AccountId: 011433970860
ContactId: 5fe5fbc8-550c-4f7f-8e99-c9a573ed89c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1547750 ms
Total Talk Time (AGENT): 526040 ms
Total Talk Time (CUSTOMER): 503414 ms
Interruptions: 16
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/5fe5fbc8-550c-4f7f-8e99-c9a573ed89c6_20250411T12:57_UTC.wav
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[CUSTOMER][POSITIVE] Thanks
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII], good morning. My name is [PII] and last name initial [PII] [PII]. I'm calling from provider's office regarding the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, I will just give you.
[CUSTOMER][NEUTRAL] Sure. [PII]. It is the direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure. Just give me a moment. OK. The first policy number is 02462630. Uh, total 6 claims. Yeah.
[AGENT][NEUTRAL] And how many claims do you have in total today?
[AGENT][NEUTRAL] 6 claims?
[AGENT][NEUTRAL] And may I have the first member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII], uh sorry, [PII], and the date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service and the total bill for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yeah, it's 68-2023 and the total charge $3480 even.
[CUSTOMER][NEUTRAL] I the client to umbrella client and my Wednesday call when they're going to the.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I don't like that.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Can you verify the name of the facility on the claim?
[CUSTOMER][NEUTRAL] Yeah, sure. It's Galloway Anesthesia Associates.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, I got.
[CUSTOMER][NEUTRAL] I mean, I mean.
[AGENT][NEUTRAL] So, there was another policy active on that data service. Let me see if there's a claim under that policy because this one doesn't have one. Hold on one moment.
[CUSTOMER][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Uh, that that is not.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] I appreciate.
[CUSTOMER][NEUTRAL] Yeah, sure, sure.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, let me go back.
[AGENT][NEUTRAL] Because why did they start the policyholder at 2, so then I need to go back and make sure. Wait a minute, wait, wait, wait.
[AGENT][NEUTRAL] 630 was not active, so it don't matter. So go back to 2303926 and see and she's number 3.
[AGENT][NEUTRAL] Not 2 because they have the policyholders 2 2303026.
[AGENT][NEUTRAL] That's what I'm looking for.
[AGENT][NEUTRAL] 06083023.
[AGENT][NEUTRAL] Hey, how many times did they send it?
[AGENT][NEUTRAL] 12.
[AGENT][NEUTRAL] You said all deniers dupes. OK, wait.
[AGENT][POSITIVE] My goodness. Is there any more?
[AGENT][NEUTRAL] So the very first one.
[AGENT][NEUTRAL] It is 338-3735.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah 146.
[AGENT][NEUTRAL] 348959635164863539177356485703.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] To
[AGENT][NEUTRAL] Do
[AGENT][NEUTRAL] Dupes are the real ones.
[AGENT][NEUTRAL] R
[AGENT][NEUTRAL] 374 5 and 847, OK.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm there.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for this wait. Uh, so I had to take a look at the claim because we, well, for one, the policy number that you provided was not active on the data service. So the active policy was policy number 230.
[AGENT][NEUTRAL] 392 6.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then under that policy, the claim was submitted 24 5 times.
[CUSTOMER][NEUTRAL] Uh, actually it's.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] So the original claim was received on [PII].
[CUSTOMER][NEUTRAL] Sorry, your normal day rate.
[CUSTOMER][NEUTRAL] You know just.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That claim number is 338.
[CUSTOMER][NEUTRAL] I feel like uh.
[AGENT][NEUTRAL] 373 5.
[AGENT][NEUTRAL] And on [PII].
[AGENT][NEUTRAL] The claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] So it was dinner on [PII], right Maximum benefits existed.
[AGENT][NEUTRAL] Yes, because the maximum payable for this data service has been met.
[CUSTOMER][NEUTRAL] $2 amount or uh visits?
[AGENT][NEUTRAL] Maximum payable dollar amount.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. May I have the dollar amount?
