AccountId: 011433970860
ContactId: 64db7cd4-3d42-4377-91fb-9ad12d71adb2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364820 ms
Total Talk Time (AGENT): 147444 ms
Total Talk Time (CUSTOMER): 147087 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/64db7cd4-3d42-4377-91fb-9ad12d71adb2_20250217T19:44_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, my name is [PII] calling from provider's office, uh, to check the claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] I just have one with me.
[AGENT][NEUTRAL] OK. And what is that patient's policy number, please?
[CUSTOMER][NEUTRAL] OK, the policy number would be uh.
[CUSTOMER][NEUTRAL] 02478746 M as in Mike.
[CUSTOMER][NEUTRAL] C as in Charlie, and the 7.
[AGENT][NEUTRAL] Thank you one moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Are you gonna
[CUSTOMER][NEUTRAL] And the.
[CUSTOMER][NEUTRAL] To
[AGENT][NEUTRAL] And you said your phone number is [PII], is that correct?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] And any information [PII] that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Uh OK. Um the patient's name is uh [PII], last initial [PII]. Last name would be, it's like [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth would be [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Uh, for the date of service [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the total bill amount.
[CUSTOMER][NEUTRAL] And for the bill amount it's $14,063 and even.
[AGENT][NEUTRAL] 14063.00. Is that correct?
[CUSTOMER][POSITIVE] Yes, you're right, absolutely.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was received for her [PII]. The received date on this claim was [PII].
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] It was
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] uh-huh we process them.
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The claim number is 355-067-8.
[CUSTOMER][NEUTRAL] Mhm, I do have the claim number here.
[AGENT][NEUTRAL] And the reason for the denial on this claim states to please provide copies of the primary insurance. OK, please provide copies of your explanation of benefits from your primary insurance carrier. We need to have the primary insurance company's explanation of benefits sent to us for review.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Recently, we have sent uh your primary Away. Have you received that one and uh it was sent on.
[AGENT][NEUTRAL] No, we have not.
[CUSTOMER][NEUTRAL] It was sent on the [PII].
[AGENT][NEGATIVE] No, sir, that was not received.
[CUSTOMER][NEUTRAL] Not received it? OK. May I know how can I receive, I mean, uh, resubmit that form?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] You can. You may submit it through to our secured fax line at [PII] attention claims.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. What would be the time will be filing to submit this one?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][NEUTRAL] Oh, OK. OK. Uh, can you please spell me your name?
[AGENT][NEUTRAL] [PII] and the first initial to my last name [PII] My name and today's date will be your call reference number. And [PII], once we have processed the claim, you may also check claim status and print our explanation of benefits by going to [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] OK, just a moment. Uh, for the confirmation, the received date was uh [PII] and uh denied on [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, OK, I got you. Thanks for information, but take care. I'm gonna resubmit this, uh, primary, OK.
[AGENT][POSITIVE] Well, you are certainly very welcome.
[AGENT][POSITIVE] OK, well, if that's all then that I can help you with today, [PII], thank you again for calling APL and I hope you have a nice rest of your day. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Oh