AccountId: 011433970860
ContactId: 3f0c6b4f-f1af-4c65-907e-a71f08a333b6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 477739 ms
Total Talk Time (AGENT): 101935 ms
Total Talk Time (CUSTOMER): 223724 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/3f0c6b4f-f1af-4c65-907e-a71f08a333b6_20250508T18:58_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APM. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. Initial of my last name, [PII], calling from provider office to check on a claim status. But before I proceed, kindly note that this call is being recorded for quality and training purposes. Are you OK with that?
[AGENT][POSITIVE] I'd be happy to assist with claim status today, [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] It is [PII] the [PII] of [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is 019.
[CUSTOMER][NEUTRAL] 821
[CUSTOMER][NEUTRAL] 75 M Mike Lima 8.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And the date of service for the claim?
[CUSTOMER][NEUTRAL] Yeah, there are two data services for the same patient, and the first one is [PII]. Bill amount is $1,606 even.
[AGENT][NEUTRAL] And the tax ID?
[CUSTOMER][NEUTRAL] 542 1.
[CUSTOMER][NEUTRAL] 29332.
[AGENT][NEUTRAL] Thank you for that. I'm showing claim was denied because we need the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] Yeah, like, uh, for both data services we have, uh, already sent the primary UB through fax, uh, for this service we have sent on [PII].
[CUSTOMER][NEUTRAL] And for the other one it is [PII].
[AGENT][NEUTRAL] I'm not sure we sent that. Can you verify the fax number you used?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that's the correct one. I'm not sure we've received it. If you wanna try sending it again, that's fine.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me send you again.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] So I have 2 more claims, so the call reference will be the same or different?
[AGENT][NEUTRAL] It'll be the same. It's just my name [PII] last [PII] [PII], and the date and time of the call. Uh, now are the claims for a different, um, policy number or the same policy number?
[CUSTOMER][NEUTRAL] Same policy, uh, different member ID but same provider.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, the next policy is 02377455.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] It is [PII]. The amount is $1,011 even.
[AGENT][NEGATIVE] Claim denied because I'm not claim denied because we need the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] OK, so you need primary before this one also, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, primary you'll be.
[CUSTOMER][NEUTRAL] What it
[CUSTOMER][NEUTRAL] Uh, do you have the claim number?
[AGENT][NEUTRAL] Claim number is 3556755.
[CUSTOMER][NEUTRAL] And received it?
[CUSTOMER][NEUTRAL] And claim received on?
[AGENT][NEUTRAL] [PII] claim denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. OK. Just a moment, pulling up the next one.
[AGENT][NEUTRAL] Is it a different patient?
[CUSTOMER][NEUTRAL] Yeah, different patients, same provider.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 243
[CUSTOMER][NEUTRAL] Yeah. The next member ID is [PII] and [PII].
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] It is [PII]. Bill amount is $300 even.
[AGENT][NEUTRAL] And you said that data service was [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm not sure we have that claim on file.
[CUSTOMER][NEUTRAL] We don't have claim um like actually we have previously made the call and we have sent the primary because it was.
[AGENT][NEUTRAL] Oh, that's a different policy. Hold on a minute.
[CUSTOMER][NEUTRAL] Mm, no, yeah, yeah.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Do you want me to spell uh policy number again?
[AGENT][NEUTRAL] [PII]. OK, um, and OK, I see it right here. So it looks like we denied it because we needed the EOB and then the second time we received it, we made a $50 payment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, OK, 19.
[CUSTOMER][NEUTRAL] Yeah, on [PII] you have sent and you have made the payment of $50 so the remaining $10 you will pay or not like.
[AGENT][NEUTRAL] Patient responsibility.
[CUSTOMER][NEUTRAL] OK, she's ready.
[CUSTOMER][NEUTRAL] OK. $10.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Uh, the last one.
[CUSTOMER][NEUTRAL] Different
[CUSTOMER][NEUTRAL] Pa ID
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] It is 024.
[CUSTOMER][NEUTRAL] 787
[CUSTOMER][NEUTRAL] 69 Miami, L Lima 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] And the patient name is
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] The data service for the claim?
[CUSTOMER][NEUTRAL] It is [PII]. The amount is $300 even.
[AGENT][NEGATIVE] I'm showing claim denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK, uh, it is patient responsibility, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] $15.
[CUSTOMER][NEUTRAL] Yeah, uh,
[CUSTOMER][NEUTRAL] So what is the plan that patient have?
[CUSTOMER][NEUTRAL] Do you have the plain name?
[AGENT][NEUTRAL] This is a gap policy.
[CUSTOMER][NEUTRAL] Gap policy, OK.
[CUSTOMER][NEUTRAL] and got it.
[CUSTOMER][POSITIVE] OK. So, thank you, [PII] for your assistance and have a wonderful day ahead.
[AGENT][NEUTRAL] Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] That's it. Thank you.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] Yeah bye.