AccountId: 011433970860
ContactId: 57c04c1a-d289-4bce-a149-0155ae20ab25
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1657550 ms
Total Talk Time (AGENT): 390565 ms
Total Talk Time (CUSTOMER): 648145 ms
Interruptions: 16
Overall Sentiment: AGENT=1.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/57c04c1a-d289-4bce-a149-0155ae20ab25_20250422T16:12_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII].
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] calling for the provider to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So may I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] I'm sorry, [PII], before that, what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII]. My extension, it's a direct line.
[AGENT][NEUTRAL] Thank you, [PII]. What is the policy number?
[CUSTOMER][NEUTRAL] Policy number is 01832260 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, let me just repeat that to you. I have that as 01832260ML8.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] And the member's first name, I would like to spell it [PII], and the last name I would like to spell it again, it's [PII]. And the date of birth will be [PII].
[AGENT][NEUTRAL] I'm sorry, if you could repeat that policy number because I do not show this number on this policy number.
[CUSTOMER][NEUTRAL] OK, the policy number is 018322.
[CUSTOMER][NEUTRAL] 60 ML 8.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK and uh will be required to submit uh denied you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] OK, thank you very much for the information. I have it pulled up and again you're calling for claim status. I can assist you, [PII], what is the date of service and total charge amount?
[CUSTOMER][NEUTRAL] And the date of the date of service is [PII].
[CUSTOMER][NEUTRAL] And the total charges will be, give me a minute, I will like.
[CUSTOMER][NEUTRAL] Again, the total charges will be $779 even.
[AGENT][NEUTRAL] OK, so that was [PII] for $779 even.
[CUSTOMER][POSITIVE] Yeah, you're right.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[CUSTOMER][NEUTRAL] and I have one more option just put that on the first.
[CUSTOMER][POSITIVE] I like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And also [PII], you're able to check claim status by visiting a secure portal at [PII] and on that website you'll be able to obtain an E to be as well.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Um, if you could just bear with me please, I'm still searching for this.
[AGENT][NEUTRAL] Claim let's see if we have it on file.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Almost done.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and again you said that was total charge was $779 correct?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, I did not show that claim on file.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The claim is not on file?
[AGENT][NEUTRAL] I did not show that claim on file. Um, can you verify the procedure code or code's billed?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Uh just a minute. Let me just verify the bill amount once again.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The total the total charges are $662 even.
[AGENT][NEUTRAL] OK, thank you for re-verifying that. It shows that we did receive that claim and it shows that it did not. Give me one moment I'll get that that dial for you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, shows up the claim denied because the major medical did not apply any charges towards the deductible co-pay or co-insurance. So therefore no payment was made on this particular claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so primary did not, uh, made any, uh, charges towards deductible co-pay coinsurance.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEGATIVE] OK, so you, because of that, you didn't make any kind of payment over here.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Bear with me a minute.
[AGENT][NEUTRAL] Certainly.
[CUSTOMER][NEUTRAL] OK. So the claim number is uh the last four digits of the claim number is 3129.
[CUSTOMER][NEUTRAL] 9.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The last four digits of the claim is 0519.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0519. OK, bear me.
[AGENT][NEUTRAL] For our claim number, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, actually, uh, [PII], we have submitted the claim once again with the medical records and the appeal, appeal letter. So have you received the medical records and the appeal letter?
[AGENT][NEUTRAL] OK, one moment. When was that submitted?
[CUSTOMER][POSITIVE] And yeah and we have also submitted additional supporting documents also.
[AGENT][NEUTRAL] When was it submitted?
[CUSTOMER][NEUTRAL] On January, oh sorry, on [PII].
[AGENT][NEUTRAL] [PII]. OK, one moment.
[CUSTOMER][NEUTRAL] really
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment, still searching, thank you, [PII].
[AGENT][NEUTRAL] OK, may I place you on hold?
[CUSTOMER][NEUTRAL] Yeah, sure. Why not?
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK [PII], thank you so much for your patience with me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][POSITIVE] OK, thank you. Yes, thank you so much. We did receive the information as far as an appeal and it shows that appeal decision which I can read this to you if you like when you're ready.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, it says that to whom, I'm sorry, to whom it may concern this letter is regarding your correspondence received in our office on [PII] regarding your claim made under [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK bye.
