AccountId: 011433970860
ContactId: 5b844a21-127a-404d-8c1d-0f975c1c9262
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1813729 ms
Total Talk Time (AGENT): 476409 ms
Total Talk Time (CUSTOMER): 392182 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/5b844a21-127a-404d-8c1d-0f975c1c9262_20250109T20:24_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from provider's office, check on claim status.
[AGENT][NEUTRAL] OK [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that. And what is your callback number, please, [PII]?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, my callback number is [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Uh, I have checked the claim for 4 claims. Uh, the 23 claims are same for. One is different for Eda.
[AGENT][NEUTRAL] OK, what about patient? Is it, what about for patients? How many patients do you have?
[CUSTOMER][NEUTRAL] Patient is different. Uh, um, 44 patients.
[AGENT][NEUTRAL] 4 different patients.
[CUSTOMER][NEUTRAL] For different patients to provide us.
[AGENT][NEUTRAL] And one claim each?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can help you with those. And [PII], you will use my name that I gave you as your call reference number for each one along with today's date. My name and today's date will be your call reference number for each.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, sure. Thank you.
[AGENT][NEUTRAL] Also, any
[CUSTOMER][NEUTRAL] Could you spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, OK. [PII], last name, sir?
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information you're welcome, [PII], and any information that I provide for you today on any of the claims that I check will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] And then for any of the claims that you need a copy of the explanation of benefits, you may go to our portal and print those and that website for our portal is secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your first?
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Once again, I noted that. Once again, I noted that.
[AGENT][NEUTRAL] OK. And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] Give me a minute.
[CUSTOMER][NEUTRAL] S E C U R E D, right? [PII]. a.m.
[AGENT][NEUTRAL] No, no, it's [PII].
[AGENT][POSITIVE] So again, I'll say it's secured.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And the first number's policy number, please.
[CUSTOMER][NEUTRAL] Yes, the policy number is 1551671.
[AGENT][NEUTRAL] 1551671. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And any information that I did, uh, I've already said that. I'm sorry. And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes. The patient date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Their name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount please?
[CUSTOMER][NEUTRAL] [PII] 2024. And the total bill amount is 5 $57.86.
[CUSTOMER][NEUTRAL] The balance is $30.
[AGENT][NEUTRAL] The total bill amount is 57.86.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Mm, give me a minute.
[CUSTOMER][NEUTRAL] $151. The balance is $30.
[AGENT][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] So again, the data service is 716-2024 and the total bill amount on the claim is $151. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Balance is only $30.
[AGENT][NEUTRAL] Yes, sir, but I asked for the total bill amount on the claim and the total bill amount is 15151, correct?
[CUSTOMER][NEUTRAL] $115 yes.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][POSITIVE] Yes, 151. Yes, perfect.
[AGENT][NEUTRAL] OK. So this claim was received. It was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is.
[AGENT][NEUTRAL] 352-291-5
[AGENT][NEUTRAL] And the reason for the denial on this claim?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] State office visits are not covered by the above numbered policy. The members supplemental policy data does not cover office visits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on the other code, it was also denied with the remark, benefits are payable only if your major medical insurance provider provides benefits.
[AGENT][NEUTRAL] If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] OK, uh, we don't have a UV. Would you send a fax to the UV?
[AGENT][NEUTRAL] The EOB can be obtained from that portal that I gave to you. That was what I gave you that for, to print the EOB.
[CUSTOMER][NEUTRAL] Yeah, uh,
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] But uh I don't have access to the portal.
[AGENT][NEUTRAL] Do you have access to the internet where you can set up the portal?
[CUSTOMER][NEUTRAL] No, I don't have access to the portal.
[AGENT][NEUTRAL] You have to set up a user name and a password.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're saying you can't do that? Is that what I'm trying to understand what you're saying to me.
[CUSTOMER][NEUTRAL] One second, I'll check that.
[AGENT][NEUTRAL] Yes, you have to create a profile under the medical or dental provider.
[AGENT][NEUTRAL] So that you can have access to that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Username, uh, uh, I select the portal, uh.
[AGENT][NEUTRAL] You would create all of that.
[AGENT][NEUTRAL] Mhm, and you will have to select new user and you will have to walk and complete each of the screens.
[AGENT][NEUTRAL] Answering the questions.
[AGENT][NEUTRAL] Related to the claim to create your profile.
[CUSTOMER][NEUTRAL] Uh, I select the portal access and uh after the next step, the provide the following information for medical or dental provider account. I will update the tax ID.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You will need to enter that as that information that it's asking for. Yes, you will need to enter.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One second. OK.
[CUSTOMER][NEUTRAL] Um, OK. So you want to the next one?
[AGENT][NEUTRAL] Were you able to get that set up?
[CUSTOMER][NEGATIVE] No, uh, I have some error.
[CUSTOMER][NEUTRAL] Uh, for the portal. Uh, no user was found with that, uh, information. That's why and that please try again. If the seller, uh, please contact the customer customer services.
[AGENT][NEUTRAL] Yes, so what is the tax?
[AGENT][NEUTRAL] Uh-huh. And the tax ID number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, uh, the tax ID number is all told, right? [PII].
