AccountId: 011433970860
ContactId: 3ff98311-50f4-4257-afc5-153e4c580ed4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1629489 ms
Total Talk Time (AGENT): 371957 ms
Total Talk Time (CUSTOMER): 397896 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/3ff98311-50f4-4257-afc5-153e4c580ed4_20250327T15:59_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is Am. It's [PII], and I'm checking claim status.
[AGENT][NEUTRAL] OK, well, I can help you with the claim status and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And um how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, in total, I have.
[CUSTOMER][NEUTRAL] 6 claims to check.
[AGENT][NEUTRAL] May I have the first member's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy number is 01936591 M for Mary L Lima 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, member's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Date of service, [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $1,599.18.
[AGENT][NEUTRAL] 18 or 80?
[CUSTOMER][NEUTRAL] 18.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So for [PII], I'm not showing a claim on file for [PII].
[CUSTOMER][NEUTRAL] You said there's no claim on file.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And can you verify me the eligibility? What's the eligibility active to the date of service.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] So the policy was active from [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Right, that's when the policy will lapse.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I, can you also verify me the payer ID and the claim and address as well.
[AGENT][NEUTRAL] Actually, I'm sorry, I'm sorry. Hold on one second.
[AGENT][NEGATIVE] My system glitched. This policy is not lapsing, it's active and it's paid up until that date.
[CUSTOMER][NEUTRAL] So you said the policy was active, that's what you mean, right, till [PII], effective from [PII].
[AGENT][NEUTRAL] Right, I
[AGENT][NEUTRAL] So I had said that it's going to lapse on September on [PII], but my system when I was going through the, my system glitched, so if the policy is active, it's no um future lapse date.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Oh, no feature. OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. Thank you for that, confirming that. Yeah, if you don't mind, can also verify me the pay your ID and the claim and address as well.
[AGENT][NEUTRAL] Our payer ID is 60801.
[AGENT][NEUTRAL] And our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], zip code is [PII].
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] So it's [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what is the timely filing for the claim submission?
[AGENT][NEUTRAL] Um, there's no timely filing as long as the policy is active, you can file the claim at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] There is no family problem.
[CUSTOMER][NEUTRAL] All right, thank you. So like uh for the entire call, the reference number will remain the same or it will be different for each claim?
[AGENT][NEUTRAL] No, it'll be the same for the entire call. It'll be my name and today's date. First initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Alright then let's move on to the next one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, whenever you're ready, I have the uh member ID.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] 01740502 M for [PII].
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] His name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [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 for the claim you like me to check on?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Date of service, [PII].
[CUSTOMER][NEUTRAL] We charge $3,981.04.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Nicholas Children's Hospital.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 353.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 6944.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the claim was received and processed on the same date, [PII], right?
[AGENT][NEUTRAL] Um, hold on, let me go back. Hold on one second.
[AGENT][NEUTRAL] No, it was received on [PII].
[AGENT][NEUTRAL] It processed on [PII].
[CUSTOMER][NEUTRAL] OK, this was about the primary EOB.
[AGENT][NEUTRAL] Correct, deny requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] And like, uh, is there any, you know?
[CUSTOMER][NEUTRAL] Fax number or the mailing address to submit this primary EOB?
[AGENT][NEUTRAL] Sure, the mailing address would be the same. Our fax number is also um [PII].
[AGENT][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] Let me double check that because I just went blank. Hold on one moment.
[CUSTOMER][NEUTRAL] And is there any?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just to confirm, [PII].
[CUSTOMER][NEUTRAL] [PII]. And is there any attention that we need to put no attention.
[AGENT][NEUTRAL] That'll be attention APL claims department.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Department
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, let's move on to the next one.
[CUSTOMER][NEUTRAL] OK, the next member ID is 0240. 0, OK, sorry.
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] I have to know each policy when we're done. Hold on one second.
[CUSTOMER][POSITIVE] Oh, no problem. Take your time.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] 02408940. [PII].
[AGENT][NEUTRAL] And the membe[PII]'s first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Oh, this is for the [PII].
[CUSTOMER][NEUTRAL] And the bill charge amount was.
[CUSTOMER][NEUTRAL] $3,881.46.
