AccountId: 011433970860
ContactId: 3fa9f708-a576-4223-9d75-c43786687d79
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1048640 ms
Total Talk Time (AGENT): 298634 ms
Total Talk Time (CUSTOMER): 439223 ms
Interruptions: 6
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/3fa9f708-a576-4223-9d75-c43786687d79_20250513T19:30_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provider check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, um, so I'll be more than happy to help you with the claim status, and you said your name is [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The contact number is [PII]. It's a direct line and the policy number will be 01816167.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have today in total?
[CUSTOMER][NEUTRAL] 3.
[AGENT][NEUTRAL] All for the same member?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] for the different one.
[AGENT][NEUTRAL] OK, and can you verify this member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The member's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Sure. The date of service is [PII] and the total charges will be, bear with me just a second and uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The total charges will be $5,414 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What you going in?
[AGENT][NEUTRAL] OK, do you mind if I place you on just a brief hold, [PII], while I look through these claims?
[CUSTOMER][NEUTRAL] Uh yeah, sure.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So it looks like the claim just finished processing today, um, but we received it on [PII].
[CUSTOMER][NEUTRAL] Like or email like.
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 0560.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] On
[AGENT][NEUTRAL] And there will be a payment of $450 sent to the provider for this claim.
[CUSTOMER][NEUTRAL] $450.
[CUSTOMER][NEUTRAL] And the other amount is the same.
[AGENT][NEUTRAL] The what do you mean the other amount?
[CUSTOMER][NEUTRAL] A large amount allowed.
[AGENT][NEUTRAL] That's what was billed, so that we paid what was billed to us.
[CUSTOMER][NEUTRAL] Alright, OK.
[CUSTOMER][NEUTRAL] And well how was the payment then via check or EFT?
[AGENT][NEUTRAL] It will be a check, but as I stated, it just um
[CUSTOMER][NEUTRAL] Every day I have.
[AGENT][NEUTRAL] It just finished processing today, so all the um like the check number and all of that will populate tonight at [PII].
[CUSTOMER][NEUTRAL] Oh, like
[CUSTOMER][NEUTRAL] OK, perfect. So you need more time to, for the payment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Right, everything will process tonight at [PII]. We just finished it today.
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] OK, so what would be the normal claim processing time?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The time the time to process a claim is 7 to 10 business days, but this claim has already been processed. It just finished today, so it needs time to update so we can give you the check number, but that happens at [PII] tonight.
[CUSTOMER][NEUTRAL] What will be the normal processing?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bear with me just a moment.
[CUSTOMER][NEUTRAL] Like this
[CUSTOMER][NEUTRAL] OK [PII] and.
[CUSTOMER][NEUTRAL] As you said, the payment, the claim is set to pay. It's not paid yet, but it will be paid tonight, am I right?
[AGENT][NEUTRAL] OK, the claim has finished processing, so I'm able to see the amount that is going to be paid, which is $450. In terms of a check number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, yeah, I got you, but
[CUSTOMER][NEUTRAL] Yeah, but the check number, the payments, mailing address, and everything has been not popped up yet, popped up yet. Am I right?
[AGENT][POSITIVE] Right, because we just finished it today, so that's why I'm able to see the amount. If you want to give us a call back later in the week, we'll have that information for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, yeah, that's what I'm asking what will be the turnaround time for the processing.
[AGENT][NEUTRAL] The the claim is done processing. We just need time for it to show in our system. You can call us by Friday and it'll be in the system.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, that's what I'm asking you. What will be the turnaround time?
[AGENT][NEUTRAL] There isn't one. I'm just giving you one for the call. So Friday will be a good day if you'd like to call us for the check information.
[CUSTOMER][NEUTRAL] Yeah, can I get your number?
[CUSTOMER][NEUTRAL] this one.
[AGENT][NEUTRAL] Would you like to move on to the next claim?
[CUSTOMER][NEUTRAL] Uh, yeah, and just a moment, give me a minute.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the turnaround time.
[CUSTOMER][NEUTRAL] OK, will be the 3 days.
[AGENT][NEUTRAL] You, whichever you could uh.
[AGENT][NEUTRAL] I don't want to say there is no turnaround time, sir. Today at [PII], all the information will populate between tonight and whenever you like, you can call for an update on the checking information. It's just not on here right now because we just finished processing it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, no worries.
[CUSTOMER][NEUTRAL] What will be the call reference number for our conversation?
[AGENT][NEUTRAL] The call reference number for the entire call will be my name and today's date, and again, that's [PII].
[CUSTOMER][POSITIVE] OK, perfect. So we move to the next thing?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, for the different member.
[CUSTOMER][NEUTRAL] And the member ID, bear with me just a moment.
