AccountId: 011433970860
ContactId: 53bad186-456c-4a8c-97b7-7f9028957b83
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1336369 ms
Total Talk Time (AGENT): 320937 ms
Total Talk Time (CUSTOMER): 406718 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/53bad186-456c-4a8c-97b7-7f9028957b83_20250410T21:28_UTC.wav
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[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you for calling APL. This is Sa[PII]How can I help you?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, hi, uh, good afternoon. My name is Ha[PII]and last I initial for Na[PII]I'm calling from provider's office regarding the claim status.
[AGENT][NEUTRAL] OK, Ha[PII]I'm happy to check on a claim. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 01719350.
[AGENT][POSITIVE] Thank you. And can I get a good callback number?
[CUSTOMER][NEUTRAL] 61[PII]It is a direct line.
[AGENT][NEUTRAL] Thank you for that. And then if I can get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's Ja[PII]and the date of birth is Se[PII].
[AGENT][POSITIVE] Thank you, data service.
[CUSTOMER][NEUTRAL] OK. The date of service is 3-[PII]nd the total charge $1500 even.
[AGENT][NEUTRAL] Thank you. So the claim was received on Fe[PII].
[AGENT][NEUTRAL] Claim was denied Fe[PII].
[AGENT][NEUTRAL] Uh, we received a primary explanation of benefits. However, we need something, it doesn't show the deductible co-pay or co-insurance, so we need a more detailed explanation of benefits from the primary.
[CUSTOMER][NEUTRAL] OK. And may I have the claim number?
[AGENT][NEUTRAL] 356-884-6
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. So how can I set up with the, OK, I will try it.
[CUSTOMER][NEUTRAL] resubmit again. OK. Thank you. That's more than the claim.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Is there another number that you need to check, or?
[CUSTOMER][NEUTRAL] Yeah, it's a different member.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] How many claims you can provide the one cost?
[AGENT][NEUTRAL] As many as needed.
[CUSTOMER][NEUTRAL] OK. Totally, I need 10 claims.
[AGENT][NEUTRAL] Uh, I'll just need to notate these before we move on to the next, so give me one moment, please.
[CUSTOMER][NEUTRAL] Sure. Can you please spell your name?
[AGENT][NEUTRAL] My name is spelled S [PII].
[AGENT][NEUTRAL] My last initial is T [PII].
[CUSTOMER][POSITIVE] Yeah, thank you, sir.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Alright, what is the next member ID?
[CUSTOMER][NEUTRAL] Yeah sure.
[CUSTOMER][NEUTRAL] The next member ID is 01820389 M for Mary, L for Lima 8.
[AGENT][NEUTRAL] Thank you. Name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The patient name is um Si[PII].
[CUSTOMER][NEUTRAL] Films and the date of birth 7-[PII].
[AGENT][POSITIVE] Thank you. Data service.
[CUSTOMER][NEUTRAL] The date of service is uh Ja[PII]nd the total charge $4,191 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Do you have an amount after the primary paid?
[CUSTOMER][NEUTRAL] Um, one second, I can forward how much amount is paid and how much amount is spending.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, the primary is paid $778 111 cents and the remaining coincidence is $373.11.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] this one is.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] You got the claim?
[AGENT][NEUTRAL] Looks like we did receive the claim on Fe[PII]It was denied on Fe[PII]Uh, the max benefit payable for the state of service had already been met.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][POSITIVE] Maximum benefits existed.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] By dollar amount or by visits?
[AGENT][NEUTRAL] And by dollar amount.
[CUSTOMER][NEUTRAL] May I know the dollar amount?
[AGENT][NEUTRAL] Mhm. The outpatient benefit amount per calendar day is a maximum of $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, may I know the claim number?
[AGENT][NEUTRAL] Uh, claim number on this one is 356-888-1.
[CUSTOMER][NEUTRAL] OK, just give me a moment.
[CUSTOMER][POSITIVE] OK. Thank you so much. And let's move to another claim.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Yeah, just give me a moment. It's loading.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The member ID is 1,082,950 M for Mary, L for Lima, 5.
[AGENT][NEUTRAL] Thank you. Patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second, it's loading.
[CUSTOMER][NEUTRAL] The patient name is Do[PII]nd the date of birth is Se[PII].
[AGENT][NEUTRAL] Thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is Ja[PII]nd the total charge is $542 even.
[AGENT][POSITIVE] Thank you. So,
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] This claim was received on Fe[PII].
[AGENT][NEUTRAL] Uh, the claim was denied Fe[PII]Of office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] OK, and what is the claim number?
[AGENT][NEUTRAL] Uh, claim number on this one is gonna be 3563699.
[CUSTOMER][NEUTRAL] OK, just give me a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Thank you. Let's move to another client.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When you're ready, I can provide the claim number, I mean, I my member ID.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] OK, uh, the member ID is 1,003,400.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is Jo[PII]nd the date of birth is Oc[PII].
[AGENT][NEUTRAL] Thank you and then what's the date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is Ja[PII]nd the total charge is $348 even.