[CUSTOMER][NEGATIVE] And many other things are very difficult for it and I'm.
[AGENT][NEGATIVE] Are you asking what the max for the benefit was because this claim was denied.
[CUSTOMER][NEUTRAL] No, no, no, like maximum benefits existed by dollar amount, right? So there is some particular dollar amount per day, right?
[AGENT][NEUTRAL] OK, so that's what you're asking. I just needed clarity. Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So on June, let me see.
[AGENT][NEUTRAL] What is this?
[CUSTOMER][NEUTRAL] That's sure doctor.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] What did he back on.
[AGENT][NEUTRAL] Hold on one moment, I'm just going through the benefits.
[CUSTOMER][POSITIVE] Yeah, sure, sure. Take your own time.
[CUSTOMER][NEUTRAL] On that.
[AGENT][NEUTRAL] So the max for the benefit is $350 per calendar day.
[CUSTOMER][NEUTRAL] OK. Uh, the claim number is 3383735, right?
[AGENT][POSITIVE] 3735. Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, I'm trying to download the Yubi through portal, but in your, uh, but in portal there is no Ubi phone. So is there any chance, can you please send any Yogi through fax?
[AGENT][NEUTRAL] Yes, if they're over a year, there will be no EOB. They only stay on the portal for a year.
[AGENT][NEUTRAL] What's a good fax number for you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure. [PII]. It is a direct line.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And it's [PII]?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So your phone number and the fax is the same?
[CUSTOMER][NEUTRAL] Oh, sorry, sorry. Uh, unfortunately, I forgot to forward the fax number. OK, the fax number is [PII].
[AGENT][NEUTRAL] OK, [PII]. [PII].
[CUSTOMER][POSITIVE] Yeah, it's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so I'm sending this over to you now. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Are you going to need the explanation of benefits for each claim we go over?
[CUSTOMER][NEUTRAL] Uh, if in case there is no UB in portal, so definitely I need a UB.
[AGENT][NEUTRAL] I'm asking so I know if I need to send this individually or at the end of the call. So will you need them for each one or I don't know what's on the portal, but if it's, are they all more than a year old?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. So at the end of the call, you can provide all yours, OK?
[AGENT][NEUTRAL] May I have the next member's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] We're just gonna place you on a brief hold, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Because what is have me all over the place, um.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I'm gonna note this. I'll send the EOBs at the end and not each one after I finish.
[AGENT][NEUTRAL] OK, offer number 615 is not number one.
[AGENT][NEUTRAL] For claim status verified.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] There's too many numbers.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, thank you so much for holding. So is this the member's social security number because it's too many numbers for account number.
[CUSTOMER][NEUTRAL] Uh, no, this is the member ID. So, OK, uh, let's try to the patient name and date of birth.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] If this is the member ID on their card, do you see APL on the card?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That might be their primary.
[CUSTOMER][NEUTRAL] Um, just give me a moment. I'm checking.
[CUSTOMER][NEUTRAL] I'm checking the patient ID card.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just give me a moment, it's loading.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] documents.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So you have the ID card. We're looking for the policy.
[CUSTOMER][NEUTRAL] OK. Uh, I have one. Yeah, yeah, I, yeah, I got an ID card. Like there is a two types of uh member IDs in hospital benefits and outpatient benefits that number.
[AGENT][NEUTRAL] Yes, that's what I was trying to let you know. So those numbers are the same, the ML 7 or 8 at the end is different. I just need the numbers. That's the policy number.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah. It's a, it's ending is different. One is 71 is 8. OK, I can provide in hospital, OK?
[AGENT][NEUTRAL] I just need the numbers, that's all.
[AGENT][NEUTRAL] The numbers are the same for in-hospital and outpatient.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. It's 019.
[CUSTOMER][NEUTRAL] 475
[CUSTOMER][NEUTRAL] 97 M for Mary, L for Lima 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII], uh, and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And again, all the information provided on this call is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge is $2,862 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] you get the.
