed on [PII].
[CUSTOMER][POSITIVE] 1324. Thank you so much. And could you please verify with the pay your address, please?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you so much for that information. And uh may I also have a copy of you before this one, please?
[AGENT][NEUTRAL] OK. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh one center.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hey, you have the next policy number?
[CUSTOMER][NEUTRAL] Yeah, so may I have the call reference number for this number, please?
[AGENT][NEUTRAL] Uh, call reference will be the same for all. It's my name is [PII] and today's date.
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, sir. The next member ID, give me a minute.
[CUSTOMER][NEUTRAL] The next member ID is 01897890.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Is these are [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] What was the date of service and bill charges?
[CUSTOMER][NEUTRAL] The date of service is [PII] with the bill amount of $153 even.
[AGENT][NEUTRAL] So the claim number for this?
[CUSTOMER][NEUTRAL] The claim number for this one is.
[CUSTOMER][NEUTRAL] It is 351-6030.
[AGENT][NEUTRAL] It was received 10-724. Pro 1010, 24.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Your office visit is not covered under the policy member policy, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Policy.
[CUSTOMER][NEUTRAL] May I know the policy type for this member, please?
[AGENT][NEUTRAL] You need this EOB?
[AGENT][NEUTRAL] That supplemental.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. So the member don't have office visit coverage, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much for that details and also give me a minute.
[CUSTOMER][NEUTRAL] And uh I, and I also need a copy of you before this one also.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, did you have another plan?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can I provide you with the next number right then?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The member ID is 023.
[AGENT][NEUTRAL] You have the claim number?
[AGENT][NEUTRAL] Um, if you have the claim number, that would be easier.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The claim number here is 352-582-5.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient name?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] It looks like it was received 111-2024, processed 115 2024.
[AGENT][NEUTRAL] We made a payment of 13328.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I have the payment info, please?
[AGENT][NEUTRAL] Uh, paid on 114, and that was for 13328.
[AGENT][NEUTRAL] And check number is 2,011,860 single check.
[CUSTOMER][NEUTRAL] It is 20118.
[AGENT][NEUTRAL] 2,011,860.
[CUSTOMER][POSITIVE] 860. Thank you so much.
[CUSTOMER][NEUTRAL] And may I have the cash rate please?
[AGENT][NEUTRAL] A date is 12-26-24.
[AGENT][NEUTRAL] Paid to 15.
[CUSTOMER][NEUTRAL] 12:26.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's the same address, right? Or different?
[AGENT][NEUTRAL] Address is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Can we move on to the next member?
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] How many more do you have?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, your.
[CUSTOMER][NEUTRAL] 5 more claims.
[CUSTOMER][NEUTRAL] Give me a minute.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Do you just need EOBs for all of these because I can just take the claim numbers and fax you the EOBs which is gonna have the information you're asking for.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, yeah, I do also have a dinner clarification.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Can I
[CUSTOMER][NEUTRAL] Give me a minute.
[CUSTOMER][NEUTRAL] Can I provide you with the
[CUSTOMER][NEUTRAL] Next claim number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is 3521576.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] And you needed a clarification on the denial?
[CUSTOMER][NEUTRAL] Yes, it is denied for non-covered charges. May I know whether the office visit is not covered under the patient plan?
[AGENT][NEUTRAL] It's not covered under the patient plan, correct.
[CUSTOMER][NEUTRAL] OK, thank you so much for that. And I do also have another member for the same denial and it is also an office visit call.
[AGENT][NEUTRAL] OK, and that claim number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The claim number, give me a minute.
[CUSTOMER][NEUTRAL] The claim number is 3515306.
[AGENT][NEUTRAL] Are you needing the EOBs for these?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Just need a clarification whether it is also for the same reason.
[AGENT][POSITIVE] Uh yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a minute.
[CUSTOMER][POSITIVE] Thank you so much. OK. Can we on to the next claim?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][POSITIVE] 3 more. OK, thank you so much. Give me a minute.
[CUSTOMER][NEUTRAL] Give me a minute, it's taking some time to load.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Can I provide you with the next claim number?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.