AccountId: 011433970860
ContactId: 3fc2e421-f3d8-450a-8c47-d1018023b695
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 973359 ms
Total Talk Time (AGENT): 237330 ms
Total Talk Time (CUSTOMER): 249780 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/3fc2e421-f3d8-450a-8c47-d1018023b695_20250417T19:02_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], um, this is [PII] from Arent Health Services, and I would like to check on some claims status, please.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status, and can you repeat your name for me please and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII]. And the best call back number is [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] And well I have 3 patients on file um let me see, and I have 8 claims in total for them.
[AGENT][NEUTRAL] 8 claims.
[AGENT][NEUTRAL] And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, it is 02560592.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it is [PII]. Date of birth.
[CUSTOMER][NEUTRAL] [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 um data of service and the total bills?
[CUSTOMER][POSITIVE] Yes. It is actually.
[CUSTOMER][NEUTRAL] Are two claims for this memory and it is the same date of service. It is 12-9-2024 and the first one is with a billed amount of $224 and the 2nd 1 $50.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, let me see.
[CUSTOMER][NEUTRAL] Like the facility, well, it is.
[CUSTOMER][NEUTRAL] Eureka Park Clinic or AHS Oklahoma Physician Group.
[AGENT][NEUTRAL] Thank you for that, and it came up AHS Oklahoma Physician Group. So I'm not showing a claim on file for the $224 but for the $50 we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim number is 3554774.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Let me just go ahead and make some notes here. Thank you so much. OK, [PII]? Hold on a second.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So process date [PII]. OK, got that.
[CUSTOMER][NEUTRAL] And OK, and you need a copy of the primary.
[CUSTOMER][NEUTRAL] You'll be.
[AGENT][NEUTRAL] Yeah. Mhm.
[CUSTOMER][POSITIVE] OK. So, yes, well, I can definitely send it over.
[CUSTOMER][NEUTRAL] Faxed to you and
[CUSTOMER][NEUTRAL] And well in that case for the first data service, um, I do show here that let me just double check.
[CUSTOMER][NEUTRAL] It was already processed by the primary as well, so it would be great if we can fax you the claim and the UV as well.
[AGENT][NEUTRAL] Yes, you can file a claim for the 224. Um, there's no timely filing.
[CUSTOMER][NEGATIVE] There's no timely filing along with the EOB as well, if it was already processed by the primary.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed through primary, but it was never sent to secondary, so you're filing a claim for the $224 and you're just presenting the explanation of benefits for the $50 because we did receive a claim for that.
[CUSTOMER][NEUTRAL] Exactly, yes. However, I'm talking about the, the other one, the $224 so it was already processed by the primer as well. So it would be great if you can attach the UB as well, or it's not necessary just the claim.
[AGENT][NEUTRAL] When you file the claim for the $224 the explanation of benefits from primary insurance will be included. You're filing a claim for that one.
[AGENT][NEUTRAL] Because there's nothing on file here.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Oh, OK. Thank you so much, and for the clarification, and well, the next member is, let me see.
[AGENT][NEUTRAL] Hold on one second. So that's all for this member?
[CUSTOMER][NEUTRAL] OK, the
[CUSTOMER][NEUTRAL] Oh yeah, let me just, could you please send me
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh no, it's not, yeah, we're done with that one, sorry.
[AGENT][NEUTRAL] OK, hold on one moment, let me note that policy.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] It is 01823412.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, of course. It is uh [PII].
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And again, just for the call, 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 this number?
[CUSTOMER][NEUTRAL] Yes, for the service is [PII].
[CUSTOMER][NEUTRAL] And build the amount 224 and second date of service is [PII] build amount 224 as well.
[AGENT][NEUTRAL] All right. Did you have any others for this member or just those two?
[CUSTOMER][NEUTRAL] Just those two.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] Alright, and would the provider be the same on this claim or would it be a different provider?
[CUSTOMER][NEUTRAL] Oh, let me just double check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is the same one, HSS Oklahoma Heart, but it says heart.
[AGENT][NEUTRAL] Alright, so
[AGENT][NEUTRAL] So for the $224 we received that claim. Hold on one moment, 43.
[AGENT][NEUTRAL] We received it on [PII].
[AGENT][NEUTRAL] The claim number is 352-7430.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the [PII].
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] You're welcome. Um, that claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3511981.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][POSITIVE] OK. Thank you so much. And could you please send me via fax those to you with?
[AGENT][NEUTRAL] I sure can. And what is a good fax number for you?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And um what should, what attention should I put?
[CUSTOMER][NEUTRAL] Uh, you can put attention to my name, that is [PII]
[AGENT][NEUTRAL] Alright, and that was [PII]?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] All right. So I'll go ahead and send that as well. Um, hold on one moment. Do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Sure, no worries, thank you for your time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] Alright, thank you so much for holding. I apologize for that wait. So I just faxed the um two explanation of benefits over for you. And what's the next policy number?
[CUSTOMER][POSITIVE] OK. Thank you so much. No worries. And the next policy number is
[CUSTOMER][NEUTRAL] 02356342
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] 02356342.
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII], [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Thank you for that. And so, um, for this product, APL doesn't um administer this product. So for the claims, you would have to reach out to Web TPA and I have that phone number for you um when you're ready and they'll be able to assist you with the claims for this number.
[CUSTOMER][POSITIVE] Oh, for this member, perfect, yes, what's the phone number?
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, perfect. Well, that's all I needed to know so far. I appreciate your help and uh.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today, or did you have more?
[CUSTOMER][POSITIVE] Um, no, actually that's it for today, OK? Thank you.
[AGENT][POSITIVE] Alrighty, well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you.