AccountId: 011433970860
ContactId: 448265b3-5273-4b71-a75e-12b0e97a2ebf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1026650 ms
Total Talk Time (AGENT): 352599 ms
Total Talk Time (CUSTOMER): 355720 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/448265b3-5273-4b71-a75e-12b0e97a2ebf_20250610T20:43_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] Hi, [PII]. This is [PII] calling from provider's office, checking on the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh, no, I do have 3 claims to check.
[AGENT][NEUTRAL] Can you, are they for the same patient or you have one data service in 3 different patients?
[CUSTOMER][NEUTRAL] Uh, 3 different patients.
[AGENT][NEUTRAL] And one date of service each, is that correct?
[CUSTOMER][NEUTRAL] Uh, I need to check that actually. One moment. Let me check that.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, I do have 2 data service for one member and, uh, OK, let me check other.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, that's fine, [PII] let's go ahead and let me get your callback number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and extension would be [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the, OK, so first off, [PII], you're gonna use my name and today's date.
[AGENT][NEUTRAL] As your call reference number for each one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Also, any informa OK, any information that I provide for you on the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK. Got you.
[AGENT][NEUTRAL] And lastly, if we do have the claims on file once I provide you the claim number if you need a copy of the explanation of benefits, then you should be able to print out with the claim number from our portal by going to secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII], right?
[AGENT][NEUTRAL] All right
[AGENT][NEUTRAL] Yes, they're secured with a D on it. [PII].
[CUSTOMER][NEUTRAL] OK, in [PII] so.
[AGENT][NEUTRAL] All right. And what is the first, yeah, first patient policy number?
[CUSTOMER][NEUTRAL] Uh, one moment. Yeah, it would be 01719350.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it would be [PII] and the date of birth would be [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And what is the date of service and total bill amount please, [PII]?
[CUSTOMER][NEUTRAL] Mhm. OK. Date of service would be [PII] with the charge amount of $2610 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Sorry, uh, bill amount would be $1500 even.
[CUSTOMER][NEUTRAL] Oh sorry for that.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] It was denied on [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The claim number is 3600983.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] And the reason for the denial on this claim?
[AGENT][NEUTRAL] we have received the primary explanation of benefits that was submitted with your claim. However, the explanation of benefits received does not list the amounts applied to the deductible, co-pay, or co-insurance. Please submit a more detailed explanation of benefits that shows these amounts for further consideration of your claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK. Uh, could you please repeat the reason again so that I can document it?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Do you need me to repeat the entire thing?
[CUSTOMER][NEGATIVE] Yes, a denial reason.
[AGENT][NEUTRAL] Yes, so that was the entire we need a detailed explanation of benefits showing.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The amounts applied to the deductible, co-pay or co-insurance by the primary insurance company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Got you. So, may I get the fax number?
[AGENT][NEUTRAL] [PII] attention claims.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK you. I also get the claim's mailing address.
[AGENT][NEUTRAL] The same as the claims.
[CUSTOMER][NEUTRAL] OK, one moment. Is there any time frame to submit the primary OB?
[AGENT][NEGATIVE] There is not. No.
[CUSTOMER][NEUTRAL] OK. OK. [PII].
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] No, so that's in, that's a very old address. The correct address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And do you need any other information on this number?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yes, one moment, let me check whether I have not one moment.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, thanks for your patience. May I also get the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 60801. Got you. And no time frame, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And does this patient have another data service?
[AGENT][NEUTRAL] Or is this the only one for this member?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, only one for this member.
[AGENT][NEUTRAL] OK. Are we ready to move to the next one?
[CUSTOMER][NEUTRAL] And I'm done with this number. May I get the, may I get the call reference number before moving on that.
[AGENT][NEUTRAL] Yes, I explained to you [PII] initially that you're gonna use my name and today's date as your call reference number.
[CUSTOMER][NEUTRAL] OK. OK. [PII], may I also get the last name [PII] in of yours?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm. And the next policy number, please?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, one moment, let me pull that up.
[CUSTOMER][NEUTRAL] Yeah, I'm ready with the policy number. It would be 01820389 M like Mary, L like Lima 8.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] One moment, it's loading.
