AccountId: 011433970860
ContactId: 635f397a-bbd5-407a-810a-58d10fef5e4c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 644780 ms
Total Talk Time (AGENT): 224583 ms
Total Talk Time (CUSTOMER): 303270 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/635f397a-bbd5-407a-810a-58d10fef5e4c_20250207T19:51_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. This is [PII] calling from the provider office to know claim status and this call is being recorded for quality and training purpose.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with claim status. What is the callback number?
[CUSTOMER][NEUTRAL] Uh, just give me a second, [PII].
[CUSTOMER][NEUTRAL] So the callback number we have is [PII]. I'm sorry, [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please, ma'am?
[CUSTOMER][NEUTRAL] Just give me a second. Uh, so the, I have, uh, two claims for the same patient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so the policy number is 02145791 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth please, ma'am.
[CUSTOMER][NEUTRAL] Yes, so the, the patient's first name is [PII]. Last name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Alright thank you and it would be my pleasure to help you with both claim statuses for [PII]. What is the first date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have, it is uh [PII] with the total bill amount of $838 even.
[AGENT][NEUTRAL] 8:38.
[AGENT][NEUTRAL] I am checking for claim status for data service [PII] for 838. I don't have that claim on file, [PII].
[CUSTOMER][NEUTRAL] 8:38, right? You don't have the claim on file?
[AGENT][NEUTRAL] I do not.
[AGENT][NEGATIVE] We have not received it.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, just give me a second, [PII], let me make a note for this. Uh-huh.
[CUSTOMER][NEUTRAL] Because uh the claim was sent via paper.
[AGENT][NEUTRAL] Do you have the address it was sent to?
[CUSTOMER][NEUTRAL] Um, actually, we are not at price to send the claim via paper, so I don't have the exact details. Give me a second. Let me check anything I can check from here. So I think the address is [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. That is the correct claim submission address, but we did not receive the claim, and [PII], there is an option if you would prefer to fax the claim with the primary EOB directly to our claims department. I can provide the fax number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. So I have one fax number with me. Is it correct or not? Uh, it is [PII]. Is it right?
[AGENT][NEUTRAL] That is not our claims fax number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Provide me the number.
[AGENT][NEUTRAL] The correct claims fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], can you please help me with one more claim, uh, because, uh, with the same patient uh but different date of service, I just want to know is it on file or not?
[AGENT][NEUTRAL] I can help you with that. What's that next data service, [PII]?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] And that bill amount?
[CUSTOMER][NEUTRAL] The bill amount is $472.83.
[AGENT][POSITIVE] Thank you [PII].
[AGENT][NEUTRAL] [PII], I don't have that claim on file either.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] So for both the claim, I have to send it uh via fax only. Yeah sure.
[AGENT][POSITIVE] That's great. And that was for February. What was the date again?
[CUSTOMER][NEUTRAL] It is uh [PII].
[AGENT][NEUTRAL] Thank you. Yeah, I don't.
[CUSTOMER][NEUTRAL] Uh, do you, do, OK, so are we in a timely filing for the claim?
[AGENT][NEGATIVE] Yes, our, uh, APL does not observe timely filing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So there's no TFL.
[CUSTOMER][POSITIVE] OK. No issue.
[CUSTOMER][NEUTRAL] Um, actually, give me a second.
[CUSTOMER][NEUTRAL] Let me check some details here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so, actually, actually, I have one more claim to check. Is it on file? No, no, the patient is different.
[AGENT][NEUTRAL] Same patient?
[AGENT][NEUTRAL] And I can help you with another claim. Give me just one second, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No issue.
[AGENT][NEUTRAL] What is that policy number for the next patient?
[CUSTOMER][NEUTRAL] It's 000649354.
[AGENT][NEUTRAL] 649354
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Doesn't sound like one of ours, but I'm checking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not pulling up a policy by 649364.
[CUSTOMER][NEUTRAL] Uh, because, uh, here they have some kind of mistake from my side. OK, so I'm changing the patient, so I have one more question. Can you check this policy? It is 023.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 17,300 ML 88.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I've got that policy. What is that patient's name and date of birth?
[CUSTOMER][NEUTRAL] So the patient's name is [PII] Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Let me get her policy completely pulled up, and what is that date of service?
[CUSTOMER][NEUTRAL] Uh, so here we have the rate of service is.
[CUSTOMER][NEUTRAL] [PII], 2024 and total bill amount is $307.83.
[AGENT][POSITIVE] Thank you [PII], and what is the facility name please?
[CUSTOMER][NEUTRAL] It is vital. I'm sorry, it is uh Mediath. Vital MD and the vital MD.
[AGENT][POSITIVE] OK, thank you and
[AGENT][NEUTRAL] That total bill amount you said was $307.83.
[CUSTOMER][NEUTRAL] $7.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Just see, let me get that claim pulled up and I can give you the received date and the claim decision.
[AGENT][NEUTRAL] That claim we did receive.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] The claim was processed on [PII].
[AGENT][NEGATIVE] And it was denied as services were rendered after the policy turned.
[CUSTOMER][NEUTRAL] OK. Just give me a second. So it is denied on the same date. It is received on [PII] and denied on the [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEGATIVE] OK. It is denied as services rendered.
[AGENT][POSITIVE] After the policy term, that's right.
[CUSTOMER][NEUTRAL] After the 10 minutes.
[CUSTOMER][NEUTRAL] The policy terms.
[CUSTOMER][NEUTRAL] OK. Uh, can you please help me the uh exact time frame for this policy was active?
[AGENT][NEUTRAL] Sure, the effective date was [PII].
[AGENT][NEUTRAL] And this policy termed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 24. And just give me a second. So the date of service, actually, the date of service lies, no, it is not lying between the
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, it is not lying between the same. No issue. Just give me a second.
[AGENT][POSITIVE] Take your time. I can provide the claim number as well.
[CUSTOMER][NEUTRAL] Anything you can
[CUSTOMER][NEUTRAL] Uh, and it can be, yes, any detail you can give me for this.
[AGENT][NEUTRAL] OK, the claim number is 354.
[AGENT][NEUTRAL] 6972.
[AGENT][NEUTRAL] And I did check, [PII], the patient does not have active coverage under another policy number for that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So here I'm checking, um, patient has actually uh the Aetna plan. Then uh the secondary is uh MPL um but uh you said it is inactive, the pre
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yes, so patient does not have any surgery plan, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] That's all for now. And yes, actually, thank you. And the call reference number will be your name and today's date, right?
[AGENT][POSITIVE] Yes ma'am, and I spell my name [PII]. [PII], it's been a pleasure to assist you with that claim status today. Are you sure there's nothing else?
[CUSTOMER][NEUTRAL] [PII] Sorry, uh [PII].
[AGENT][NEUTRAL] A, yeah, [PII]
[CUSTOMER][NEUTRAL] [PII] is?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][POSITIVE] So I was mistaken writing a spelling. I'm really sorry for that.
[AGENT][POSITIVE] No problem.
[AGENT][POSITIVE] Not a problem, [PII]. It's been a pleasure to assist you, and you're sure there's nothing else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, no, thank you for helping me with this, uh, um.
[CUSTOMER][POSITIVE] I'm really glad you helped me on the last day of this Friday. Thank you.
[AGENT][POSITIVE] My pleasure, [PII] to help you claim status. Thank you for calling APL and I hope you have a lovely weekend.
[CUSTOMER][NEUTRAL] I think it
[CUSTOMER][POSITIVE] You too. Have a lovely weekend. Bye-bye.
[AGENT][POSITIVE] Thank you bye bye.