AccountId: 011433970860
ContactId: 4bea3726-a24a-4056-998c-37cb35d50223
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1140469 ms
Total Talk Time (AGENT): 431049 ms
Total Talk Time (CUSTOMER): 289235 ms
Interruptions: 5
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/4bea3726-a24a-4056-998c-37cb35d50223_20250129T17:58_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] Oh hi, this is [PII], that is [PII] calling from provider's office to check on claims.
[AGENT][NEUTRAL] OK, sure, you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Oh yeah, right.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And you did say your name is spelled [PII]?
[CUSTOMER][NEUTRAL] Uh, yeah, right.
[AGENT][POSITIVE] OK, thank you and [PII], how many clients do you have today?
[CUSTOMER][NEUTRAL] Uh, for claims.
[AGENT][NEUTRAL] For the same member or for different members?
[CUSTOMER][NEUTRAL] Uh, actually, 4 different members. No, there are 3 members. Now just let me confirm that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, actually 4 different members.
[AGENT][NEUTRAL] OK, sure, so you will use my name and today's date is your call reference number for each one.
[AGENT][NEUTRAL] Also, any information that I provide for you on the claims that I checked will be a verification of benefits and not a guarantee of payment. And lastly, [PII] if you we do have the claim on file and you need a copy of any of the explanation of benefits, you may obtain that by going to our portal to print it and our portal website is secured. [PII].
[AGENT][NEUTRAL] And what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] Uh, but before we proceed, I would like to inform you that this call is being recorded for training and quality purpose. So are you OK with it?
[AGENT][NEUTRAL] That is fine.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, first one is 147.
[CUSTOMER][NEUTRAL] 5775.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, [PII], what is uh the patient's name and date of birth?
[CUSTOMER][NEUTRAL] That is [PII]. Last name is [PII] Uh date of birth is [PII].
[AGENT][NEUTRAL] Thank you. The date of service and total bill amount.
[CUSTOMER][NEUTRAL] [PII] billed amount is $454.53.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so on this policy there is no claim for that data service. This policy was not active for that data service. This policy was active from [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Give me just one moment.
[AGENT][NEUTRAL] To see if there's another policy that was active for this state of service again it was [PII].
[CUSTOMER][NEUTRAL] I just.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So member is covered, right?
[AGENT][NEUTRAL] I'm checking that. One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, so the, the other, she has another policy that was active for that data service.
[AGENT][NEUTRAL] And that policy number that you should have is 02497628.
[AGENT][NEUTRAL] Has an effective date of [PII] and no term date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me just a moment.
[AGENT][NEUTRAL] OK. So this claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 0375.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] There was a benefit paid on.
[AGENT][NEUTRAL] I'm sorry, in the amount of $50 on code 99214.
[AGENT][NEGATIVE] The other code was denied.
[AGENT][NEUTRAL] And with the remark on the payment, it states with this payment the maximum benefit amount.
[AGENT][NEGATIVE] For services provided during this office visit have been exhausted.
[CUSTOMER][NEUTRAL] Uh, what is the limit?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Uh, so,
[CUSTOMER][NEUTRAL] Patient responsibility was processed by primary that was $60 for the CPT 99214.
[AGENT][NEUTRAL] And again, we paid the benefit amount of $50 and with that payment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 0 50, yeah.
[AGENT][NEUTRAL] I'm sorry, let me.
[CUSTOMER][NEUTRAL] $10 is still.
[AGENT][NEUTRAL] With that payment, the benefit maximum was met for that data service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh yeah, so I just wanted to know what is the benefit for the one data for the single data of service. So how many do.
[AGENT][NEUTRAL] $50.
[CUSTOMER][NEUTRAL] So, for one data of service, you guys paid $50 for that CPT.
[AGENT][NEUTRAL] That is correct, and that is the maximum that this policy will pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, OK, all right, thank you. I just give me a moment to get another claim details.
[AGENT][NEUTRAL] Yes, ma'am, cause that's fine because I have to make notes on each coin that we do, so it's gonna take me a couple of minutes to do that.
