AccountId: 011433970860
ContactId: 46766afa-e5e1-427d-a1ac-95095daeb393
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1442319 ms
Total Talk Time (AGENT): 433298 ms
Total Talk Time (CUSTOMER): 377117 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/46766afa-e5e1-427d-a1ac-95095daeb393_20250227T14:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. My last initial is [PII]. And uh I have uh like uh 6 points with me, and I would like to know the status of the claim. Would you be able to help me with that?
[AGENT][NEUTRAL] You said you have 6?
[CUSTOMER][NEUTRAL] Yes, I know.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with your claims, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, [PII]. It is [PII].
[AGENT][NEUTRAL] And are all the claims for the same member or they're different members?
[CUSTOMER][NEUTRAL] Different members.
[AGENT][NEUTRAL] And will you need explanation of benefits for each claim we go over?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's a good fax number for you?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]. And the attention is my name with my last initial.
[AGENT][NEUTRAL] And can you repeat your um last initial?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Fax number was [PII]. Attention [PII]
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, so I'll be sending the explanation of benefits for each claim we go over today. What's the first member's policy number?
[CUSTOMER][NEUTRAL] First members policy number 01359407.
[AGENT][POSITIVE] 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] OK. The patient's first name is [PII], last name is [PII], and the 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 and the total bills?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, [PII]. The date of service is [PII].
[CUSTOMER][NEUTRAL] With the amount of $177.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Mhm. Take your time, no issues.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, sure. It's Mercy Clinic.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] 311.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII], I'm sorry, [PII]. Sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3113252.
[CUSTOMER][POSITIVE] No issues.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great. Thank you so much. Mm.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] And let me get that EOB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so I'll send all the explanation of benefits at the end. Um, what was the next member's policy number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure. So, uh, hm the next member's policy number is 1191316.
[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, sure. My first name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, sure. The date of service is [PII].
[AGENT][NEUTRAL] And the total bill?
[CUSTOMER][NEUTRAL] Total bill is 177.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the policy number that you provided termed on [PII], but there is another policy number here, 1 1359369 that was active from [PII]. So I'm gonna look on that one to see if there's a claim because that was active.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for that.
[AGENT][NEUTRAL] You're welcome, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] And that was [PII], right? OK, here it is.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 32.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Mhm. No issues. You can take your time.
[AGENT][NEUTRAL] So we thank you, we received the claim twice. So the first time we received it was on [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 325.
[AGENT][NEUTRAL] 2856.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], um, that claim was denied because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And actually, hold on, that was the 2nd 1. Hold on 1 2nd.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] 0442.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] So that was the second time we received it. The first time we received it, my apologies, it's not in order, was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. [PII], right?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, [PII]. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim number is 3138044.
[CUSTOMER][NEUTRAL] 313-804-4. OK?
[AGENT][NEUTRAL] And on [PII], um, it was denied because office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][POSITIVE] Noted. Great.
[AGENT][NEUTRAL] And let me note this policy. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I have, you do now for this one, do you want both of the explanation of benefits?
[CUSTOMER][NEUTRAL] Now the first benefits will do.
[AGENT][NEUTRAL] First one, OK.
[CUSTOMER][POSITIVE] The original benefits is, yeah.
[AGENT][NEUTRAL] Hold on, let me make sure which one was the 1st 144. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that's from me. OK.
[AGENT][NEUTRAL] OK. So I have that one to send to you and let me note this policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right the next member's policy number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, I'm ready. So, with the next policy number is 01752008.
[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] Yeah, sure. member's first name is [PII], last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And again, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and total bills?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. The date of service is [PII], but the amount is $118 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so for this one, I'm showing you received the claim on [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3149658.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I have that one to send and then the um next member whenever you're ready.
[CUSTOMER][NEUTRAL] Yes, give me a moment. OK. I'm ready with the next number. It is [PII], 1191228.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member's first name is [PII]. Last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you, and the data service and total bills?
[CUSTOMER][NEUTRAL] The service is [PII] with the amount of $177 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so this one also um terminated on [PII] and there is an active policy or was an active policy um from [PII]. Um, that's policy number 1359286.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm gonna look on that policy to see if there's a claim.
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] You're welcome. Hold on one second.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] And would this be a different provider than the other uh claims or this is they're all the same provider?
[CUSTOMER][NEUTRAL] And it's the same uh facility actually, but the individual provider is different.
[AGENT][NEUTRAL] OK, as long as the facility is the same, OK. And um I'm showing we received this claim on [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 322.
[AGENT][NEUTRAL] 0443.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], um, the claim was denied because office visits are not covered on the policy.
[CUSTOMER][MIXED] OK, same denial. Great.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, whenever you're ready, I'm ready for the next member.
[CUSTOMER][NEUTRAL] OK, give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for being patient. So I'm ready with the next member.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is 01359382.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Mhm. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, sure, member's first name is [PII], last name was [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and the data service and total bills.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] D of service is [PII] with the amount of $121 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so I'm showing we received this claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 316.
[AGENT][NEUTRAL] 7947.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And I, may I have your uh last name first initial?
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] You're welcome. And did you have any other claims?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yes, I do have uh one more client with me.
[AGENT][NEUTRAL] Oh, sure.
[CUSTOMER][NEUTRAL] OK. So, uh, uh, I'm ready with the member ID whenever you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][POSITIVE] Mhm, that's great. So the next member ID is 02031590.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Me's first name is [PII], last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And now for the, wait a minute, hold on one second. This is a dental claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I'm asking.
[CUSTOMER][NEUTRAL] Uh, no, uh, this is a medical claim only.
[AGENT][NEUTRAL] Oh, OK. The reason I'm asking is because she only has a dental policy with us. So I'm not sure who her medical policy is through.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm OK. So, this patient has only a dental plan?
[AGENT][NEUTRAL] Mhm. And and this policy was active from [PII], but it's only dental.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, give me a minute. Let me document it, sir.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, were you, uh, you didn't receive any claim from our end, right? So since the patient has only dental plan?
[AGENT][NEUTRAL] Um, I can check and see if there's a claim here. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm mhm OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, here we go. I, I just wanted to make sure I was in the right place, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, so we did receive a claim. Hold on one second.
[CUSTOMER][NEUTRAL] Mm mhm.
[AGENT][NEUTRAL] So, claim, uh, we received it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is 3273082.
[CUSTOMER][NEUTRAL] 327-3082, right?
[AGENT][POSITIVE] Mhm, that's correct.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied because this is a dental-only policy. There are no medical benefits.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. So you said the same, right?
[AGENT][NEUTRAL] Yes, did you need this EOB faxed to you as well?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Yes, I need it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] And thank you so much for the information. Actually, I have got enough information from you for today's call. And uh the one last question I have is, what was the timely filing to submit an appeal?
[AGENT][NEUTRAL] For an appeal, it is 180 days from the denial date.
[CUSTOMER][NEUTRAL] OK. 180 days from the denial date. Great. Thank you so much. And uh in the EOP there is a date called check date, right? Is that the denial date?
[AGENT][NEUTRAL] Hold on, let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]. Hold on one moment. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that's the date the um claim finished processing.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. And yeah, for today's call, I have got enough information from you, [PII]. Thank you so much for that. And have a great day.
[AGENT][POSITIVE] You also, and thanks for calling APL and I am sending the explanation of benefits over to you now, um, so you'll be receiving them within a few minutes or shortly.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, mhm.
[CUSTOMER][POSITIVE] OK. OK, thank you so much. I really appreciate your effort, [PII].
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You know, you have provided me with enough information. Thank you so much for that.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.