[AGENT][NEUTRAL] [PII]'s limited medical expense supplemental insurance plan.
[AGENT][NEUTRAL] Um, it goes on to say that we have reviewed the documentation you submitted upon our review. It has been determined that the claim was processed correctly in accordance with the policy contract.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's in still process?
[AGENT][NEUTRAL] Uh, no, it states that the initial processing of the claim.
[AGENT][POSITIVE] Is correct.
[CUSTOMER][NEUTRAL] Yes. So what's the status of the claim?
[AGENT][NEUTRAL] Which states that the major medical.
[AGENT][NEUTRAL] The major medical did not apply any charges. I'm so sorry, the major medical did not apply any charges towards the deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] So what's the status of the game?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I didn't, I'm not able to understand what's the status of the claim right now.
[AGENT][NEUTRAL] OK. The status of the appeal states that we processed the claim correctly the first time, which was denied as the major medical did not apply any charges towards the deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, just give me a minute. Let me just check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so [PII], the primary, uh, is, is not going to pay, so.
[CUSTOMER][NEGATIVE] You will also not pay on this claim.
[AGENT][POSITIVE] That is correct, [PII], yes.
[CUSTOMER][NEUTRAL] Uh me.
[CUSTOMER][NEUTRAL] OK, give me a minute.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What's the received date of the claim? Uh, [PII].
[AGENT][NEUTRAL] I'm sorry, are you asking for the initial claim or the appeal?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh yeah, for the appeal which was submitted with the documents. Uh, so you have received it uh as an appeal, am I right?
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] That is correct, yes, it shows received as of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, sorry, when was the received date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Of
[CUSTOMER][NEUTRAL] And what's the denial date?
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It was denied as of [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]. OK. Perfect. And could you please tell me, is the service not covered under the provider's contract or the payer guideline?
[AGENT][NEUTRAL] The claim denied because the major medical did not apply any charges towards the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Uh, do you follow Medi Medicare guidelines?
[AGENT][NEUTRAL] We assist with the major medicals, deductible, co-pay and or co-insurance.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Well let me hang out, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so [PII], could you please help me with the call reference number for our conversation?
[AGENT][NEUTRAL] OK [PII], we do not provide call reference numbers. You can use my name [PII] last initials [PII] and today's date. Anything else I can assist you with, please?
[CUSTOMER][NEUTRAL] Yeah, I do have more 12 more 3 claims with me. Could you please assist me with that?
[AGENT][NEUTRAL] And also you're able to check claim status by visiting our secure portal at [PII]. [PII], give me one moment please.
[AGENT][NEUTRAL] And what's that policy number [PII]?
[CUSTOMER][NEUTRAL] Yeah, the policy number is Z as in Zulu Z as in Zulu.
[CUSTOMER][NEUTRAL] 8,363,030
[AGENT][NEUTRAL] That is not one of our policy numbers, [PII].
[CUSTOMER][NEUTRAL] OK. Could you please find with the
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Name and the date of birth?
[AGENT][NEUTRAL] Um, that is not one of our policy numbers.
[CUSTOMER][NEUTRAL] Uh yeah, but you can find with the name, no?
[AGENT][NEUTRAL] We can try out the name, but is that is that name associated with that that policy number you just provided?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is the last name please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] I'm sorry, can you spell that for me?
[CUSTOMER][NEUTRAL] Uh, the first name?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And the first name is [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what is the date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, I did not show that member in our system.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] So you're not able to find the member?
[AGENT][NEUTRAL] That is not one of our policy numbers and that member is not in our system.
[CUSTOMER][NEUTRAL] OK, give me a minute.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, fine. What will be the call reference number for our conversation?
[AGENT][NEUTRAL] Again, we do not provide call reference numbers, [PII] in today's date. That's correct.
[CUSTOMER][NEUTRAL] Your name, uh
[CUSTOMER][POSITIVE] Yeah, yeah, yeah, got it.
[CUSTOMER][NEUTRAL] Shall we move to the next claim?
