AccountId: 011433970860
ContactId: 4592b336-72dc-4c00-bb73-1833eb0a5c0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 684789 ms
Total Talk Time (AGENT): 163040 ms
Total Talk Time (CUSTOMER): 131938 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/4592b336-72dc-4c00-bb73-1833eb0a5c0d_20250325T17:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] It's [PII] calling from provider of the claim status.
[AGENT][POSITIVE] OK, I'm happy to check on a claim for you today. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, sure. It's 1241931 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Alright, can you repeat that policy number one more time, please?
[CUSTOMER][NEUTRAL] Uh, it's 1241931 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Oh, it's [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you. Data service.
[CUSTOMER][NEUTRAL] Oh, it's [PII] with a bill amount of $1,097.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] So it looks like we did receive a claim for the state of service claim was received [PII].
[AGENT][NEUTRAL] The claim was denied. The insured's primary provided full benefits, so there was nothing payable from us.
[CUSTOMER][NEUTRAL] Uh, this claim was received.
[AGENT][NEUTRAL] Claim was received on [PII], yes.
[CUSTOMER][NEUTRAL] And then on?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Has primary paid more than secondary?
[AGENT][NEUTRAL] For the secondary insurance. So the insured's primary provided full benefits, so there was nothing payable for us.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, may I know what is the allowed amount for this?
[AGENT][NEUTRAL] Are you asking for their benefits for outpatient?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] This is verification of benefits, not guarantee of payment. The patient plan has an outpatient calendar uh max per day of $750.
[CUSTOMER][NEUTRAL] Uh, this is the allowable amount for this member for a day.
[AGENT][POSITIVE] Per day, correct.
[CUSTOMER][POSITIVE] And uh payment has just allowed $35 and cents and it was paid $285 and cents and 20 is co-payment.
[AGENT][NEUTRAL] So, our records show that the insured's primary paid for the entire claim. If that's not the case, then a corrected claim needs to be resubmitted.
[CUSTOMER][NEUTRAL] Yeah, uh, may I know in your end what is the payable amount for the pri insurance?
[AGENT][NEUTRAL] We don't have those details. You would need to contact the insured.
[CUSTOMER][NEUTRAL] Um, may I have the PIN number for this?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you so much and can you also fax me the COP copy?
[AGENT][NEUTRAL] What's a good fax number?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Should we mark attention to anybody?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] OK, [PII], I.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sending the COV via fax. It should be there in about 5 minutes. Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Uh, I do have, uh, for the same member one more claim for date of service.
[AGENT][NEUTRAL] It's such a different member?
[CUSTOMER][NEUTRAL] No, for the same number, the date of services in [PII].
[CUSTOMER][NEUTRAL] With the bill amount of $599.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so it looks like we did receive a claim for the state of service.
[AGENT][NEUTRAL] Um, one moment.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Claim was denied on [PII]. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] And what is the member's plan?
[AGENT][NEUTRAL] Member has a secondary meddling plan.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Is it HMO or PPO?
[AGENT][NEUTRAL] It's neither. It's a secondary plan.
[CUSTOMER][NEUTRAL] May I have the claim number for this one?
[AGENT][NEUTRAL] 356-844-3.
[CUSTOMER][NEUTRAL] Oh, it's
[CUSTOMER][NEUTRAL] 356-844-3
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] And can you also fax me the COB copy?
[AGENT][POSITIVE] Yes, I can send this one as well.
[AGENT][NEUTRAL] EOB for this one is on its way. Was there anything else that I can help with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, that's OK, and I also didn't catch up your name you can spell it for me.
[AGENT][NEUTRAL] Uh my name is spelled [PII]
[CUSTOMER][NEUTRAL] Can I have your last name [PII].
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] You so much send me also to have the system call.
[AGENT][NEUTRAL] Call reference is my name with my last initials and today's date.
[AGENT][NEUTRAL] My last initial again is [PII], first name [PII]. Today's date is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] OK, got it. Thank you so much for asking. Have a wonderful day.
[AGENT][POSITIVE] You too. Take care.