[AGENT][NEUTRAL] OK, so we don't have a claim on file with that.
[AGENT][NEUTRAL] Date of service, the range or [PII].
[CUSTOMER][NEUTRAL] So there is no claim on file.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And can you verify if policy was active during the updated service?
[AGENT][NEUTRAL] Let's see, hold on one moment.
[AGENT][NEUTRAL] Yes, this policy was active from [PII], so it was active on your data service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, and the next member's policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Yes, my policy number is 01480322.
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member's name is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Uh, it's a date range, [PII]. And the bill charge $5,645.76.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Damn.
[AGENT][NEUTRAL] And what is the name of the provider's office?
[AGENT][NEUTRAL] On the claim?
[CUSTOMER][NEUTRAL] Nicholas Children's, Nicholas Children's Hospital.
[AGENT][NEUTRAL] So I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 9359.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Requesting a more detailed explanation of benefits that shows the amount paid towards the deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] So there's also the night for the primary EOP right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] It's 1395406 MLS.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Remember's name is [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] Yeah
[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 total or the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Yeah, date of service, it was for [PII], and the bill charge was for $569.09.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm trying to received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 3453.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because it's not a covered loss under the policy plan.
[AGENT][NEUTRAL] Therefore, no amount payable um for the expense, so it's not a covered expense.
[CUSTOMER][NEUTRAL] So claim was denied to like the patients and not have active coverage during the date of service.
[AGENT][NEUTRAL] No, no, no, that's different. The claim was denied because it's not covered by the patient's policy.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Let me check all the service on this.
[CUSTOMER][NEUTRAL] So like these are the emergency service, like for the emergency service is not covered under the patient plan.
[AGENT][NEUTRAL] So let me see what's being billed. Hold on one moment.
[AGENT][NEUTRAL] And and do you mind if I place you on just a brief hold while I take a look at the claim?
[CUSTOMER][POSITIVE] Uh, no problem. You take your time.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Am.
[CUSTOMER][NEUTRAL] Yes, hi.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So yes, the code 99203 is for an outpatient office. That type of facility is not covered on the member's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's still like uh the code 99203 is for outpatient and it's not covered under the facility, right?
[AGENT][NEUTRAL] It's an outpatient office, and that's the office part is why it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there's no cover under the facility.
[CUSTOMER][NEUTRAL] Just a moment here.
[CUSTOMER][POSITIVE] OK, thank you so much for your patiently waiting.
[AGENT][NEUTRAL] Welcome. Hold on one moment, I'm just noting the policy.
[AGENT][NEUTRAL] OK, and the next member's policy number.
[CUSTOMER][NEUTRAL] Yeah, the next policy number is 01740502ML7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And just a moment.
[CUSTOMER][NEUTRAL] Yeah, date of birth is [PII].
[AGENT][NEUTRAL] Thank you and the date of service and total bills?
[CUSTOMER][POSITIVE] Thank you and the same service?
[CUSTOMER][NEUTRAL] [PII] and total charge amount was for $3,981.04.
[AGENT][NEUTRAL] OK, we just went over that one. Did you need the claim number again?
[CUSTOMER][NEUTRAL] That one did you need the claim number again?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, just a moment here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wait, wait.
[CUSTOMER][NEUTRAL] Since I have opened the same account like account which we have checked before, sorry about that.
[AGENT][NEUTRAL] No it's OK.
[CUSTOMER][NEUTRAL] OK, correct number ID for this is.
[CUSTOMER][NEUTRAL] 1984141.
[AGENT][NEUTRAL] OK, 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] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member's name is.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Date of service [PII].
[CUSTOMER][NEUTRAL] And the bill charge was for $696.22.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] OK, I just located it. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I'm sure we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3486055.
[CUSTOMER][NEUTRAL] OK my number is 348.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That it was denied on [PII] for primary UOP.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you. All [PII], yeah, thank you so much, uh Ms. [PII], for the information for helping me out. That will be all for now. Thank you.
[AGENT][POSITIVE] You're very welcome. And was there anything else? Well, you said that's all. Well, thank you so much for calling APL and I hope you have a good day, OK?
[CUSTOMER][POSITIVE] Thank you. You have a wonderful day. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] OK. OK, bye-bye.