AccountId: 011433970860
ContactId: 51f2a14c-069b-46ab-85f1-f8609f8dd697
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1150560 ms
Total Talk Time (AGENT): 298672 ms
Total Talk Time (CUSTOMER): 532720 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/51f2a14c-069b-46ab-85f1-f8609f8dd697_20250218T16:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, hi, [PII]. This is [PII] calling from provider office. We need some further claims. Could you assist me?
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] I'm happy to check on a claim for you today, [PII] What is the patient's policy number?
[CUSTOMER][NEUTRAL] Uh yeah, sure. Yeah, the policy number is 02350207.
[AGENT][NEUTRAL] Alright, let me just pull this up here. Give me one moment, please.
[CUSTOMER][NEUTRAL] I'm just in the email.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I please have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. Patient first name is
[CUSTOMER][NEUTRAL] [PII] and last name is [PII] and last, and the date of birth is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Thank you for that and then what is the date of service?
[CUSTOMER][NEUTRAL] Oh yeah, sure. It's the whole data service and the service is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, [PII] build amount.
[CUSTOMER][NEUTRAL] Yeah, uh, sorry, yes, it's correct. The bill amount is $35.65.
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][POSITIVE] All right, thank you so much for your patience and waiting on that. So it looks like we did receive the claim [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the claim was denied. We requested the primary EOB.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh, the for primary you will be right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, may I know the denial date for this claim?
[AGENT][NEUTRAL] Claim was denied [PII].
[CUSTOMER][NEUTRAL] Yeah, and may I know the claim mailing address to submit the claim with primary UB and timely filing limit?
[AGENT][NEUTRAL] No timely filing the claim mailing address is going to be [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] that.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] I think so yeah of course.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, sure, I got it. And you said no timely filing limit to submit the claim, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Oh yeah, sure. Thank you so much. And can I have a call reference number for this one date of service?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name again is [PII], that's [PII] Last initial to my name is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yeah, I got it. And I have another few more data service for the same patient. You can assist me for that one.
[AGENT][NEUTRAL] Mhm. What's the next date of service?
[CUSTOMER][NEUTRAL] Oh yeah, sure. The next one that service is [PII] and the total charge is just a second.
[CUSTOMER][NEUTRAL] 26.1.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] The total charge is $238 even. It's [PII] and the total charge is $238 even.
[AGENT][NEUTRAL] Thank you for that. So we did receive this claim [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Claim was denied, uh, office visits are not covered.
[CUSTOMER][NEUTRAL] And what?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Of cities are not covered under the patient plan or a provider plan. It's a patient plan, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Under the patient's plan, mhm correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And may I know the patient plan name?
[AGENT][NEUTRAL] We are the secondary medlink.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, Metlink, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, sure. Thank you. And may I know the uh the denial date for this claim?
[AGENT][NEUTRAL] Claim was denied [PII], same date it was received.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh yeah, and may I know the claim number for this one?
[AGENT][NEUTRAL] 323.
[AGENT][NEUTRAL] 2364.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I got it. Thank you. And we just want the next one, date of birth?
[AGENT][NEUTRAL] Mhm. What's the next date of service?
[CUSTOMER][NEUTRAL] Yeah, it's the same date of service. It's [PII] and the charge amount is $85.89.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEUTRAL] Uh, the claim was denied. It looks like services were not covered in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That service within the.
[CUSTOMER][NEUTRAL] Yeah, may I know the claim number for this one?
[AGENT][NEUTRAL] Claim number is 323.
[AGENT][NEUTRAL] 2359.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, I got it. May I know the date for this claim?
[CUSTOMER][NEUTRAL] I might have enough.
[AGENT][NEUTRAL] Claim was denied [PII].
[CUSTOMER][NEUTRAL] Yeah, I got it. Uh, for the verification, may I know the mailing address?
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] A PO mailing address is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah, sure. And what's the timely paying limit for the appeal?
[AGENT][NEUTRAL] Appeals must be filed within 180 days of the decision.
[CUSTOMER][POSITIVE] OK, yeah, sure. Thank you so much for clarifying. And we just want the next one date of service.
