AccountId: 011433970860
ContactId: 55f233fe-1783-4051-befc-b1a571585a57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 645260 ms
Total Talk Time (AGENT): 301185 ms
Total Talk Time (CUSTOMER): 268618 ms
Interruptions: 10
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/55f233fe-1783-4051-befc-b1a571585a57_20250415T18:49_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, may I ask your name again?
[AGENT][NEUTRAL] So.
[CUSTOMER][NEUTRAL] You said [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], I'm sorry.
[CUSTOMER][NEUTRAL] I can't hear you. My name is [PII]. I'm calling from Lexington Medical. Just calling to see if you could assist with claim status, please.
[AGENT][NEUTRAL] OK, and you said your name is [PII]?
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am, are you able to assist with 3 different members?
[AGENT][POSITIVE] Yes, I, I can.
[AGENT][NEUTRAL] So you have one day of service for.
[CUSTOMER][NEUTRAL] Well, one different member.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see 1, that's that one that's one for him and then 2 for another member.
[AGENT][POSITIVE] Yes ma'am, I can help you with those on claim status. And what is the, you're welcome. What's a good callback number for you?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. So you, you will, since you have more than one policy to check, you're gonna use my name along with today's date if you need a call reference number for each one. Also, any information, you're welcome. Any information that I provide for you today would be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of the explanation of benefits, we do have a portal that you can print those from.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you for that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And the website for the portal is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And what
[CUSTOMER][NEUTRAL] Maybe that's why I wasn't able to find anything because I call myself on the portal but
[AGENT][NEUTRAL] Uh oh.
[AGENT][NEUTRAL] That wasn't yet.
[CUSTOMER][NEUTRAL] Let's see what portals.
[CUSTOMER][NEUTRAL] Yeah, I thought so. Let me try to log in again.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it was just saying that um.
[CUSTOMER][NEUTRAL] There it was saying that nothing was on file, the two that I checked, so I don't know, yeah, it could have just been me also.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you do have the, well, well, we'll just have to see. I can't say yet. So what's the first policy number?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It's 01972971.
[AGENT][NEUTRAL] Alright, one moment please while I get that member's information pulled up.
[CUSTOMER][POSITIVE] Yes ma'am, thank you for your assistance.
[AGENT][POSITIVE] Uh-huh. You're certainly welcome.
[AGENT][NEUTRAL] OK. And [PII], what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I almost said [PII]. I don't know. I don't see.
[AGENT][NEUTRAL] I can see where that could be done.
[CUSTOMER][NEUTRAL] Yeah, like a tongue twister, like, wait a minute.
[AGENT][NEUTRAL] Alright, and what is, does he have one data service? Was that right for him? OK, and what is the data service and total bill amount?
[CUSTOMER][POSITIVE] Yes ma'am, yes, that's correct.
[CUSTOMER][NEUTRAL] Is
[CUSTOMER][NEUTRAL] [PII] for $324 even.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] You said a check number claim number.
[CUSTOMER][NEUTRAL] Um, my number is 2650.
[AGENT][NEUTRAL] OK, so I do show that this claim was received. The received date was 75 of 2024.
[CUSTOMER][NEUTRAL] See.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 347.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 9010.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 9010 OK.
[AGENT][NEUTRAL] 10. Yes, ma'am. And the reason for the denial is that office visits are not covered by the above number policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Hm, why can I put this on the website.
[AGENT][NEUTRAL] Are you able, did you, OK, try with the claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That that might be a little easier that you did give it to me.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And if you want to verify the patient account number that we have.
[AGENT][NEUTRAL] And this is the account number that you all have for the member that you that you all file on the claim.
[AGENT][NEUTRAL] inbox.
[CUSTOMER][NEUTRAL] OK, uh, you want me to give you what I have?
[AGENT][NEUTRAL] Mhm. You can cause.
[CUSTOMER][NEUTRAL] It's um P as in Paul [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, that is what we have.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's searching maybe it'll find something, yeah yeah.
[AGENT][POSITIVE] OK. uh Hopefully, fingers crossed.
[CUSTOMER][NEUTRAL] So I did find the EOB at least yeah.
[AGENT][NEUTRAL] It did.
[CUSTOMER][NEUTRAL] It says getting in your file. I did pull up something that says search claim, so I clicked on the claim number to try to retrieve the LLB. It's down it says start and download.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And they're in the process of making, OK, so they're in the process of, of updating some information in the online service center portal. So any time you know that you're not able to find it by, you know, always call us because a lot of times once you do have the claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's easier to pull it up. And I, I'm not the technical person, so I can't tell you why that is. But the patient account number matches, so, you know, a lot of times, yeah, I found that with the claim number, you can't access it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Right, and I understand, yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That was a great thing thank you so much for that one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the last two are the same member just different dates of service.
[AGENT][NEUTRAL] Oh, it is the same policy.
[CUSTOMER][NEUTRAL] No ma'am, different, it's a different policy, different member, yeah, and different dates of services too.
[AGENT][NEUTRAL] Oh, OK, alright, OK, so.
[AGENT][NEUTRAL] OK. So do you need any other information on this number before I?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Finish up
[CUSTOMER][NEUTRAL] No ma'am, that's it. The EOB was like Christmas, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEGATIVE] And the remark that I read to you is on page 2. It should have been a 2-page document.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes ma'am, I have it yes ma'am thank you.
[AGENT][NEUTRAL] You're welcome. All right. And what is the next policy number to that you have?
[CUSTOMER][NEUTRAL] It's 016.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 73469
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth on this policy.
[CUSTOMER][NEUTRAL] Uh, let me get back to it. See, multitas don't work sometimes. It's um the name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, so what is the first date of service and total bill amount for her?
[CUSTOMER][NEUTRAL] First, uh, excuse me, first date is [PII] for $165 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was also received.
[AGENT][NEUTRAL] Do you need the received date and the process date or just the status?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] I mean you can give me the claim number and if I can pull it we can just make it easy for you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright. Well, the claim number, the claim number is 353.
[AGENT][NEUTRAL] 3609. And it was also denied to [PII] and it was denied for the same reason. Of visits are not covered. Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm, same reason.
[CUSTOMER][POSITIVE] Wow, OK.
[CUSTOMER][NEUTRAL] OK, that's her date of birth and I try to pull that her other data service. I'm sure it's probably gonna be the same thing. um, let me get back to it is, um, uh, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For $240.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, I was able to pull the ELB on this one too.
[AGENT][NEUTRAL] You were
[CUSTOMER][NEUTRAL] Yes ma'am, on that, the one we just wait, yes ma'am, I did get that LP.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, OK. So the, for the 2nd data service, we received that claim twice. The second one was denied as a duplicate, so you just want the original.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Claim number with the original denial, is that right?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that claim number is 35, OK, 356.
[AGENT][NEUTRAL] 3783.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it was denied for the same reason.
[CUSTOMER][POSITIVE] 37833563783. OK, thank you so very much uh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 356-3783. Yes, ma'am. Uh-huh.
[CUSTOMER][POSITIVE] OK, thank you so much, Ms. [PII]. I'll have all the information that I need.
[AGENT][POSITIVE] Well, you are certainly very welcome, sir.
[AGENT][POSITIVE] OK, then. Well, if that's all I can help you with, [PII], it's my pleasure in speaking to you today. Thank you again for calling APL and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] You do the same thank you very much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.