AccountId: 011433970860
ContactId: 56fd4adb-81e4-4c12-b17c-9292231bf803
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1053680 ms
Total Talk Time (AGENT): 311617 ms
Total Talk Time (CUSTOMER): 307161 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/56fd4adb-81e4-4c12-b17c-9292231bf803_20250512T13:47_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] on the claim. Can you please help me on this?
[AGENT][NEUTRAL] Sure, I can verify claim status for you, [PII], and what is the policy number, please?
[CUSTOMER][NEUTRAL] 02521722.
[AGENT][POSITIVE] Thank you, one moment, please.
[AGENT][NEUTRAL] Uh let's see.
[AGENT][NEUTRAL] OK. And do you have a callback number, call in case the call drops?
[CUSTOMER][NEUTRAL] [PII]. Could you please spell your name?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] And [PII], um, verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you and you say you're calling for a claim status correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] What was the date of service and the amount of the charge, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Data service is.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] [PII] total bill amount $1180 even.
[AGENT][NEUTRAL] Thank you. And do you have a callback, not callback, the balance after primary has processed the claim?
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that amount is?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah, uh, primary BCBS paid $241.41. They have left out $60.35.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] The secondary American public life.
[AGENT][NEUTRAL] OK, well, don't show that we received the claim for that data service. Can you verify the mailing address it was submitted to?
[CUSTOMER][NEUTRAL] They left her
[CUSTOMER][NEUTRAL] Attention claims processing [PII].
[AGENT][NEUTRAL] Uh, that is correct. Uh, if you like I can give you a fax number if you like to fax the claim to our office.
[CUSTOMER][NEUTRAL] No, I do have the, uh, once again the claim number.
[AGENT][NEUTRAL] What is the claim number?
[CUSTOMER][NEUTRAL] That belongs to you. I don't know. The claim number is 35.
[CUSTOMER][NEUTRAL] 358-366-62
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] No, sir. That is for the data service you're calling for [PII].
[CUSTOMER][NEUTRAL] So that claim number belongs to [PII] correct? Not for [PII], correct?
[AGENT][NEUTRAL] No, the claim number you gave us for [PII]. You inquired about claim number or claim for [PII], which we have not received.
[CUSTOMER][NEUTRAL] No, no, no, no, no, my, I said, uh, our data services [PII] with the bill amount $1180.
[AGENT][NEUTRAL] Um, OK. I must have misheard my bad, but I heard you say [PII], but [PII] with that claim processed as.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] The maximum, uh, the maximum benefit payable for this data service has been met.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Maximum benefits exhausted or visits a dollar amount.
[AGENT][NEUTRAL] For a data service for the dollar amount.
[CUSTOMER][NEUTRAL] dollar amount.
[CUSTOMER][NEUTRAL] What is the annual, uh, dollar amount?
[AGENT][NEUTRAL] There's not an annual amount. They have a daily benefit amounts of $200 per calendar day. This is not a guarantee of payment, just a verification of coverage.
[CUSTOMER][NEUTRAL] Ever
[CUSTOMER][NEUTRAL] When it was last met?
[AGENT][NEUTRAL] I can't give you that information.
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] OK. And [PII], and I have a small clarification. We have received a response from a coding team stating that that uh previous uh
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Services which was done by the patient has been reversed.
[CUSTOMER][NEUTRAL] But just for one time courtesy, can you please send the claim back already processing if you get the same denial, we won't get the same deny if you get.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEGATIVE] Well, the claim is received previously and it was denied the same, um, as the benefits max for the data service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah. I received, yeah, I received a letter from a patient stating that as a previous services they have been uh run by the provider, it's for different provider.
[AGENT][NEUTRAL] You are more than welcome. You can, you're more than welcome to submit an appeal. You can submit a letter stating the reason for the appeal, but no, sir, I will not send this claim back for reprocessing since it was processed correctly.
[CUSTOMER][POSITIVE] Oh that's right.
[CUSTOMER][POSITIVE] It correctly.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because without knowing the last, uh.
[CUSTOMER][NEUTRAL] Met date I can't be able to send an appeal or for a correct a claim.
[AGENT][NEUTRAL] Well, you can just submit another claim and it could be processed as a duplicate, but no, sir, um, I can't give you any information on a claim that you're not inquiring about.
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][NEUTRAL] learn about
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you please send me the UOB to the fax number?
[AGENT][NEUTRAL] Sure. What's your fax number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Attention to Paul.
[AGENT][NEUTRAL] OK, so that's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] In this case, can we submit an a current claim or we need to appeal this?
[AGENT][NEUTRAL] You will have to appeal. What other correction that needs to be made on the claim?
[CUSTOMER][NEUTRAL] Have to feel.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] OK. And what is the appeal mailing address?
