AccountId: 011433970860
ContactId: 3b65481f-bbbd-448a-8d59-4a67739a8dc8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1747689 ms
Total Talk Time (AGENT): 450788 ms
Total Talk Time (CUSTOMER): 439228 ms
Interruptions: 6
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/3b65481f-bbbd-448a-8d59-4a67739a8dc8_20250417T21:00_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, good afternoon. My name is [PII] and last term in is [PII]. I'm calling from Proda's office regarding the claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Mr. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number Mr. [PII]?
[CUSTOMER][NEUTRAL] Sure. So totally it claims, is it OK for you?
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's move to the first one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. The first member ID is 01841206 M for [PII], L for [PII], 7.
[CUSTOMER][NEUTRAL] And the patient name is [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] Bear, bear with me, uh, OK, Mr. [PII], you need to give me time to pull up the policy, look at the information and verify the information. OK, so let me pull the policy first and then we can go from there, OK?
[CUSTOMER][NEUTRAL] Yeah, OK, OK, sorry.
[AGENT][NEUTRAL] OK, it's OK. Um, let me have the name and date of birth now.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth [PII].
[AGENT][NEUTRAL] Thank you. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and the total charge $348 even.
[AGENT][NEUTRAL] OK, thank you. So that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, we received the claim on [PII], processed [PII].
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] And the claim was denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK. And may I know the member ID?
[AGENT][NEUTRAL] The member like the policy number or what member ID?
[CUSTOMER][NEUTRAL] Uh, sorry. May I know the claim number? Sorry.
[AGENT][NEUTRAL] OK. It's OK. The claim number is 3,549,300.
[CUSTOMER][POSITIVE] Thank you so much. And can you please send any your through fax?
[AGENT][NEUTRAL] OK, yes. What is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And also, can you please attention, put my name, [PII]?
[AGENT][NEUTRAL] How do you spell it?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] How do you spell your name just to make sure I spell it correctly on the fax.
[CUSTOMER][NEUTRAL] OK. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] One moment, let me go ahead and fax this one so I can finalize this 11 moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] And you don't have any other claims on this member?
[CUSTOMER][NEUTRAL] OK, one second. No.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] OK, what's the next, yeah, what's the next policy number?
[CUSTOMER][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a moment, it's loading.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK. The next member ID is 1449360M for [PII], L for Lima, 5.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge is $294 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now it's [PII].
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Good
[AGENT][NEUTRAL] All right, um, so for this one, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we received the claim on [PII], processed [PII], and the claim was denied stating that the service was rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK. Family filing, right?
[CUSTOMER][NEUTRAL] Uh, sorry, after coverage standard patient is in active.
[AGENT][NEUTRAL] Yes, the coverage was terminated. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May the effective date and termination date.
[AGENT][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] Effective date is [PII], terminated [PII].
[CUSTOMER][NEUTRAL] [PII] of the termination date.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] is the termination date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Let's move to the plan.
[AGENT][NEUTRAL] Mhm. OK, bear with me just a second. Let me go ahead and make the note and you don't need any other information on this one?
[CUSTOMER][NEUTRAL] Uh, no, thanks. Um one second, ma'am, oh, I forgot the claim number.
[AGENT][NEUTRAL] OK, let me get that for you, one moment.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] OK, the claim number on this one is 3556978.
[CUSTOMER][NEUTRAL] 3556978, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] I'm ready for the next one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next member ID is [PII] [PII].
[AGENT][NEUTRAL] And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge $340 even.
[AGENT][NEUTRAL] OK. [PII], correct?
[AGENT][NEUTRAL] I mean, [PII].
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so this one was received [PII], processed [PII], and the claim was denied. The reason for this denial is that the service was rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Of the coverage.
[CUSTOMER][NEUTRAL] OK. Uh, if you don't mind, can you please repeat again one time that I received it and denied it.
[AGENT][NEUTRAL] Um, yes, [PII], the received date.
[AGENT][NEUTRAL] [PII] is the process date.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Can you please provide the effective date and termination date?
[AGENT][NEUTRAL] Yes, that is [PII].
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] May I have a claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, that is 358-00998.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's more than the patient.
[AGENT][NEUTRAL] OK the next policy.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The member ID [PII] M for Mary L for Lima 5.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of uh [PII].
[AGENT][NEUTRAL] What's the date of service and the amount of the time?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge.
[CUSTOMER][NEUTRAL] $751 even.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] That was [PII], correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Pan.
[CUSTOMER][NEUTRAL] Be.
[AGENT][NEUTRAL] OK, and it looks like we received the claim on [PII], processed [PII].
[CUSTOMER][POSITIVE] Thanks
[AGENT][NEUTRAL] And the claim was denied. The denial reason is that the service was surrendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Mm, OK. May I the effective date and termination date.
