AccountId: 011433970860
ContactId: 3f5d76cc-c362-4ded-a2a8-8f22cbb0a7c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 920330 ms
Total Talk Time (AGENT): 332920 ms
Total Talk Time (CUSTOMER): 199440 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/3f5d76cc-c362-4ded-a2a8-8f22cbb0a7c7_20250527T20:47_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] Hello, I'm [PII] calling from Hospital regarding the claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing to check claim status. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that, [PII], and what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And how many claims do you have to check status on [PII]?
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] OK. Is it for 2 different patients or is it 1 patient with two dates of service?
[CUSTOMER][NEUTRAL] Different
[AGENT][NEUTRAL] OK, so you, I can help you with both. You will use my name that I gave you along with today's date as each call reference number for your call reference number on each one.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Also, any information that I provide for you on the claims will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of the explanation of benefits once I provide you the claim number, you can print them, [PII] by going to our portal at [PII].
[AGENT][NEUTRAL] And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] 01897878
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for him, please.
[CUSTOMER][NEGATIVE] The sorry, the service [PII] and the bill amount $153 even.
[AGENT][NEUTRAL] 153, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and you said date of services [PII], is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, so there is no claim on file for him for that data service.
[CUSTOMER][NEUTRAL] Can you please provide me the hotel down there, please?
[AGENT][NEUTRAL] I'm sorry, provide you what?
[CUSTOMER][POSITIVE] Effective and term date.
[AGENT][NEUTRAL] There is no term date. This policy is active, effective [PII].
[CUSTOMER][NEUTRAL] [PII] off.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And still active. OK. What is your mailing address?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] What was your question?
[CUSTOMER][NEUTRAL] Mailing address.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] And because this is a supplemental policy, [PII], we will have to also receive a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] What is the time to find in the.
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][NEUTRAL] Time defining limit for the same.
[AGENT][NEUTRAL] Yes, ma'am, and I just said that there is no timely filing limit.
[CUSTOMER][NEUTRAL] I mean, what is that?
[CUSTOMER][NEGATIVE] I'm just having the pain.
[AGENT][NEGATIVE] Yes ma'am, we do not have a timely filing limit. There is no timely filing limit with APL.
[CUSTOMER][NEUTRAL] But the very.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801, is it?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Call reference number and your name?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Uh, I just want, want you to spell your name.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] That uh call the first your email it, OK.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And what is your ex patient?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yes, just a second.
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] Yes, the policy number is 019.
[CUSTOMER][NEUTRAL] 3 consecutive 010.
[AGENT][NEUTRAL] 019000. Is that correct?
[CUSTOMER][NEUTRAL] 10.
[AGENT][NEUTRAL] OK, [PII], thank you. And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient's name is?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Data service [PII] bill amount $9,428.50.
[AGENT][NEUTRAL] 942 8.50.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And again, data services [PII], is that correct?
[CUSTOMER][NEUTRAL] 14.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this claim was received on 4-28-2025?
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 5065.
[AGENT][NEUTRAL] And the reason for the denial, [PII], on this claim states the following.
[AGENT][NEUTRAL] Be excuse me, benefits have been applied to the $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] $350 has been applied to the $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] Have been applied?
[CUSTOMER][NEUTRAL] $3130 applied for.
[AGENT][NEUTRAL] 350.
[AGENT][NEUTRAL] $350.
[CUSTOMER][NEUTRAL] Apply for
[AGENT][NEUTRAL] The $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] $1000.
[CUSTOMER][NEUTRAL] Deductible, is it?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] What is $1000 that is payment?
[AGENT][NEUTRAL] This policy has a $1000 outpatient calendar year deductible that must be met.
[AGENT][NEUTRAL] So the $350 benefit was applied to that deductible.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] Oh I got a meeting with this.
[AGENT][NEUTRAL] It is the same as the other one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just just. OK.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the ID?
[AGENT][NEUTRAL] The same, 60801.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Do you have time to time [PII]t for this?
[AGENT][NEUTRAL] Uh, the original claim has already been processed. We just went over the remarks.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The claim has been processed, [PII]. The initial claim there is no timely filing limit. It's the same information as the member that I just provided for you.
[CUSTOMER][NEUTRAL] There is no time to file limit.
[AGENT][NEGATIVE] For the original claim, there is not.
[CUSTOMER][NEUTRAL] For processing one?
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] So the original claim there is no um time defining limit rate.
[AGENT][NEUTRAL] No timely filing limit for the original claim to be filed.
[CUSTOMER][NEUTRAL] For processing the claim?
[AGENT][NEUTRAL] This claim has been processed, [PII].
[CUSTOMER][NEUTRAL] OK, sorry. And will you please send me the copy of your?
[AGENT][NEUTRAL] Yes, you may print that from the portal that I gave you when we first got on the call. I gave you the website that you can print that from.
[CUSTOMER][NEUTRAL] OK. Oh, you want to provide me the ID?
[CUSTOMER][NEUTRAL] I have X
[AGENT][NEUTRAL] Can you not print it, [PII]?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Can you print?
[CUSTOMER][NEUTRAL] Uh, no, I don't have that, so I'm just asking you to, uh, send the via fax.
[AGENT][NEUTRAL] I've
[AGENT][NEUTRAL] I'm sorry, you, I'm sorry. Can you repeat what you, you don't have what?
[CUSTOMER][NEUTRAL] Can you please
[CUSTOMER][NEUTRAL] I don't have the website. So can you please send me the UV via fax?
[AGENT][NEUTRAL] Just a moment, [PII].
[CUSTOMER][NEUTRAL] And I'll, I will provide you the fax number.
[AGENT][NEUTRAL] Yes, ma'am, but I'm not ready for that yet. I need to get the explanation of benefits pulled up first and get it ready to fax, and then you can provide me that.
[CUSTOMER][NEUTRAL] Oh, OK, sure.
[CUSTOMER][POSITIVE] OK, sure, take your time.
[AGENT][NEUTRAL] And what is your claim, uh, excuse me, what is your fax number, [PII]?
[CUSTOMER][NEUTRAL] 678.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that was 678301, wait just one second. Let me repeat that again. [PII]. Is that correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, that explanation of benefits has been faxed to you.
[AGENT][POSITIVE] So you should be receiving that shortly.
[CUSTOMER][NEUTRAL] OK. And also,
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] And call reference number is your name and tore it, is it?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for providing the information. Have a good day.
[AGENT][NEUTRAL] You're welcome, [PII].
[AGENT][POSITIVE] Yes, ma'am. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] OK, well thank you again for calling APL and I hope you have a nice day also.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] That bad?