AccountId: 011433970860
ContactId: 39ef6732-3f95-4afe-a43b-c836808e6a78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2247770 ms
Total Talk Time (AGENT): 498539 ms
Total Talk Time (CUSTOMER): 463747 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/39ef6732-3f95-4afe-a43b-c836808e6a78_20250506T17:30_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hi, [PII]. My name is [PII] calling from provider office. And I'm looking for a claim status.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, [PII], you said you have one claim for status, is that correct?
[CUSTOMER][NEUTRAL] Oh, no, no, actually I have 5 claims, 6 claims.
[AGENT][NEUTRAL] Because you said
[AGENT][NEUTRAL] Are they for the same patient or 6 different patients?
[CUSTOMER][NEUTRAL] 6 different patients.
[AGENT][POSITIVE] OK, yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] 302.
[CUSTOMER][NEUTRAL] [PII]. It's my direct.
[AGENT][NEUTRAL] Thank you and [PII], um you will use my name that that I gave you along with today's date as each call reference number. Also any information that I provide for you on any of the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And lastly, if we do have the claims on file and you need a copy of that explanation of benefits, once you have the claim number, you should be able to print that yourself by going to our portal that's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Dot
[AGENT][NEUTRAL] [PII]. Again, to print the EOB if you need a copy, you would get to [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] So, the first patient policy number I have, it is uh 175.
[CUSTOMER][NEUTRAL] 1206.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and [PII], what is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Mhm. So, patient name is gonna be [PII], the first name, and the last name will be [PII]. And uh the date of birth is [PII].
[AGENT][NEUTRAL] OK, now we have a different last name.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Let me take a look. [PII].
[CUSTOMER][NEUTRAL] No, the only one name, so [PII], the first name and the last name [PII] and the date of birth [PII].
[AGENT][NEUTRAL] Spell the last name that you have?
[CUSTOMER][NEUTRAL] OK. It is [PII].
[AGENT][NEUTRAL] OK, so again, I'm sorry but I can't confirm the eligibility because the name does not match.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You have different patient name in the last one?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, one moment, let me take a look.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] OK, then, no problem. Now, selling on the next member.
[AGENT][NEUTRAL] Just one moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is your extension policy number, [PII]?
[CUSTOMER][NEUTRAL] Mhm. So, the member ID I have 133.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 711
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Again, 1, M as in Mike, L as in Lima, number 7. Yeah, actually, after the 7, it is a 3 consecutive one.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII], the first name and the last name is gonna be [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service and total bill amount for her place.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It is uh [PII]. And then the bill amount of $1,273 even.
[AGENT][NEUTRAL] And you said the date of service is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, bear with me just a moment please.
[CUSTOMER][POSITIVE] Mhm take your time.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] And just one moment and I'll provide you that information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So this claim was received on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 351-1108.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the tax ID number?
[CUSTOMER][NEUTRAL] Oh, so the tax ID number, it is uh [PII].
[AGENT][NEUTRAL] OK. I do show that there was a benefit paid in the amount of $184.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That was paid on check number 2,004,980.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if you'll verify the address?
[CUSTOMER][NEUTRAL] Oh, the address will be [PII]. And the ZIP code is [PII].
[AGENT][NEUTRAL] OK, thank you. And that is where this check was mailed to?
[AGENT][NEUTRAL] That is the address.
[CUSTOMER][NEUTRAL] OK. So, may I know the issue date?
[AGENT][NEUTRAL] The same date as the process date?
[CUSTOMER][NEUTRAL] OK. [PII]. and the check was clear or it is not clear yet?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEGATIVE] It is not it is not, it does not show it's cleared from what I can see.
[CUSTOMER][NEUTRAL] So, it was not clear yet, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And can you void the check and uh reissue the new check to the same address, you know, actually, it is a long time, right? You know, [PII], so that's why.
[AGENT][NEUTRAL] Uh yes, sir, if you'll give me a few minutes, I'll be happy to submit that request before we move on to the next claim.
[AGENT][NEUTRAL] Cause I'll have to send it, yes.
[CUSTOMER][POSITIVE] OK, sure. Take your time.
[AGENT][NEUTRAL] OK, this is gonna take me a few minutes to do this, [PII], so just please be patient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Still working on your request.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] something
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Etc.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Not too bad
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] I'm almost finished with your request.
[CUSTOMER][POSITIVE] Mhm. Take your time, no problem.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and was there any other information on this member's policy, [PII], that you needed regarding this claim?
[CUSTOMER][POSITIVE] Oh, no, everything, got you.
[AGENT][NEUTRAL] That is everything on that one?
[CUSTOMER][NEUTRAL] Yes, I'm done with this claim and uh selling on the next one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and your next patient's policy number?
[CUSTOMER][NEUTRAL] Mm. So, the next member ID I have 022.
[CUSTOMER][NEUTRAL] 604
[CUSTOMER][NEUTRAL] 91
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient name is [PII] and uh the last name will be [PII]
[CUSTOMER][NEUTRAL] Oh no. O[PII] And uh the date of birth will be [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What is the date of service and total bill amount for him please, [PII]?
[CUSTOMER][NEUTRAL] Mhm. So, the latest service I have uh [PII].
[CUSTOMER][NEUTRAL] And uh the bill amount is $1,273 even.
[AGENT][NEUTRAL] OK, and again, you said the data service is 224 of 2024, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For $1,273.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was also received, [PII].
[AGENT][NEUTRAL] The received date was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 351-0709.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $181.