[AGENT][NEUTRAL] Thank you. And the patient account number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And you put the claim number in that I gave you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh, I don't, I don't know, but I have seen shoes. OK. Uh, I will check that after something. No issues. Uh, so you want the next one?
[AGENT][NEUTRAL] No, sir. I have to make my notes on this one before we can move on. Do you want me to, I will, I will fax this one to you, [PII], until you can get your portal set up.
[AGENT][NEUTRAL] But you're entering the correct information. I'm not sure and you did select new user, is that correct when you first started?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You did?
[AGENT][NEUTRAL] I'm asking you.
[CUSTOMER][NEUTRAL] Yes, uh, I did, uh, yes, I did, but, uh, I don't know why, uh, the proper messages for you contact to the customer care. cause I have a tax ID. I have a patient account number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you used also the claim number, did you try with the claim number that I gave you?
[CUSTOMER][NEUTRAL] 352-291-5, right? The claim number?
[AGENT][NEUTRAL] Yes, sir. Uh-huh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. What is your fax number? I'm not sure why you're have, why it's.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Does it need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] Uh, the extension number is the.
[CUSTOMER][NEUTRAL] patient account number [PII].
[AGENT][NEUTRAL] OK, that is not the patient account number that you gave me a moment ago, and that is not the patient account number on this claim.
[CUSTOMER][NEUTRAL] Uh, the previous one is 1, yeah, the previous one is 115826 uh.
[CUSTOMER][NEUTRAL] 82.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again that fax number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, so that explanation of benefits has been faxed to you, [PII]. What is the next member's policy number?
[CUSTOMER][NEUTRAL] Mm, yes. You send, uh, you'll be right, through fax?
[AGENT][NEUTRAL] Yes, it has been set.
[CUSTOMER][POSITIVE] Thank you. Uh, the next, uh, thank you, thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the next patient ID number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient date of birth is [PII].
[AGENT][NEUTRAL] And then, and their name.
[CUSTOMER][NEUTRAL] Uh the name is [PII].
[AGENT][NEUTRAL] OK, is the service and total bill amount?
[CUSTOMER][NEUTRAL] 730, 2024. The total bill amount is $175. The balance is $30 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again, that date of service is [PII], is that correct?
[AGENT][NEUTRAL] For $175?
[AGENT][NEUTRAL] Total bill amount, is that correct?
[CUSTOMER][NEUTRAL] $123 730 dollars, 2,024. Yeah, the bill amount is $175.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. So the
[AGENT][NEUTRAL] OK, so this claim was received on 10-14-2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] The claim number is 351-8790.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] As I stated, and the reason for the denial is that office visits are not covered.
[AGENT][NEUTRAL] This member's supplemental policy does not cover office visits.
[CUSTOMER][NEUTRAL] Mhm thank you. Uh, would you send a copy of VOB after that I on to the next one?
[AGENT][NEUTRAL] Uh, one, you're needing the COB faxed as well?
[CUSTOMER][POSITIVE] Yes, yes, yes.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] It's still loading the it's still loading the explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] And what does this one need to be put to the attention to?
[CUSTOMER][NEUTRAL] The patient account number [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][POSITIVE] OK, and the next numbers and that one has also been faxed to you and I did receive notification from the first one that I sent, [PII], that said it was successfully delivered or successfully sent.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] And what is the next member's policy? You're welcome. Next member's policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The next number policy number is uh
[CUSTOMER][NEUTRAL] L as in Lima, 61.
[AGENT][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] L as in Lima, 6, I as in India, D as in David, 32061.
[AGENT][NEUTRAL] And uh
[AGENT][NEUTRAL] OK, that is not an American public life policy number, [PII]. That would be for another company. That's not our number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm one moment, the next one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next member ID number is 02061683.
[AGENT][NEUTRAL] That was 02061683. Is that correct?
[CUSTOMER][POSITIVE] 02061683. Yes, perfect.
[AGENT][NEUTRAL] OK, this is the one that we just did.
[AGENT][NEUTRAL] What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] This one is last. The patient and date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Name and I need your name as well.
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service and total bill amount for her please.
[CUSTOMER][NEUTRAL] The data service.
[CUSTOMER][NEUTRAL] [PII], the Builder motors.
[CUSTOMER][NEUTRAL] $283. The balance is $30.
[AGENT][NEUTRAL] I'm sorry, 283.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, this claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 352-296-8.
[AGENT][NEUTRAL] This claim was also denied as office visits are not covered by the policy.
[AGENT][NEUTRAL] And are you going to need a copy of this explanation of benefits as well?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes. Uh, the tension number 11585564.
[AGENT][NEUTRAL] OK, one moment from that to load.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and this one has also been faxed to you as well.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. Was that the last one that you had?
[CUSTOMER][POSITIVE] No, this one is last. Thank you so much. Have a nice day.
[AGENT][NEUTRAL] Oh, you said this one was the last one that you had? Is that correct?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah, the previous one is last. No, no, no, I don't have a claim.
[AGENT][POSITIVE] Oh, OK. All right. Well, I thank you again for calling APL. Hopefully you can get that portal set up and
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] If that's all I can help you with at the moment, [PII]. Thank you again for calling and I hope you have a nice evening.
[CUSTOMER][POSITIVE] Thank you, bye bye.
[AGENT][POSITIVE] Yes sir, thank you. Bye bye.