AccountId: 011433970860
ContactId: 3b371aea-f8fe-43d5-9925-a77025193d90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 756890 ms
Total Talk Time (AGENT): 297084 ms
Total Talk Time (CUSTOMER): 231938 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/3b371aea-f8fe-43d5-9925-a77025193d90_20250210T21:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], good afternoon. My name is [PII]. I'm calling for claiming status, please.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Mm, the policy number, 1 2nd.
[CUSTOMER][NEUTRAL] It's 02419401.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] the be.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] Alright, thanks for verifying that information. What's a good phone number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] You gave me [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK and you said you're checking claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, we can provide information to you. What's the date of service and charge?
[CUSTOMER][NEUTRAL] The day of service, one of them is [PII] for $2,458.31.
[AGENT][NEUTRAL] OK. How many do you have?
[CUSTOMER][NEUTRAL] I have, uh, for the same the same patient, I have 2 more days of service.
[AGENT][NEUTRAL] What are the dates of service?
[CUSTOMER][NEUTRAL] Mm, I have [PII]. Give me one second, I need to review the charge amount.
[CUSTOMER][NEUTRAL] It was for.
[CUSTOMER][NEUTRAL] $374.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And the last one is uh [PII].
[CUSTOMER][NEUTRAL] And the amount on this one is.
[CUSTOMER][NEUTRAL] The the the amount was $501 saving.
[AGENT][NEUTRAL] You can also check claim status on our online service center at [PII] as well. One moment.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK, so I do not show that [PII] date of service on file, so that one has not been received.
[AGENT][NEUTRAL] You did say [PII], right?
[CUSTOMER][NEUTRAL] [PII], 5 [PII].
[AGENT][NEUTRAL] So [PII], OK, I do see [PII]. What are the pro excuse me, what are the procedure codes on the claim?
[CUSTOMER][NEUTRAL] Um, I have 784-5289502 J 2785.
[AGENT][POSITIVE] OK, I see it, thank you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So I'm showing this claim was received [PII], processed [PII], issuing a payment of $977.12.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] You said $9977.12?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 1314.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I, can I know the payment information? Check details?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let's move to the next state of service one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You're wanting to move to the next date of service?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, so we're gonna go ahead and move to [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. [PII], that's what I have written down. I may have said the [PII], but I have [PII] for $374.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim received [PII] processed on [PII].
[AGENT][NEUTRAL] And what are the procedure codes on this claim?
[CUSTOMER][NEUTRAL] 93,000 and 99214.
[AGENT][NEUTRAL] OK, I only show one procedure code on this claim, and that is procedure code 93,000, uh, pay $10.87.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't show an office visit charge on that claim.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Maybe it was not submitted because the patient does not have um benefits for office visit.
[AGENT][NEUTRAL] OK. The claim number is 353.
[CUSTOMER][NEUTRAL] OK, well.
[AGENT][NEUTRAL] 4959.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the last date of service I have is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that is 4501.
[AGENT][NEUTRAL] Uh, the state of services after the policy term.
[AGENT][NEUTRAL] I do think they have another policy, so let me look under the one that became effective [PII]. Give me a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and I do see, I don't see [PII].
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go back and look at the other policy number real quick.
[AGENT][NEUTRAL] So what we need to do is move this claim under the other policy.
[AGENT][NEUTRAL] And so we can send this back to be reprocessed?
[CUSTOMER][NEGATIVE] Because this one was denied uh for coverage terminated.
[AGENT][NEUTRAL] Right, but they have a new policy. Let me give you the current policy number that was effective [PII], that number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] 255.
[AGENT][NEUTRAL] 6504.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So we'll request that the the state of service be reprocessed under that that current policy number.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Alright, anything else I could help with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, I would like to know if are you able to see the the payment information for the first to claim the check um the check number and the day.
[CUSTOMER][NEUTRAL] And if the checks were already cash.
[AGENT][NEUTRAL] So for
[CUSTOMER][NEUTRAL] But before are you going to give me any reference number for the sending back?
[AGENT][NEUTRAL] I'll give you that at the end of the call, so I'm gonna go back to claim number 353-4959. This is for Data Service [PII].
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] 24
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The check number for this date of service is 201.
[AGENT][NEUTRAL] 5653.
[AGENT][NEUTRAL] Uh, the check date is the date that the claim was processed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This check cleared on [PII].
[CUSTOMER][NEUTRAL] It was a single check or uh it is a bulk amount OK paper check.
[AGENT][NEUTRAL] It's a single check, paper check, single paper check.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then claim number 354-1314.
[AGENT][NEUTRAL] The check number is 2018542.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This check was issued the date that the claim was processed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm showing that
[AGENT][POSITIVE] This check appears to be still outstanding.
[AGENT][NEUTRAL] What's your billing address?
[CUSTOMER][POSITIVE] Outstanding.
[CUSTOMER][NEUTRAL] OK, our billing address is [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Yeah, that's the address that the check was mailed to?
[CUSTOMER][NEUTRAL] Mhm, but is it still on this outstanding?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] When was they did again, the, the check for this one?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Um.
[CUSTOMER][NEUTRAL] How long we need to wait until the, the, the check can be reissued or are you able to do it right now?
[AGENT][NEUTRAL] Yeah, we can. It's been over 30 days so we can verify.
[AGENT][NEUTRAL] Um, whether or not the check is cleared, that may take anywhere from 3 to 5 business days, but we can check to see if this check has actually cleared the bank if it has not, um, then request that this check be voided and a new one reissued.
[AGENT][NEUTRAL] But like I said, that process is about 3 to 5 days.
[CUSTOMER][NEUTRAL] OK, can, can we request a reissue check right now?
[AGENT][NEUTRAL] Yes, well, we have to first verify if it's cleared the bank even though I show it outstanding sometimes when they check with the bank it's cleared so we have to do that process first and if it has not cleared then at that time they can void this current check and reissue a new check. If it has cleared, they'll send us a copy of the front and the back. Does the check come to your location or does it go to a different building?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] It's, it goes to to my location, but in a different floor.
[AGENT][NEUTRAL] OK, can you check with them first?
[CUSTOMER][NEUTRAL] OK. OK, so.
[AGENT][NEUTRAL] Since you have the check number and the amount before we do the, before we start the process and in fact if they do not have it, then you can call us back at that time and then we can start the process.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I will do that. I'm going to check with them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, can I have the reference number for this call? That was the only patient that I have for today. Thank you so much.
[AGENT][NEUTRAL] OK, you'll use my name and today's date is your reference [PII].
[AGENT][NEUTRAL] Oh NYA.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then first initial last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. That's all for now. Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You're welcome and thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] Bye.