[AGENT][NEUTRAL] That was paid on single check [PII].
[AGENT][POSITIVE] And this check also still shows that it's outstanding and it was sent to that same address.
[CUSTOMER][NEUTRAL] Mhm. OK. And uh this one also [PII]. And this one also, can you void the check and uh reissue the new check to the same address?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I can send the request. It's gonna take me a few minutes. I'll send, I have to send another request like I did on the other one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Almost finished.
[CUSTOMER][POSITIVE] Mhm. Take your time.
[AGENT][NEUTRAL] OK, and do you need any other information on this one before I finish it out?
[CUSTOMER][POSITIVE] Oh everything, got you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Mhm. So, the next member ID I have 199.
[CUSTOMER][NEUTRAL] 3963.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] So, patient name is [PII], the first name and the last name gonna be [PII]. And uh the date of birth will be [PII].
[AGENT][NEUTRAL] Thank you. Data service and total bill amount?
[CUSTOMER][NEUTRAL] So, the data service I have [PII], 2024.
[CUSTOMER][NEUTRAL] And uh the total charge is $1,273 even 1273.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So I do show that this claim was received. This claim was received on 9-25-2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed and denied on 9-27-2024.
[AGENT][NEUTRAL] Uh, let me go back. Let me verify that. I went to the, I clicked to the next screen very fast. Hold on one second. Yes, 927-2024 is when it was processed and denied.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 073 2.
[AGENT][NEUTRAL] And the reason for the denial on this claim, Allen, states.
[AGENT][NEUTRAL] The maximum amount payable for this occurrence has been met.
[AGENT][NEUTRAL] Her occurrence means treatment for the same or related condition unless separated by a period of 90 days.
[AGENT][NEUTRAL] Treatment for the same or related condition, separated by 90 days or an unrelated condition will be considered a new per occurrence. There was another claim received for the same data service prior to yours that maxed out the benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, then I understand.
[CUSTOMER][NEUTRAL] Mm, so [PII], it was uh the 98.
[AGENT][NEUTRAL] Processed and denied, yes, sir, as the maximum amount payable for this occurrence has been met.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm. OK, then, perfect. Thank you so much. And uh you said that you are not able to provide the UB and you wish to get that from the portal, right?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, sir, now that you have the claim number, you should be able to print that.
[CUSTOMER][NEUTRAL] Oh, OK then. Uh mm, uh, can you provide the website again number? Uh, can you please provide the website name again, I'm sorry. It is AB.
[AGENT][NEUTRAL] And do you need anything else on this number?
[AGENT][NEUTRAL] No, it's, it's the first word is [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Dot
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, got you. I am [PII] Awesome, thank you.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yes, sir, secured. [PII]. Yes, sir. And was there anything else on this one, [PII], you needed?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Everything that uh and uh shall him on the next member?
[AGENT][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, and the next number's policy number, [PII]?
[CUSTOMER][NEUTRAL] Mhm. So, the next member ID will be 021.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 975.
[CUSTOMER][NEUTRAL] 45 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you. And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is uh the one moment. OK, got you. [PII] is the first name and the last name will be [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the data service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Oh, this one I have [PII].
[CUSTOMER][NEUTRAL] And the charge amount will be $2,032.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And you said data service is 7-13-2024?
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show this claim was received. This claim was received on [PII].
[AGENT][NEUTRAL] [PII] and it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 351.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1054.
[AGENT][NEUTRAL] And the denial remark states inpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][POSITIVE] Mm, OK. Awesome then, thank you so much.
[AGENT][NEUTRAL] You're welcome. And do you need any other information on this claim?
[CUSTOMER][NEUTRAL] No, no, we can move on the next one.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And the next, uh, and this will be your last one, is that right, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is that policy number?
[CUSTOMER][NEUTRAL] 123.
[AGENT][NEUTRAL] Yeah, this is
[CUSTOMER][NEUTRAL] Uh, so this one, the 6 stone, correct, the last one.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] OK. And the policy number?
[CUSTOMER][NEUTRAL] Mhm. So then member ready.
[CUSTOMER][NEUTRAL] I have 022.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 557
[CUSTOMER][NEUTRAL] 05
[CUSTOMER][NEUTRAL] M as in Mike.
[CUSTOMER][NEUTRAL] L as in Lima, 7.
[AGENT][NEUTRAL] Thank you. And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient name is gonna be [PII] is the first name and the last name will be [PII] and uh the date of birth, uh, I have [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the data service and total bill amount for her place.
[CUSTOMER][NEUTRAL] Oh, this one I have [PII].
[CUSTOMER][NEUTRAL] And uh the bill amount will be $2,032 even.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 2032.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um, the
[AGENT][NEUTRAL] What is the who is the facility, what is the facility name?
[CUSTOMER][NEUTRAL] Uh, it is, uh, [PII] take care, the same one.
[AGENT][NEUTRAL] OK. OK, same thing. OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so this claim was also received. It was received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3511331.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this was denied outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. So, thank you so much.
[AGENT][POSITIVE] Well, you're very welcome. And is there anything?
[CUSTOMER][POSITIVE] And uh and everything got you.
[AGENT][NEUTRAL] Was there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Everything I really appreciate you, [PII], and have a wonderful day. Enjoy the rest of the day.
[AGENT][POSITIVE] Well, you're certainly very welcome. Oh, well, thank you so much. I hope you have a nice uh rest of your day as well, [PII], and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] You too. Take care. Bye-bye.
[AGENT][NEUTRAL] Uh-huh, bye-bye.