[AGENT][NEUTRAL] The same mailing address for claims [PII].
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] Last
[AGENT][NEUTRAL] You must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] 50
[AGENT][NEUTRAL] And you have up to 180 days from the time the claim was processed to submit an appeal.
[CUSTOMER][NEUTRAL] For the appeal.
[CUSTOMER][NEUTRAL] Hold on one second.
[CUSTOMER][NEUTRAL] The appeal mailing address is [PII]. The zip code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, and the TFLS?
[CUSTOMER][NEUTRAL] 180 days.
[AGENT][NEUTRAL] You have up to 180 days from the time the claim was processed to submit an appeal. You must submit a letter stating the reason for the appeal.
[CUSTOMER][NEUTRAL] From, uh, process it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Claim received and processed date.
[AGENT][NEUTRAL] Uh, claim received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Uh, playing with
[CUSTOMER][NEUTRAL] OK, need to appeal this. Can I have the reference number for this particular card?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK, shall I proceed the next member ID?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, no, give me one moment please.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK. And what was the next policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] 023
[CUSTOMER][NEUTRAL] 893-3887
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. Uh, what's the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Hold on, let me check.
[CUSTOMER][NEUTRAL] 02389387 is not your one of your numbers?
[AGENT][NEUTRAL] Uh, you gave more numbers than that. Give that to me one more time to make sure I have it correct.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][POSITIVE] I have it correct.
[CUSTOMER][NEUTRAL] 023893887.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Same date of birth.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Patient name [PII], [PII].
[CUSTOMER][NEUTRAL] [PII] is the date of birth.
[AGENT][NEUTRAL] I'm sorry, what was the date of birth again?
[CUSTOMER][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With the total bill amount $158 even.
[AGENT][NEUTRAL] And you said data service [PII], correct?
[CUSTOMER][NEUTRAL] Um, correct. [PII] with the total bill amount is $158.
[AGENT][NEUTRAL] OK. And what was the balance after primary?
[CUSTOMER][NEUTRAL] Uh, $30.30.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and name of the provider's office?
[CUSTOMER][NEUTRAL] Provider's office. Same Medical University of South Carolina.
[AGENT][NEUTRAL] OK, I'm showing this claim process as a duplicate.
[AGENT][NEUTRAL] But I don't show we received it previously, so I will send this claim back so it can be reprocessed.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] When was the claim received date?
[AGENT][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Uh, the claim was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] for
[CUSTOMER][NEUTRAL] Mhm. The claim number?
[AGENT][NEUTRAL] 358-521-0.
[CUSTOMER][NEUTRAL] 10.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How long it will take?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] Not with this.
[CUSTOMER][NEUTRAL] I'm sorry. How long it will take now to reprocess this me?
[AGENT][NEUTRAL] I say give it 7 to 10 business days.
[CUSTOMER][NEUTRAL] How much business account it is?
[CUSTOMER][NEUTRAL] Do you have any ticket number?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. Can I use your name in today's date, correct?
[AGENT][POSITIVE] Uh, that's correct.
[CUSTOMER][NEUTRAL] Oh, that's correct. OK, I do have the last question. Shall I go ahead?
[AGENT][NEUTRAL] Uh, no, give me one moment, please.
[CUSTOMER][NEUTRAL] OK. OK. OK, OK.
[AGENT][NEUTRAL] OK, what is the next policy number?
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 023
[CUSTOMER][NEUTRAL] 893-84.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] [PII], [PII], date of birth.
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] [PII] total bill amount $1,668 even.
[AGENT][NEUTRAL] You said [PII], correct?
[CUSTOMER][POSITIVE] Uh, correct. Correct.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] The primary
[CUSTOMER][NEGATIVE] Yes, I think this came primary not paid.
[CUSTOMER][NEGATIVE] They have canceled out 459.81. They denied the claim, uh once again.
[CUSTOMER][NEUTRAL] As a deductible, they process the claim as deductible and are not paid.
[AGENT][NEUTRAL] OK, uh, show this claim process that's needing the primary EOB.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] All right, you're welcome. And is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] You can resubmit the claim.
[CUSTOMER][NEUTRAL] Yeah, when was the claim received and processed date?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, the claim was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Claim number?
[AGENT][NEUTRAL] 3583957
[CUSTOMER][NEUTRAL] 957
[CUSTOMER][NEUTRAL] 358395 so need primary OB we can resubmit along with the primary OB correct?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the patient effective date?
[AGENT][NEUTRAL] [PII] and the policy is active.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] What is your pay ID? That's it.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][POSITIVE] Thank you. Have a happy day. Bye.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You too, thanks for calling APL Paul bye.
[CUSTOMER][NEUTRAL] Bye.