[CUSTOMER][POSITIVE] Oh, OK, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 19
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, sure. And the next member's policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 016.
[CUSTOMER][NEUTRAL] 59604.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] right
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the data service and total bill amount?
[CUSTOMER][NEUTRAL] [PII], billed amount is $309 even.
[AGENT][NEUTRAL] OK, this is also an old policy.
[AGENT][NEUTRAL] This policy number you gave me termed 115 of 2020.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Let me look at the other policy that was active for the data service under the correct policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you need to update her policy number, please, to 0187.
[AGENT][NEUTRAL] 3918.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 01873918, right?
[AGENT][NEUTRAL] Right. Effective date [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Mhm, that is correct.
[CUSTOMER][NEUTRAL] So is it active still now?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Uh, so you will not process as, uh, with the previous one?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] No, ma'am, because it wasn't active for the data service it termed in the year [PII]. Your service date is in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the claim was processed under this policy number that I just gave you which was active for this data service.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] And the claim was received on [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 351-1692.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This claim has been denied at this point and the reason for the denial states to please provide copies of your primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Um, actually, we did send the primary UV via fax.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[AGENT][NEGATIVE] Yes, ma'am, that has not been received.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 74.
[CUSTOMER][NEUTRAL] [PII]. OK, can I have fax number where I can send it again?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, just give me a moment to get another claim.
[AGENT][NEUTRAL] I, when I'm still making my note on this one.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Look.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh my [PII]
[CUSTOMER][NEUTRAL] Yeah, that
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] again
[AGENT][POSITIVE] OK, and surely I'm ready when you are for the next policy number.
[CUSTOMER][NEUTRAL] Uh yeah, that is.
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 05754.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] [PII], bill amount is $277.08.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so this claim was also received on one moment and I'll give you this. Do you need the receive date and the process date or just the status?
[CUSTOMER][NEUTRAL] OK, so this.
[CUSTOMER][NEUTRAL] Uh, no, I, I do need the receipt process it.
[AGENT][NEUTRAL] OK, so this going, uh, let's see one moment.
[AGENT][NEUTRAL] This claim was received on 11-26-2024, processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is 353-586-5.
[AGENT][NEGATIVE] And this claim was also denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK. Uh, claim number is 353-5865, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK then, thank you, just give me a moment.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] But I'm, I'm ready whenever you get your, your last patient pulled up.
[CUSTOMER][NEUTRAL] Uh yeah, that is 018.
[CUSTOMER][NEUTRAL] 479-977
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] Your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] The data service and total bill amount.
[CUSTOMER][NEUTRAL] [PII] $350 even.
[AGENT][NEUTRAL] OK, so this, the policy number you gave me is also not a valid number for that data service.
[AGENT][NEUTRAL] That policy number you gave me termed 112024.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The correct policy number that you should have for this data service is 02505754.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It does not have a term date. The effective date is [PII].
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] In just a moment to check. I will check to see if the claim was received and processed under this correct policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And how much again did you say the total bill amount was?
[CUSTOMER][NEUTRAL] 350 even.
[AGENT][NEUTRAL] 3350.
[CUSTOMER][NEUTRAL] Yeah, right. 350.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 3, I'm sorry, I'm having a little 350, correct?
[CUSTOMER][NEUTRAL] Uh yeah, right.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So again the correct policy number is 0250.
[AGENT][NEUTRAL] 5754.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again, this policy is active.
[AGENT][NEUTRAL] With an effective date.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This claim was received and processed under this claim num under this policy number rather it was received [PII] and processed the same day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, on what day it was received?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it was also denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, and what is the claim number?
[AGENT][NEUTRAL] It is 358, excuse me.
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 3805.
[CUSTOMER][NEUTRAL] 352-380-5
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK. Uh, OK, then. Thank you so much. Have a great day.
[AGENT][POSITIVE] Well, you have very, yes, ma'am. So if that's all I can help you with for today, then thank you again for calling APL and I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] Oh you too goodbye.
[AGENT][POSITIVE] Uh, thank you. Bye bye.