[AGENT][NEUTRAL] OK, so for this one, we have, let's see.
[CUSTOMER][NEUTRAL] OK uh I'll.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Effective [PII].
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] And terminated [PII].
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Thank you and may I have the claim number.
[CUSTOMER][NEUTRAL] You'll be.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Therapy is kind of daily.
[AGENT][NEUTRAL] The claim number on this one is.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] 358.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 0421.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Let's move the claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment, let me finalize the note.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Alright, go ahead with the new policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's loading.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, the member ID is 60801?
[AGENT][NEUTRAL] And that's the payer ID.
[CUSTOMER][NEUTRAL] OK. Uh, the patient name is [PII].
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] Uh, well, because we don't have a valid member ID.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And you don't have her social?
[CUSTOMER][NEUTRAL] OK. One second, I can provide the social security number.
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] Yeah. Actually, we don't have any social security number. Is there any chance, can you please check with patient name and date of birth?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, um, I can do a name search bear with me.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you know Ms. [PII], um Miss [PII] address?
[CUSTOMER][NEUTRAL] OK. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh yeah, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, I'm still searching. OK.
[AGENT][NEUTRAL] Mm let me I think it's this one. What's her date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, yeah, and what is the day of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK, you found the claim?
[AGENT][NEUTRAL] Uh, I need the date of service and the amount of the claim.
[AGENT][NEUTRAL] A family member.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge is $348 even $348.
[AGENT][NEUTRAL] OK, let me see if I can find it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] I don't see that claim on file. You said [PII]?
[CUSTOMER][NEUTRAL] [PII], yeah, [PII].
[AGENT][NEUTRAL] Yeah, that claim is not on file.
[CUSTOMER][NEGATIVE] And the total charge $348 even.
[AGENT][NEUTRAL] Mhm. That claim is not on file.
[CUSTOMER][NEUTRAL] OK. And what is the effective date and termination date?
[AGENT][NEUTRAL] OK, so this particular policy has an effective date of
[AGENT][NEUTRAL] In [PII] and it's still active at the moment.
[CUSTOMER][NEUTRAL] Um, just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sorry for the inconvenience. Can you please repeat again one more time the effective date?
[AGENT][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] In [PII], which is active at the moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No claim on file. Thank you. And let's go to the other patient.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me just. And do you need the policy number to submit the claim because you didn't have a policy number, and maybe that's why you.
[CUSTOMER][NEUTRAL] Oh yeah, yeah. I forget, I forget to take your policy number.
[AGENT][NEUTRAL] You're doing some of the kind.
[AGENT][NEUTRAL] OK. The policy number for this one? Yes, 02.
[CUSTOMER][NEUTRAL] Yeah, can you please provide the policy number?
[AGENT][NEUTRAL] 33
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7116.
[CUSTOMER][NEUTRAL] 023371-16, right?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and bear with me just a minute, let me finalize the note on this one.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, OK. Take your own time.
[AGENT][NEUTRAL] Like
[AGENT][NEUTRAL] Alright, and what is the next policy number?
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 3 consecutive 4.
[CUSTOMER][NEUTRAL] 50
[CUSTOMER][NEUTRAL] 1 M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and the total charge $2,862 even.
[AGENT][NEUTRAL] 2,863.
[CUSTOMER][NEUTRAL] No, $2,862 2862.
[AGENT][NEUTRAL] 16. OK. Now it's [PII], OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me look at this one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm waiting on an EOB and see if this is your claim, bear with me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] OK, um, no, I don't see that claim on file for the 2,862.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] May I know the effective date and termination date?
[AGENT][NEUTRAL] We have an effective date of [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] I can still like to.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Let's move to the last claim.
[AGENT][NEUTRAL] Bear with me just a second, let me finalize the note.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] The policy number is 02265489 M for Mary L for Lima 8.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure. It's [PII] and the date of birth, [PII].
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK. It's [PII] and the total charge is $237 even.
[AGENT][NEUTRAL] OK, [PII] or [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Let me see if I can find that.
[AGENT][NEUTRAL] OK, so this one was received on [PII], processed [PII].
[AGENT][NEUTRAL] And it was denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK. And may I have the claim number?
[AGENT][NEUTRAL] For this one is 30 I'm sorry, 358.
[AGENT][NEUTRAL] 0405.
[CUSTOMER][NEUTRAL] Thank you and can you please send any over through fax?
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] I just.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Because I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 6.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah. Thank you. And can you please spell your name?
[AGENT][POSITIVE] OK. You're welcome.
[AGENT][NEUTRAL] That's [PII], last initial [PII].
[CUSTOMER][POSITIVE] Yeah, thank you. Thank you for giving this information. Have a nice day.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You as well. Thank you for calling APR.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, bye bye.