[AGENT][POSITIVE] Please, thank you.
[CUSTOMER][NEUTRAL] Uh, just a moment, bear with me. The policy ID is fetching.
[CUSTOMER][NEUTRAL] Yeah, the policy ID is 018.
[CUSTOMER][NEUTRAL] 325
[CUSTOMER][NEUTRAL] 20 M as in Mike L as in Lima, and 8.
[AGENT][NEUTRAL] OK, verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth will be [PII].
[AGENT][NEUTRAL] OK, thank you for the verification process. What's that date of service and the total charge amount please.
[CUSTOMER][NEUTRAL] The date of service is [PII] and total charges will be, bear with me.
[CUSTOMER][NEUTRAL] Total charges will be $1000.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it shows that the claim was received and the maximum payment of $75 was made. Give me one second please, um, [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Again, that claim was received and the payment of $75 was made on that claim.
[CUSTOMER][NEUTRAL] OK. When was the claim received?
[AGENT][NEUTRAL] [PII] and it processed on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. How was the payment done? I check or EFT?
[AGENT][NEUTRAL] It was a single paper check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please tell me the check number?
[AGENT][NEUTRAL] Of course, 2039632.
[CUSTOMER][NEUTRAL] Uh, uh, could you please repeat the check number once again?
[AGENT][NEUTRAL] Of course, 2039632.
[CUSTOMER][NEUTRAL] 203.
[CUSTOMER][NEUTRAL] 632. Am I right, last three digits.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh and when, when was the claim paid?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] 5 and a loan amount and the paid amount?
[AGENT][NEUTRAL] $75.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And $75.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] $75 even.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And allowed unpaid amount is same because that means there is no patient responsibility.
[AGENT][NEUTRAL] Um, APR does not determine patients responsibility, but we pay the allowed amount of $75.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Uh, could you please tell me the payment's mailing address as well?
[AGENT][NEUTRAL] Of course it was sent to Dispatch Health Florida INC [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And could you please verify me the patient's account number?
[AGENT][NEUTRAL] Of course. It shows 1555802, V like Victor 13869.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] And could you please uh tell me the, sorry, could you please tell me the claim number?
[AGENT][NEUTRAL] Of course, the claim number shows 359-0442.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The claim number is 359-0442.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Just a moment, let me make a note.
[CUSTOMER][NEUTRAL] Mm. And you were a single paper check, am I right?
[AGENT][POSITIVE] Single paper check, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please verify me the payment cash clear date?
[AGENT][POSITIVE] Um, it was just processed and released on the [PII]. It shows outstanding currently.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so the payment is outstanding.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] It's not, it's not clear yet.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Oh, [PII], bear with me. I will not take more time. Just one second.
[CUSTOMER][NEUTRAL] OK, and could you please send me a copy of your Bangla.
[AGENT][NEUTRAL] OK, [PII], you're able to receive that you'll be on that website at [PII].
[CUSTOMER][NEUTRAL] OK, so you're not able to fax me the copy of your?
[AGENT][NEUTRAL] Uh, you can obtain that you'll be from our website as well as check claim status, but for this one I will send that you'll be to you. What is your fax number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes. It's 866.
[CUSTOMER][NEUTRAL] It's 254-869 in attention to the patient's account number.
[AGENT][NEUTRAL] I'm sorry, can you repeat that fax number again?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure, why not. It's [PII].
[AGENT][NEUTRAL] OK, and attention to patients account number, OK.
[AGENT][NEUTRAL] Anything else how can I help you with, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, no, done with it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] Just, uh, one question for, just one question for them and how much time you will receive the UV.
[AGENT][NEUTRAL] Um, it will be sometime today, but if you log on to that website at [PII], you'll be able to get it sooner.
[CUSTOMER][NEUTRAL] OK, and we will receive you be at the end of the day.
[AGENT][NEUTRAL] You should receive the ELB by the end of the day. However, again, if you log on to that website, you'll be able to get that ELB sooner.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Anything else I can help you with, [PII]?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][POSITIVE] Well thank you so much for calling APL. Take care. Have a good day bye bye.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Bye bye.