AccountId: 011433970860
ContactId: 4ac5f044-5a5d-42c6-9c29-f556d68716cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321880 ms
Total Talk Time (AGENT): 138589 ms
Total Talk Time (CUSTOMER): 175704 ms
Interruptions: 7
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/4ac5f044-5a5d-42c6-9c29-f556d68716cc_20250225T19:13_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from Mercy Hospital, checking on a claim. Could you please help me with that?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status, [PII], and um may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, Me's policy number is 01828776.
[AGENT][NEUTRAL] 01828776.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, ma'am. My first name is [PII]. Last 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. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII]. The amount is $549.38.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] and this.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It is Mercy Hospital Lincoln.
[AGENT][NEUTRAL] OK, this is it.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] As per update of 4255 you just I just uh.
[AGENT][NEUTRAL] Alright, so I'm showing that the claim was received on [PII].
[CUSTOMER][NEUTRAL] yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number is 354-5892.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] It's not it.
[CUSTOMER][NEUTRAL] Hold for hold of.
[AGENT][NEUTRAL] The facility charged for the amount of $292.38 was denied because primary insurance provided full benefits.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] They didn't get.
[AGENT][NEGATIVE] The facility charge for $257 was denied.
[AGENT][NEUTRAL] Because benefits are only payable for services listed on the schedule of benefits, so this wasn't a covered service.
[CUSTOMER][NEUTRAL] OK, may I know what is the allowed amount as per you because you're stating it is already, uh, maximum amount is paid by the primary.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But the primary has paid only $202.65 right?
[AGENT][NEUTRAL] $292.38.
[AGENT][NEUTRAL] So then you'll need to present an explanation of benefits that shows that they did not pay the full benefits because what we received showed that they did pay the full benefits.
[CUSTOMER][NEUTRAL] So as for you, uh, could you please repeat that amount again? How much is the primary paid?
[AGENT][NEUTRAL] I, so all I've said was of the $292.38 the explanation of benefits that we received showed that primary insurance pay that in full. If you have an explanation of benefits that shows they did not, you can submit that to us and we can reprocess that code on this claim.
[CUSTOMER][NEUTRAL] Mai state the update to with me.
[CUSTOMER][NEUTRAL] I'm not calling in at the time we call yesterday. Ma I want go and just.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please help me with the mailing address?
[AGENT][NEUTRAL] Sure, our mailing address is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I bought this one.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 2 was just I.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] is a.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] put.
[CUSTOMER][NEUTRAL] May I have the fax number as well?
[AGENT][NEUTRAL] 877.
[CUSTOMER][NEUTRAL] Even with the.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Attention
[AGENT][NEUTRAL] APL claims department.
[CUSTOMER][NEUTRAL] Could you please help me in the timely filing limit?
[AGENT][NEUTRAL] Um, there's no timely filing limit as long as the policy was active on the data service. Hold on one moment, let me get that for you.
[CUSTOMER][NEUTRAL] It's a
[CUSTOMER][NEUTRAL] My
[AGENT][NEUTRAL] And this policy has been active since, hold on one second.
[CUSTOMER][NEUTRAL] No one is opening model for fine.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] This policy has been active since [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you for that information. Could you please help me with the call reference?
[AGENT][NEUTRAL] So there's no call reference number. You can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for providing assistance, sir. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] ID card, we have a call confirmation.
[CUSTOMER][NEUTRAL] What you can do tomorrow