AccountId: 011433970860
ContactId: 5886e3c6-bdde-4735-9478-ae8feeabe286
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1092290 ms
Total Talk Time (AGENT): 203569 ms
Total Talk Time (CUSTOMER): 463259 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/5886e3c6-bdde-4735-9478-ae8feeabe286_20250320T20:00_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is calling from provider's office. I do have a patient for that one. Claim is tonight. I want to discuss about it.
[CUSTOMER][NEUTRAL] to let you know.
[AGENT][POSITIVE] Yes, ma'am. I can assist you with claim status. First, can I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] [PII], callback number [PII].
[AGENT][NEUTRAL] Thank you, sir. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Uh, patient's ID is 01568605 M like Mike L like Lima 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] [PII] will charges $859 even.
[AGENT][NEUTRAL] You said the date of service was [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] Yes, [PII]. I'm not showing a claim on file with that date of service.
[CUSTOMER][NEUTRAL] I can provide you the uh reference claim number.
[AGENT][NEUTRAL] You have a claim number?
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][NEUTRAL] OK. What's the claim number?
[CUSTOMER][NEUTRAL] 3,573,400
[AGENT][NEUTRAL] OK, I do show that claim on file, but it's under a different policy number. One moment.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth one more time.
[CUSTOMER][NEUTRAL] [PII]'s date of birth, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, yes, ma'am. I'm showing that we received this claim on.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] Oh, I'm sorry. Oh yeah, [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the claim processed on [PII].
[AGENT][NEUTRAL] And one moment, please.
[AGENT][NEUTRAL] Yes, and the claim denied um because this policy expired on [PII].
[CUSTOMER][NEUTRAL] In January.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, but how is it possible because, uh, for the same patient, I do have, uh, some more detail service on which we received the payment. Let me uh check uh what's the policy Is mentioned on that one. Just allow me one moment.
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] She's
[CUSTOMER][NEUTRAL] Um, because I think, uh, on this one, different policy I just mentioned, just allow me one moment, please. Uh, sorry, my system is taking a little bit.
[CUSTOMER][NEUTRAL] More time.
[CUSTOMER][NEUTRAL] Give me one more moment, please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] If I.
[CUSTOMER][NEUTRAL] G A P G B
[CUSTOMER][NEUTRAL] Specific.
[CUSTOMER][NEUTRAL] Community.
[CUSTOMER][NEUTRAL] was
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Um, can you please verify the policy ID which you provide which I provided to you initially, uh, for under that policy ID patient is active and eligible.
[AGENT][NEUTRAL] OK. What was the policy ID again, please? Please repeat it.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Uh yeah, sure. 0156.
[CUSTOMER][NEUTRAL] 01568605 M like Mike L like Lima number 8.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Question.
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] And what's the date of service and bill charges on the claim again?
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Um, [PII]. And let me confirm the charge amount.
[CUSTOMER][NEUTRAL] It's $859 even.
[AGENT][NEUTRAL] OK. This claim here is for secondary gap insurance and I'm not showing that claim on file. So does the claim need to be resubmitted under this policy number?
[AGENT][NEUTRAL] Because this is the this is the current policy.
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] Mm. Got it. Uh, actually, I do have some more specific questions. I'm not sure what's going on this patient because when I checked my system, I found that uh for this patient, uh, there's one more data service which is processed under
[CUSTOMER][NEUTRAL] Oh, got it. I got it, got your point. OK, so can you please confirm that from when it is active?
[AGENT][NEUTRAL] OK. Just let me advise you that verification of coverage does not guarantee payment of claims. This is a policy for secondary gap insurance, and I'm showing the effective date on this policy was [PII] and this policy is still active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. Thank you. And what's the time funding limit for submit the claim?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] Oh, got it. And uh call reference and after that, I do have one more data service for the same patient and one more last patient.
[AGENT][NEUTRAL] What's the next date of service?
[CUSTOMER][NEUTRAL] Um, OK. So, the next stage of service.
[CUSTOMER][NEUTRAL] [PII] and the bills.
[AGENT][NEUTRAL] OK. And this is for [PII].
[CUSTOMER][POSITIVE] Mm, yes, correct.
[AGENT][NEUTRAL] OK, I'm not showing.
[CUSTOMER][NEUTRAL] And one more thing, can you please confirm?
[AGENT][NEUTRAL] I'm not showing that claim on file either.
[CUSTOMER][NEUTRAL] Um, I can provide you the claim number.
[AGENT][NEUTRAL] And what's the claim number?
[CUSTOMER][NEUTRAL] 3571679.
[AGENT][NEUTRAL] And what did you say the date of service was?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] always
[AGENT][NEUTRAL] OK, I found this claim. Um, we received this claim on [PII].
[CUSTOMER][NEUTRAL] Um, sorry for the inception, actually, for that one, I do have only one specific question. E entire claim is paid except to A 7038. This one is. So, can you please confirm that why A7038 is denied?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, yes, because it's a disposable item and disposable items are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Possible I can.
[CUSTOMER][NEUTRAL] Covered under
[CUSTOMER][NEUTRAL] Can you please provide me with the patient's plan name?
[AGENT][NEUTRAL] Medlink, M E D L I N K.
[CUSTOMER][NEGATIVE] Mad link.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mm, got it.
[CUSTOMER][NEUTRAL] Can we please move to the next question?
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Uh, so the next policy ID is 02462869 M like Mike Lima 8.
[AGENT][NEUTRAL] OK, thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]'s date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you. And what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] [PII]. And the bill charge amount 1600.
[CUSTOMER][NEUTRAL] $32 even.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] He
[AGENT][NEUTRAL] OK, I'm showing that we received this claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It processed on [PII].
[AGENT][NEGATIVE] And it's denying because we need the ELB from the primary insurance company.
[CUSTOMER][NEUTRAL] OK. Can you please provide me the claim number for this one?
[AGENT][NEUTRAL] Yes, the claim number is 35712772.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] 3571272, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And uh there's any family finding limit for submit collected claim?
[AGENT][NEGATIVE] No, there's no timely filing limit.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] Um, OK, just give me a moment. I, uh, let me check if I do have uh other data service for this patient. This is the last patient which I have. One more last moment, please.
[AGENT][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm gonna to go closer with uh do oxygen convert to purchase me to stop regarding.
[CUSTOMER][NEUTRAL] Um, actually, for this patient, I do have, uh, one data service as well. On this 1, 87038 is billed and this one is denied. So can you please also confirm that this is be covered under this patient policy or not?
[AGENT][NEUTRAL] What's the date of service again, please repeat it.
[CUSTOMER][NEUTRAL] Uh yeah, sure. [PII], build amount for this 1 $859 even.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that A 7038 also denied because it's a disposable item.
[CUSTOMER][NEUTRAL] So disposable item is not covered by the insurance, right? OK, got it.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Uh, your name, please? I think I missed your name again.
[AGENT][NEUTRAL] My name?
[AGENT][NEUTRAL] Sure. My name is [PII]. It's spelled [PII] and my last initial is [PII], and my name and today's date is the reference number.
[CUSTOMER][NEUTRAL] Something
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK. If you just give me one more last moment, let me check, uh, uh, uh.
[CUSTOMER][POSITIVE] OK. No, this is the only last one. Thank you so much for your help, baby.
[AGENT][POSITIVE] OK. Thank you, sir, for calling APL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] There.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] On.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] to the
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I