[CUSTOMER][NEUTRAL] It's data services, yeah, it's [PII].
[AGENT][NEUTRAL] Uh, yes, what's the next, yeah.
[CUSTOMER][NEUTRAL] And the total charge amount is $249.90.
[CUSTOMER][NEUTRAL] 800
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII], correct?
[CUSTOMER][NEUTRAL] Um, um, sorry, it's [PII]. It's [PII].
[AGENT][NEUTRAL] Oh OK. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we did receive this claim [PII].
[AGENT][NEUTRAL] Uh, the claim was denied. Office visits are not covered under members policy.
[CUSTOMER][NEUTRAL] OK. And may I know the denial date for this claim?
[AGENT][NEUTRAL] Claim was denied [PII].
[CUSTOMER][NEUTRAL] And what's the claim number for this one?
[AGENT][NEUTRAL] That would be 339-755-7.
[CUSTOMER][NEUTRAL] Uh, it's 339-7557, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, yeah, sure. And we just want the next one. The next one data service is uh [PII].
[CUSTOMER][NEUTRAL] Uh, oh, I'm sorry, I'm sorry, I'm sorry. I said December is [PII].
[CUSTOMER][NEUTRAL] And the total charge is $152.74.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So claim is received on [PII].
[AGENT][NEUTRAL] Uh, the claim was denied. Services are not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And may I know the dinner date for this one?
[AGENT][NEUTRAL] Claim was denied [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And what's the claim number for this one?
[AGENT][NEUTRAL] Uh, claim number is going to be 323-8132.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yeah, I got it. Thank you. And we just want the next one.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Mhm. That's the next date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, the next one data service is [PII] and the total charge is $115.07.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][POSITIVE] Yes I can.
[CUSTOMER][NEUTRAL] 90
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So basic.
[AGENT][NEUTRAL] OK. So we received this claim [PII]. Uh, the claim was denied. Services are not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Every
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Claim was denied on [PII].
[CUSTOMER][NEUTRAL] Yeah, sure. And what's the claim number for this one?
[AGENT][NEUTRAL] 3359675.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I got it. Thank you. And we just want the next one data service. The next one is [PII] and the total charge is
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $238 even.
[CUSTOMER][NEUTRAL] they
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] yeah, like cash.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Uh, the claim was denied, office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Claim was denied and processed [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And what's the claim number?
[AGENT][NEUTRAL] Claim number is 3259553.
[CUSTOMER][POSITIVE] Yeah, I got it.
[CUSTOMER][POSITIVE] Yeah, we just want the next one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The next one data service is [PII].
[CUSTOMER][NEUTRAL] And the total charge is
[CUSTOMER][NEUTRAL] $368.96.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, the uh the baseball.
[CUSTOMER][NEUTRAL] Is for the.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEGATIVE] I was denied. Office visits are not covered under the member's policy. Claim was denied same date [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number on this one is 339-5002.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I got it. And I have a last one date of service.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And the total charge is
[CUSTOMER][NEUTRAL] $35.65.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] I was, I was actually buying.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, just I'm just.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Right, so the claim was received on [PII].
[AGENT][NEUTRAL] Uh, the claim was denied [PII], requesting the primary EOB.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the claim number on this is 319-6934.
[CUSTOMER][NEUTRAL] Yeah, I got it. And one more, one more help for your side, and I missed the claim number for the first claim, but I for the date of service. Could you please verify and say the claim number for that one?
[AGENT][NEUTRAL] What was the date of service again?
[CUSTOMER][NEUTRAL] Uh yeah, sure. Just a second.
[CUSTOMER][NEUTRAL] Yeah, the data service is [PII] and the total charge is $541.43.
[CUSTOMER][NEUTRAL] I didn't know.
[CUSTOMER][POSITIVE] Oh thank you so much.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] The claim number for that was 324.
[AGENT][NEUTRAL] 9312.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, I got it. Thank you so much for giving this information. Thank you.
[AGENT][POSITIVE] Mhm. You're welcome. Anything else I can help with, [PII]?
[CUSTOMER][POSITIVE] Uh, no, sir. Uh, no thanks. Thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] Yeah. Have a good day. Bye for now.