AccountId: 011433970860
ContactId: 3b88a7ea-47ee-4923-9c36-436093b769b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1143319 ms
Total Talk Time (AGENT): 330094 ms
Total Talk Time (CUSTOMER): 281954 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/3b88a7ea-47ee-4923-9c36-436093b769b3_20250117T21:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, good afternoon. My name is [PII] and last name initial on [PII]. I'm calling from provider's office regarding claim status.
[AGENT][NEUTRAL] Sure, [PII], I can help you with the claim status. May I have your call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, sure. [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you, [PII], and can you tell me the name of the facility or provider's office you're calling from today?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Uh, the provider of his name is Gastro Health LLC.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what's the policy certificate or member ID number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Uh, the member ID is 01797918 M for Mary, L for Lima, 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And just give me one moment please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] And may I please have you verify the patient's uh name and their date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII], and the date of birth is [PII], sorry, [PII], [PII].
[AGENT][POSITIVE] Great, thank you.
[AGENT][NEUTRAL] OK, thank you for verifying that here and go ahead and give me the uh claim details, date of service and the amount please.
[CUSTOMER][NEUTRAL] Yes, sir. The date of service is [PII] and the total charge is $348 even.
[AGENT][POSITIVE] OK, thank you very much. Just give me one moment while I search claims please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, just verifying date of service [PII] total charges billed were $348.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I show we received that claim in our office on [PII].
[AGENT][NEUTRAL] And the claim number 35.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 352 7.
[AGENT][NEUTRAL] 908 is the claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was finalized and processed out on 11-8-2024.
[AGENT][NEUTRAL] And the claim denied due to the office visit is not covered under this policy, so the secondary policy does not, uh, does not have benefit available for the office visit fee, so the office visit is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one second.
[CUSTOMER][NEUTRAL] So office visit is not covered under the patient plan, right?
[AGENT][NEUTRAL] That's right, mhm.
[CUSTOMER][NEGATIVE] The ENM code is not covered under the question plan number is no plan.
[CUSTOMER][NEUTRAL] Can you please send any of it through fax?
[AGENT][NEUTRAL] I sure can. What's your fax number here?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] And put my name [PII].
[AGENT][NEUTRAL] OK, and that's [PII] and it's [PII] is the fax?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Attention [PII], OK, I'll send that over to you momentarily. Did you have any other questions?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, that's more than the claim.
[AGENT][NEUTRAL] You have another time?
[CUSTOMER][NEUTRAL] Yeah, actually 3 claims. So you already provided 1 claim and the remaining 2 claims is pending.
[AGENT][NEUTRAL] OK, and um these are for the different members or same member?
[CUSTOMER][NEUTRAL] It's a different member.
[AGENT][NEUTRAL] OK, so just give me one moment while I send this fax over to you and then we can move on to the next claim.
[CUSTOMER][NEUTRAL] Yeah, sure. And can you please spell your name?
[AGENT][NEUTRAL] I can. It's [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] My last initial [PII].
[CUSTOMER][POSITIVE] Yeah, thank you, [PII].
[AGENT][NEUTRAL] You're welcome [PII] just give me one moment to send this fax to you and then I'll take that next patient ID number.
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, sure, sure.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, that fax is on its way to you. You can go ahead with the next uh policy number when you're ready, please.
[CUSTOMER][POSITIVE] Yeah, yeah, I'm ready. The next member ID goes to.
[CUSTOMER][NEUTRAL] OK, uh, one second, one second please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Under the same patient, I have a few more data services are there. Sorry for the inconvenience.
[AGENT][NEUTRAL] Uh, for the first patient, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, give me a moment, OK? It's loading.
[AGENT][NEUTRAL] Yeah, that's fine.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][POSITIVE] Yeah, thank you for your understanding.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][NEUTRAL] Yeah. The next date of service is uh
[CUSTOMER][NEUTRAL] [PII] and the total charge $348 even.
[AGENT][NEUTRAL] I'm sorry, September?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Go ahead and repeat that date for me.
[CUSTOMER][NEUTRAL] [PII] and the total charge $348 even.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do have that claim.
[AGENT][NEUTRAL] And it's gonna be that same denial code for the office visit?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And claim details.
[CUSTOMER][NEUTRAL] OK. Can you please provide the receipt denied claim number, that's it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so it was processed on [PII], received [PII]:25 process [PII] claim number 35.
[AGENT][NEUTRAL] 35
[CUSTOMER][NEUTRAL] 1 2nd, 1 2nd.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] One second, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, carry on. May I know the claim number?
[AGENT][NEUTRAL] 35
[AGENT][NEUTRAL] 35
[AGENT][NEUTRAL] 257.
[CUSTOMER][NEUTRAL] Thank you. Is there any chance, can you please send any over through fax this one also?
[AGENT][NEUTRAL] I can mhm let me go ahead and set that up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Once completed, that's more than that like.
[AGENT][NEUTRAL] Is the next claim for the same member as well?
[CUSTOMER][NEUTRAL] Yeah, same member. The date of service is.
[CUSTOMER][NEUTRAL] [PII] and the total charge $347.34 dollars even.
