AccountId: 011433970860
ContactId: 5e28cea6-7e67-4d4d-9040-db0dcf85c35b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406679 ms
Total Talk Time (AGENT): 177252 ms
Total Talk Time (CUSTOMER): 103980 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/5e28cea6-7e67-4d4d-9040-db0dcf85c35b_20250307T16:34_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling you from provider's office, checking on claim status.
[AGENT][NEUTRAL] Hey, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Two claims.
[AGENT][NEUTRAL] For the same number or different patients?
[CUSTOMER][NEUTRAL] Different patient.
[AGENT][NEUTRAL] OK [PII], so you will use my name that I gave you along with today's date as your call reference number for each. Also [PII], any information that I provide for you will 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, you may print that by going to our portal and the website for our portal is secured. [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 974.
[CUSTOMER][NEUTRAL] 90 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And what is your patient's name, please, and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII] Date of birth is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII]. Total charge $349 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the provider group name for this claim?
[CUSTOMER][NEUTRAL] Holy Cross Medical Group.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So this claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] There was a benefit paid in the amount of $10.
[AGENT][NEUTRAL] And that was paid on single check 202-6308.
[AGENT][NEUTRAL] And the remarks on this claim?
[AGENT][NEUTRAL] That was, that was paid on code 82306.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Code
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Code 36415 was denied, stating benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by the major medical insurance, please send me an explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] When was the
[AGENT][NEGATIVE] And the other codes were denied because the insured's major medical coverage provided full benefits, and no benefits were payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, sure. Just to confirm, the claim was allowed $10 and it has been paid $10 I'm right? With no patient responsibility?
[AGENT][NEUTRAL] That is correct. We do not determine patient responsibility. That is up to the provider, but the check was issued the same date as the process date I gave you.
[CUSTOMER][NEUTRAL] OK. And when was the check?
[CUSTOMER][NEUTRAL] OK, sure. And when was the check issue done?
[AGENT][NEUTRAL] The date of the process date that I gave you?
[CUSTOMER][NEUTRAL] [PII]. I'm right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, can I get the claim number?
[AGENT][NEUTRAL] 356-0087.
[CUSTOMER][NEUTRAL] OK. And can you please verify me the check payment address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And when was the check cashed on?
[AGENT][POSITIVE] It is still outstanding as of now?
[CUSTOMER][POSITIVE] Still outstanding. OK. Can you please do a check print?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] I'm sorry, I did not understand the question, [PII].
[CUSTOMER][NEUTRAL] Mm, can you please do a check, please?
[AGENT][NEUTRAL] Let's see, give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, I can submit a request. Are you wanting this check to be reissued?
[CUSTOMER][NEUTRAL] Uh, no, uh, we just want to know where the check has been laying, yeah.
[AGENT][NEUTRAL] OK, so
[AGENT][POSITIVE] OK, so now I can't do that. No, sir, I'm sorry, I can't do that. We have mailed it and as of now, it is still outstanding.
[AGENT][NEUTRAL] It has not been cashed as of now.
[CUSTOMER][NEUTRAL] It has been not yet cast.
[AGENT][POSITIVE] It was mailed to the PO box that I gave you. That is correct.
[CUSTOMER][NEUTRAL] Yeah, that address is correct, but uh we need to uh check it.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So we can send you to our posting team. So you need to request for a check trace to know whether the check is linked in the bank or it has been cashed.
[AGENT][NEUTRAL] It has not been cashed as of now, that's what I'm stating.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][POSITIVE] OK, sure. Thank you. Have a good day. Bye-bye.
[AGENT][NEUTRAL] OK. Is that all I can help you with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, thanks for assisting. Have a good day. Bye bye.
[AGENT][POSITIVE] OK, well thank you again for calling APL and I hope you have a nice weekend as well.
[CUSTOMER][NEUTRAL] I do.