[CUSTOMER][NEUTRAL] Yes, uh, it would be.
[CUSTOMER][NEUTRAL] [PII] and the date of birth would be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. The data service and total bill amount.
[CUSTOMER][NEUTRAL] You're welcome. It would be [PII] with the charge amount of 4 $4,288 even.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so this claim was received. The received date is going to be [PII].
[AGENT][NEGATIVE] It was processed and denied on [PII].
[CUSTOMER][POSITIVE] Good
[AGENT][NEUTRAL] The claim number is 357.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0079.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And again this claim was denied and the reason for the denial on each line item states the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] I did.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] And did this number have another data service or?
[CUSTOMER][NEUTRAL] OK, uh, benefits is in the phone.
[CUSTOMER][NEUTRAL] Yeah, I do have a few more questions on this. So was it, uh, you know, maximum benefits, uh, uh, in the, in the dollar amount or per widges?
[AGENT][NEUTRAL] Yes, dollar.
[CUSTOMER][NEUTRAL] OK. May I know the dollar amount uh for maximum?
[AGENT][NEUTRAL] 500, 500 per calendar day for covered outpatient services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Calendar day, right? So, may I know when was last covered?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again, it was met with a claim received prior for the same date of service prior to yours.
[CUSTOMER][NEUTRAL] A day, right? For the, for the
[CUSTOMER][NEUTRAL] OK. Um, may I know on which and pay it was covered?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm sorry, I can't provide you another provider's information on a claim for another provider.
[CUSTOMER][NEUTRAL] Uh, no, uh, may I know the claim num OK, no problem. Uh, may I know the claim number?
[AGENT][NEGATIVE] No, I cannot provide that.
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] I gave you the claim number for your claim. I can't give you information on another claim.
[AGENT][NEGATIVE] For another provider.
[CUSTOMER][NEUTRAL] OK, got you. So, could you please fax me the UOB?
[AGENT][NEUTRAL] I gave you the website for you to be able to print the explanation of benefits once I gave you the claim number.
[AGENT][NEUTRAL] I gave you our portal website at the beginning of our call.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK. Uh, one moment, let me check if I have any data services for this member. Uh, no, uh, no other data services for this member. Let's move to another member.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This was the only one?
[AGENT][NEUTRAL] OK. And you, how many more do you have?
[CUSTOMER][NEUTRAL] Yes, uh.
[CUSTOMER][NEUTRAL] Uh, last number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Last number and last claim as well um member ID whenever you are ready.
[AGENT][POSITIVE] Mhm. I'm ready.
[CUSTOMER][NEUTRAL] 00, sorry, uh let me start over. 02295955 M like Mary, L like Lima 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Patient name would be [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], and the date of birth would be [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Data service and total bill amount justice.
[CUSTOMER][NEUTRAL] [PII] with the charge amount of $348 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and you said that the data service is 414 of 2025, is that correct?
[CUSTOMER][POSITIVE] Exactly. Exactly.
[AGENT][NEUTRAL] OK, we do not have a claim on file for this member for this data service.
[AGENT][NEUTRAL] Now when you do submit the claim, make sure to send the detailed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Copy of the primary insurance company's explanation of benefits because we must also have that for review.
[CUSTOMER][NEUTRAL] OK. Uh, same mailing address and the payer ID?
[AGENT][POSITIVE] Yes, sir. That is correct.
[CUSTOMER][NEUTRAL] OK. OK. May I also get the timely spending limit?
[AGENT][NEUTRAL] The timely filing limits?
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Got you. And uh may I also know the patient's plan effective and term date if any?
[AGENT][NEUTRAL] The policy is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm. And still active right?
[AGENT][NEUTRAL] Correct, no term date.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm done. Thank you. Thanks for your assistance, [PII]. You have a great day. Bye for now.
[AGENT][POSITIVE] Oh, you're welcome. OK, well, if that's all then [PII] that I can help you with, it was my pleasure in speaking to you and thank you again for calling APL and I hope that you have a nice rest of your day as well.
[CUSTOMER][NEUTRAL] You too as well. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.