[AGENT][NEUTRAL] 3:48.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] This claim was received on Fe[PII].
[AGENT][NEUTRAL] Denied Fe[PII].
[AGENT][NEUTRAL] Office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] OK, may I know the claim number?
[AGENT][NEUTRAL] The claim number for this is going to be 356-579-5.
[CUSTOMER][NEUTRAL] OK. Just give me a moment. I'm trying to download you with quota.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK. Thank you so much. That's more than the claim.
[AGENT][NEUTRAL] OK, policy number when you're ready.
[CUSTOMER][NEUTRAL] Yeah, just give me a moment.
[CUSTOMER][NEUTRAL] OK, and the member ID.
[CUSTOMER][NEUTRAL] It's 01820389 M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is Si[PII]Date of birth 7-[PII].
[AGENT][NEUTRAL] Thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is Ja[PII]nd the total charge $4,288 even.
[AGENT][NEUTRAL] I believe we already checked this one.
[CUSTOMER][NEUTRAL] Uh, yeah, patient is same but date of service is different. So just now I said, I seen this patient earlier.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] And the date of service is 1/[PII]r 11[PII]I'm sorry.
[CUSTOMER][NEUTRAL] 11[PII].
[AGENT][NEUTRAL] OK, so claim was received on Fe[PII].
[AGENT][NEUTRAL] Denied Fe[PII]Max benefit payment for the date of service had already been met.
[CUSTOMER][NEUTRAL] Maximum benefits, OK. My dollar amount or?
[AGENT][NEUTRAL] It's a max benefit per calendar day of $500.
[CUSTOMER][NEUTRAL] OK, and the same scenario, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK we go ahead and change it.
[CUSTOMER][NEUTRAL] Um, just give me a moment, OK? I'm trying to download the UOB. And can you please provide the claim number?
[AGENT][NEUTRAL] 356-888-81.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, it's loading.
[CUSTOMER][POSITIVE] Just give me a moment. Sorry for the inconvenience.
[AGENT][POSITIVE] Yeah, no problem.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, thank you so much. That's more than that.
[AGENT][POSITIVE] OK, I'm ready for the next policy number when you are.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The member ID is 01[PII] [PII].
[AGENT][NEUTRAL] Thank you. And patient name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The patient name is Ka[PII]nd the date of birth is Fe[PII].
[AGENT][POSITIVE] Thank you, data services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is Ja[PII]nd the total charge $340 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, so it looks like we did receive a claim for the state of service on Ma[PII].
[AGENT][NEUTRAL] Claim was denied on Ma[PII]Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Office is it's OK. You know the claim number.
[AGENT][NEUTRAL] Claim number on this 3572984.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a moment. I'm down uh the EOP.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. How is it going today?
[AGENT][POSITIVE] Good.
[CUSTOMER][POSITIVE] Not bad.
[AGENT][POSITIVE] Yeah, good, thanks for asking. How about yourself?
[CUSTOMER][POSITIVE] Yeah, it's good so I'm waiting for weekend.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So everyone wants to waiting for a week, right?
[AGENT][POSITIVE] Everybody's always ready, yeah.
[CUSTOMER][NEUTRAL] Yeah, so one day to go.
[AGENT][NEUTRAL] One day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes. OK. Thank you so much and let's move to another claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Good for them.
[CUSTOMER][NEUTRAL] Yeah. The member ID is 02[PII] [PII].
[AGENT][NEUTRAL] Thank you. Patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is Ed[PII]nd the date of birth is Fe[PII].
[AGENT][POSITIVE] Thank you for that and then data service.
[CUSTOMER][NEUTRAL] OK. The date of service is Ja[PII]nd the total charge $2,862 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] So it looks like we did receive a claim for this state of service on Fe[PII]Claim was denied Fe[PII]Max benefit payable for this state of service had already been met.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] By dollar amount, right?
[AGENT][NEUTRAL] Correct. The excuse me, the uh max benefit amount is per calendar day on this patient plan of 500 per day.
[CUSTOMER][NEUTRAL] $500 per day.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] made a claim number?
[AGENT][NEUTRAL] 356-814-7.
[CUSTOMER][NEUTRAL] 356-814-7
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. It's loading. Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. And one more claim is there, that is the last one.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Just give me a moment. It's loading.
[CUSTOMER][NEUTRAL] I just.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Yeah, um, the next member ID is 02270639.
[AGENT][NEUTRAL] All right. And then patient name and date of birth?
[CUSTOMER][NEUTRAL] OK. The patient name is Va[PII]nd the date of birth is Fe[PII].
[AGENT][POSITIVE] Alrightage of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] OK. Um, the date of service is Fe[PII]nd the total charge is $348 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim was received Fe[PII].
[AGENT][NEUTRAL] Claim was denied on Ma[PII].
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK. And then the claim number?
[AGENT][NEUTRAL] 3570082
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah. Thank you, Sa[PII]Thank you for giving this information. Ha[PII]a nice day and once happy weekend.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.