[AGENT][NEUTRAL] 348 for 87 2024.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, claim 353525-7 is on its way to you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And I also have that 87 claim. I'm gonna give you that claim detail in one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 5844 OK claim received 114.
[AGENT][NEUTRAL] Process date is 115. It was finalized on 115 claim number 35.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 25
[AGENT][NEUTRAL] 844.
[AGENT][NEUTRAL] And again that office says that is not covered under the plan, same denial code.
[AGENT][NEUTRAL] And would you like me to send this one as well?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yeah, sure, sure. Can you please send any over the fax?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you got that claim number 352-584-4, that's for the [PII].
[CUSTOMER][POSITIVE] Yeah, I got it.
[AGENT][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] Yeah, I got it. Thank you.
[AGENT][NEUTRAL] You're welcome just one moment while I send that fax over to you.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] OK, that one's on its way to you as well.
[CUSTOMER][NEUTRAL] Thank you. So let's move to another claim, like another patient.
[AGENT][NEUTRAL] OK, what's that policy number?
[CUSTOMER][NEUTRAL] Yeah. The policy number is 1557558M for [PII], L for Lima 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's 1557558, is that right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And data service and the amount on the claim please.
[CUSTOMER][NEUTRAL] OK. The date of service is [PII] and the total charge, $340 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this claim, um, I do have on file claim receive date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, claim was processed, finalized on [PII].
[AGENT][NEUTRAL] Claim number 35.
[AGENT][NEUTRAL] 37
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 953.
[AGENT][NEUTRAL] And that claim denied due to uh the services were rendered after the policy termed, so this policy is no longer active, effective date.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy term, the termination date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I see no coverage after [PII].
[CUSTOMER][NEUTRAL] So ma does not have any other instances?
[AGENT][NEGATIVE] Not with us mm mm.
[AGENT][NEUTRAL] There's no active there's no active policy.
[CUSTOMER][NEUTRAL] No other senses.
[CUSTOMER][NEUTRAL] OK, thank you. And can you please send any over through fax?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, sir. Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] I'm sending that to you now.
[AGENT][NEUTRAL] And is that the only claim for this member?
[CUSTOMER][NEUTRAL] Uh, no, that's more than the claim.
[AGENT][NEUTRAL] For the same number?
[AGENT][NEUTRAL] It's different.
[CUSTOMER][NEUTRAL] Uh, it's a different number.
[AGENT][NEUTRAL] OK, so just give me one moment please.
[CUSTOMER][NEUTRAL] OK. When you're ready, I can provide the
[CUSTOMER][NEUTRAL] I'm already
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So, can I provide the member ID?
[AGENT][POSITIVE] Yes, go ahead when you're ready please.
[CUSTOMER][NEUTRAL] Yeah. It's 05814701.
[CUSTOMER][NEUTRAL] And the patient name is [PII].
[AGENT][NEUTRAL] OK, that one's not coming up in my system. [PII], what's the last name?
[CUSTOMER][NEUTRAL] Yeah, I can spell the name, the last name. It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] OK. The date of birth is [PII].
[AGENT][NEUTRAL] OK, so I'm still searching, so just give me one moment please.
[CUSTOMER][POSITIVE] Yeah, sure, sure. Take your time.
[AGENT][NEUTRAL] You have a social security number for this number?
[CUSTOMER][NEUTRAL] Um, just give me a moment. I'm checking. Is there any social security number there?
[CUSTOMER][NEUTRAL] Uh, no, there is no social security number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And it is [PII].
[CUSTOMER][NEUTRAL] Actually, it's showing like it's American Health Resources, so you are handling this process, I mean this incident, American Health Resources.
[AGENT][NEUTRAL] No, we're American Public Life or APL.
[AGENT][NEUTRAL] So that wouldn't be our member.
[CUSTOMER][NEUTRAL] So this is the different
[AGENT][NEUTRAL] Yeah, I'm not
[CUSTOMER][NEUTRAL] This is the different insurance?
[AGENT][NEUTRAL] Right, I'm not finding that number in our system and it is [PII] correct? [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What city and state are they in?
[CUSTOMER][NEUTRAL] [PII] State.
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] [PII] State.
[AGENT][NEUTRAL] Oh, OK, [PII] is the state, yeah, I don't have that number in our system.
[CUSTOMER][NEUTRAL] OK, thank you. And thank you for giving this information. And may I know the call reference number?
[AGENT][NEUTRAL] Certainly, uh, [PII], the call reference number you used my name in today's date and again it's [PII].
[CUSTOMER][NEUTRAL] Can you please spell it
[AGENT][NEUTRAL] Yeah, R O
[CUSTOMER][POSITIVE] Uh yeah, you already provided and I'm sorry.
[AGENT][NEUTRAL] XY last initial L and today's date. Any other questions?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah. Thank you, [PII].
[CUSTOMER][POSITIVE] Uh, no thanks. And thank you for giving this information and have a nice day, happy weekend.
[AGENT][POSITIVE] You same to you thank you for calling API Harry you have a great weekend as well bye bye.
[CUSTOMER][NEUTRAL] Yeah, bye bye.