AccountId: 011433970860
ContactId: 4749bf6f-7484-4aed-a906-7225586586f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1048140 ms
Total Talk Time (AGENT): 257062 ms
Total Talk Time (CUSTOMER): 234481 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/4749bf6f-7484-4aed-a906-7225586586f8_20250616T20:44_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes, my first name is [PII] and my last name is [PII] calling you from the provider's office looking for claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Mr. and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, yes, the contact number is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] The patient's OK, just uh the patient ID is 021-79837.
[AGENT][NEUTRAL] Thank you. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Date of birth is uh [PII]. 1st name is [PII], last name is [PII].
[AGENT][NEUTRAL] What is the date of service and the amount of the claim, [PII]?
[CUSTOMER][NEUTRAL] 7 18 [PII] total charge is $5,134.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And also I have a specific question on this screen.
[AGENT][NEUTRAL] OK, one moment, let me see if I can find that first, and that was [PII], correct?
[CUSTOMER][NEUTRAL] Uh that that.
[AGENT][NEUTRAL] OK, let me pull the details.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] I'm waiting on the EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm so sorry, uh, could you please repeat again your name, please?
[AGENT][NEUTRAL] Sure, my name is [PII]. That's [PII]. That's initial [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like this claim, let's see.
[AGENT][NEUTRAL] Mm, I don't see a member submission. Let me double check, OK. Sorry, I don't see a provider submission for that amount.
[AGENT][NEUTRAL] When did uh the providers send in the claim, Mr. [PII]?
[CUSTOMER][NEUTRAL] So, uh, actually the claim was denied as maximum benefit rate, so we sent an appeal on [PII].
[CUSTOMER][NEUTRAL] And this is under the claim number 3563479.
[AGENT][NEUTRAL] OK, Mr. [PII], I do apologize, but that claim number 3563479 was processed under the member. We have not received the uh claim from the provider.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Just uh let me check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you're saying that uh you never received the claim for the state of service?
[AGENT][NEUTRAL] We did not receive a claim from the provider for that data service.
[CUSTOMER][NEGATIVE] Uh, OK, but as for the previous call, uh, stating it was denied.
[AGENT][NEUTRAL] Bear with me just a second.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, we have not received the claim from the provider. If we receive any claims that it was from the member, um, we cannot give you the information because that was not from the provider. So if you need a denial EOB to be sent out to the provider, we need the claim to come from the provider.
[CUSTOMER][NEUTRAL] S
[CUSTOMER][NEUTRAL] Let's
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] This.
[CUSTOMER][NEUTRAL] Um, so, uh, what is the memory effectively?
[AGENT][NEUTRAL] OK, the effective date is going to be.
[AGENT][NEUTRAL] Let's see [PII].
[AGENT][NEUTRAL] Terminated [PII].
[CUSTOMER][NEUTRAL] And the time the following limit.
[AGENT][NEGATIVE] We don't have timely filing limits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, thank you. Let's move to the next patients.
[AGENT][NEUTRAL] OK, let me make a note on this one. Bear with me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] OK, here we go. OK, what's the next policy?
[CUSTOMER][NEUTRAL] The next set is 01884094.
[AGENT][POSITIVE] Mm thank you.
[AGENT][NEUTRAL] And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and the first name is [PII]. Last name is [PII].
[AGENT][NEUTRAL] Let me have the name and date of birth one more time.
[CUSTOMER][NEUTRAL] The first name is, uh this, I mean, the first name is [PII] Last name is [PII], [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Do you see another name besides [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] [PII] total charge is $1,277 even.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, Mr. [PII], I don't have a [PII] or a summer listed under the policy.
[CUSTOMER][NEUTRAL] So is it like uh you're saying that the claim is not on file or?
[AGENT][NEUTRAL] The member is not listed and the claim is not on file, both of them. The member is not listed and the claim is not on file.
[CUSTOMER][NEGATIVE] You don't find the patience.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, uh, let's move to the next.
[CUSTOMER][NEUTRAL] Patience. I have 2 more claims.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, let me make a note on this one.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, what is the next policy number?
[CUSTOMER][NEUTRAL] Uh, yes, the patient ID 2331811.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, first name is [PII], last name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] total charge is $1,204 even.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK bear with me just a second, let me pull this EP.
[AGENT][NEUTRAL] All right. So it looks like we processed this claim on [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is that all payable benefits was applied towards the calendar year deductible.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, what is the deductible amount?
[AGENT][NEUTRAL] The amount that was applied towards the deductible was $262.67.
[CUSTOMER][NEUTRAL] And the claim number.
[AGENT][NEUTRAL] It is 3604599.
[CUSTOMER][NEUTRAL] OK uh.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] OK, and uh can you uh fax me the EOB?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Uh, the fax number is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Bear with me.
[AGENT][NEUTRAL] It's gonna be to your attention, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right. What is the next policy?
[CUSTOMER][NEUTRAL] 02357788.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's uh first name is [PII] and the last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] total charge is $5,975 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, looks like we have not received a claim from the provider on this one.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] Can I have the member's effective date?
[AGENT][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] The effective date on the policy is [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] To be funny.
[CUSTOMER][POSITIVE] OK, thank you so much and uh do you have any call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you will. Do you need the spelling of my name or any other information, Mr. [PII]?
[CUSTOMER][POSITIVE] Um, no, that's all I need. Thank you so much, and, uh, yes, uh, have a very blessed.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You as well. Have a good afternoon and thank you for calling AP Mr. [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.