[CUSTOMER][NEUTRAL] The member ID is 01823113 M as in Mike, L as in Lima, and the number 8.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, it's the member's first name is [PII] and the last name is
[CUSTOMER][NEUTRAL] I would like to spell the last name. It's [PII], again, [PII].
[CUSTOMER][NEUTRAL] And the date of birth will be [PII].
[AGENT][NEUTRAL] Thank you for that. And the date of service and total bill?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total bill amount will be $300 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And did you need the claim status on the original claim or the duplicate or both?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh, the recent claim has been denied as duplicate.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is there recent claim denial is duplicate.
[AGENT][NEUTRAL] I don't know. Can you say that slowly, please?
[CUSTOMER][NEUTRAL] I'm asking you the recent claim is denied, denied as duplicate or not.
[AGENT][NEUTRAL] Yes, we have an original claim and we have the duplicate. I'm asking which one would you like me to give you the status on or both?
[CUSTOMER][NEUTRAL] OK. You can provide me, yeah, you can provide me the both. First, you can start with the duplicate one.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] The duplicate was received on [PII].
[AGENT][NEUTRAL] Claim number is 3574588.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And on [PII], the claim was denied as a duplicate.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Of the original claim, which was received on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The claim number is 332.
[AGENT][NEUTRAL] 8771.
[CUSTOMER][NEUTRAL] the TV.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on the policy.
[CUSTOMER][POSITIVE] OK, perfect. Just a moment.
[CUSTOMER][NEUTRAL] Under the member's plan, am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A that.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, could you please tell me which CPT code is not covered under the member's plan?
[AGENT][NEUTRAL] There's only one CPT code on the claim, it's 99213.
[CUSTOMER][NEUTRAL] OK, and the office visits are not covered, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And what will be the time you find to submit the corrected claim?
[AGENT][NEGATIVE] Um, there's no timely filing for corrected claims.
[CUSTOMER][NEUTRAL] OK. What will be the mailing address to submit the collected claim?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And what will be the mailing address to submit the correct claim?
[AGENT][NEUTRAL] The address I just gave you.
[CUSTOMER][NEUTRAL] OK, perfect. And what will be the timely filing, whether it will be the same, no timely filing limit?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any specific form for an appeal?
[AGENT][NEUTRAL] Um, no, there's no, um, forms for an appeal. You would just have to show that it wasn't, um, done in the office.
[CUSTOMER][NEUTRAL] And OK, perfect. And it denied you is required while submitting the claim or a fee.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, shall we move to the next one?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Yeah, sure. Take your time. Tell me once you're ready.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and then um next member's policy number?
[CUSTOMER][NEUTRAL] 01816168.
[CUSTOMER][NEUTRAL] I'll be in the box.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the member's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][NEUTRAL] Thank you for that. And the date of service and total bills?
[CUSTOMER][NEUTRAL] If you like
[CUSTOMER][NEUTRAL] The service will be [PII] and total bill amount, give me a second and uh just a moment.
[CUSTOMER][NEUTRAL] $9,232 is the total bill amount.
[AGENT][NEUTRAL] Did you say 1000 or 9000?
[CUSTOMER][NEUTRAL] 9000.
[CUSTOMER][NEUTRAL] $9,232.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, so I'm not showing a claim on file for [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, the claim is not on file.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] um
[CUSTOMER][NEUTRAL] OK. Is the patient active on the date of service?
[AGENT][NEUTRAL] Yes, um, this policy is still active, it's been effective since [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK. And could you please tell me, are you primary or secondary?
[AGENT][NEUTRAL] We're secondary.
[CUSTOMER][NEUTRAL] Do you have any information about when was the coordination of benefits were updated?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, the coordination of benefits has been the same since the policy became effective, um, which was [PII]. We are second to United Healthcare only.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK perfect and the further details will be the same claim submission, timely filing and the mailing address.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Could you please help me with the pay ID then?
[AGENT][NEUTRAL] Sure, 60801.
[CUSTOMER][POSITIVE] Perfect. And the prefer mode of submission will be the either mail or electronic.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The preferred mode of submission will be either mail or electronic, am I right?
[AGENT][NEUTRAL] Preferred, or, whichever you prefer.
[CUSTOMER][NEUTRAL] OK, perfect. And call reference number will be your name and today's date. Am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you for your assistance, [PII]. I hope you have a great day and
[CUSTOMER][POSITIVE] It was a pleasure talking to you, [PII].
[AGENT][POSITIVE] All right, thank you. Um, a pleasure talking to you also, [PII], was there anything else I can assist with?
[CUSTOMER][POSITIVE] Uh, no, [PII], thanks for your assistance.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. Bye-bye.