[AGENT][NEUTRAL] And would this be the same um provider or a different provider?
[CUSTOMER][NEUTRAL] Uh, it's a different provider. The group name is Gastro Health LLC.
[AGENT][NEUTRAL] There we go.
[AGENT][NEUTRAL] OK, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3552283.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We received the explanation of benefits, however, it does not list the amounts applied to the deductible co-pay or co-insurance. So we're requesting a more detailed explanation of benefits that shows the amount paid towards those charges.
[CUSTOMER][NEUTRAL] OK, request your primary OB.
[CUSTOMER][POSITIVE] OK. Thank you so much. And this one, no yo is required, OK. I got the yo portal.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's more than the claim.
[AGENT][NEUTRAL] Um, hold on one moment. I have to know each one. I'll let you know when I'm ready. Hold on one second.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK. And the next member's policy number?
[CUSTOMER][NEUTRAL] 02253357
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] um.
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge $250 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And would this be the same provider or a different provider?
[CUSTOMER][NEUTRAL] Same provider.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm showing that we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3571072.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the maximum payable for this occurrence has been met.
[CUSTOMER][NEUTRAL] OK for denied on [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] May I know the dollar amount?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The benefit is up to $500 per occurrence.
[CUSTOMER][NEUTRAL] $500 per day, right?
[AGENT][NEUTRAL] Let me make sure, hold on one second. This is the deductible.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Hold on, let me double check that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh, OK, so it's $250 per occurrence is the maximum.
[AGENT][NEUTRAL] For outpatient.
[CUSTOMER][NEUTRAL] OK. Thank you. And this one also no your is required. That's more than the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah. 02552102.
[CUSTOMER][NEUTRAL] And the patient name is [PII]. Yeah.
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] Hold on one second. The policy number was 02550102.
[CUSTOMER][NEUTRAL] No, no. It's 02552102.
[AGENT][POSITIVE] Thank you, the phone broke up, so I missed that. Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK. [PII] and the date of birth [PII].
[AGENT][POSITIVE] Thank you for that and the date of service and the total bill for the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII] and the total charge is $350 even.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And would this be the same um provider or a different provider?
[CUSTOMER][NEUTRAL] Same provider.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3561857.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. And this one also I got you have been portal.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When you are ready, I can forward the next one.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, the next member's policy number?
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, it's loading.
[CUSTOMER][NEUTRAL] 0145 0248 M for Mary, L for Lima, 4.
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge is $348 even.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3579126.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the services were rendered after the coverage was terminated.
[AGENT][NEUTRAL] This policy was active from [PII], and there were no active policies with APL after that.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Member is [PII]. So member have any other instances?
[AGENT][NEUTRAL] There's no other access policies with APL uh since that date. If they have other insurance, we don't have access to it.
[CUSTOMER][POSITIVE] OK. Thank you so much. Let's move to the last claim.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] CU
[AGENT][NEUTRAL] OK, the next member's policy number?
[CUSTOMER][NEUTRAL] 025 09842
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. Uh, the patient is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And the date of service and the total bills?
[CUSTOMER][NEUTRAL] [PII] and the total charge $348 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And would this be the same provider or a different provider?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Same provider.
[AGENT][NEUTRAL] Alright, so I'm sure received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 357-053-2.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] No, office visits is not covered on a proficient plan.
[CUSTOMER][NEUTRAL] OK. Thank you, [PII]. Thank you for giving this information. And also, can you please send your with the fax, uh, the first one, OK?
[AGENT][POSITIVE] Yes, you're welcome and I'm sending that to you now. Was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, no thanks. And when are the call reference center?
[AGENT][NEUTRAL] Um, for the entire call will be my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Yeah, thank you and thank you for giving this information. Have a nice day and happy weekend.
[AGENT][POSITIVE] Thank you you also. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, bye bye.