AccountId: 011433970860
ContactId: 686ad2a1-6ed1-476b-8c9e-0818de166620
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 847039 ms
Total Talk Time (AGENT): 239859 ms
Total Talk Time (CUSTOMER): 249881 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/686ad2a1-6ed1-476b-8c9e-0818de166620_20250128T20:43_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] Hi [PII], [PII] is side from provider office to verify the claim status. Can you spell your name, please? [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII]
[AGENT][NEUTRAL] OK, and a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII] is my callback number and policy number is D as in David 40310128. I have a total of 4 claims for the same patient. Can you help me with it?
[AGENT][NEUTRAL] Yes. Do you have the member's ID card available?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yes, uh, no, member ID card not available.
[AGENT][NEUTRAL] OK, do you have the member's social?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, social security number I have provided me. It is [PII]. 1 moment, one moment.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] So I'm just waiting for the um policies to populate here and you said there's 4 claims for the same member?
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Can you verify the member's first and last name?
[CUSTOMER][NEUTRAL] Yes, yes. Can you repeat? Uh
[AGENT][NEUTRAL] Can you, can you verify the member's first and last name?
[CUSTOMER][NEUTRAL] Yes, a member last name is [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am. The last name is [PII] First name is [PII]
[AGENT][NEUTRAL] And this is for the medical policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] May I have all the dates of service and the total bills?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, first date of service is uh [PII].
[AGENT][NEUTRAL] And the total bill amount, you can give them all to me at the same time if you like.
[CUSTOMER][NEUTRAL] Yeah, $21.
[CUSTOMER][NEUTRAL] Uh, next, uh, date of service will be same.
[CUSTOMER][NEUTRAL] And the bill amount is $336.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And after that, uh, date of service is [PII], yes, uh, date of services is [PII]. Bill amount is $120.
[CUSTOMER][NEUTRAL] And the last one date of service is [PII]. Bill amount is $195.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claims? Would it be the same provider?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Our Lady of the Lake physician group.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][POSITIVE] Providing me another one.
[CUSTOMER][NEUTRAL] I checked in my system if.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, so for the um $21.
[AGENT][NEUTRAL] Claim. We received that claim on [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 4536.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because it's not a covered diagnostic test.
[CUSTOMER][NEUTRAL] Uh, this is for $21 claim has been denied?
[AGENT][NEUTRAL] I can double check. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Yes, this claim has been denied.
[AGENT][NEUTRAL] And the denial reason is it's not a covered diagnostic test.
[CUSTOMER][NEUTRAL] OK, C is 3544536. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you want to move on to the next one?
[CUSTOMER][NEUTRAL] And uh provide me the you provided me the claim number also. OK, no problem. Uh can you uh
[CUSTOMER][NEUTRAL] Uh yes. Can you fax me the UB?
[AGENT][NEUTRAL] Sure, what's a good um fax number for the explanation of benefits?
[CUSTOMER][NEUTRAL] Yeah, sure. fax number is for [PII].
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you repeat that, please? [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. So did you need all of the claims explanation of benefits that we go over?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, well, I can send them to you. And then did you want to go to the next one?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so for the $336.
[AGENT][NEUTRAL] That claim was also received on [PII]?
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 592 9.
[AGENT][NEUTRAL] And on [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Um, 2024, the claim was denied.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Because the policy provides no benefits for charges made by a doctor.
[AGENT][NEUTRAL] For inpatient visits.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Uh, one moment. Policy provide benefit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The charges.
[AGENT][NEGATIVE] The policy provides no benefits for charges.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Made by a doctor.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] For inpatient visits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome. And then,
[CUSTOMER][NEUTRAL] And for the next one?
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] OK, so the [PII], $120.
[CUSTOMER][POSITIVE] Yes, next one.
[AGENT][NEUTRAL] Um, that one was also received on [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] The claim number is 354.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 592 8.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I guess if you
[CUSTOMER][POSITIVE] Good time for you to live.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, for the same reason, the policy does not provide benefits.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] For charges made by a doctor?
[AGENT][NEUTRAL] For inpatient visits?
[AGENT][NEGATIVE] And the same information received and processed date and denial date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, for the [PII], but that claim number is 354.
[AGENT][NEUTRAL] 592 6.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] For a moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Provide me the call reference number.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] And I have one question.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, I have one question.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, this, uh, it is under patient plan or wider plan?
[CUSTOMER][NEUTRAL] Claim denied.
[AGENT][NEUTRAL] Because the patient, the patient's policy.
[CUSTOMER][NEUTRAL] OK. Uh, these are not covered under patient policy, right? Patient contract.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's correct. It's not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I could assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK. Can you fax me the UB or entire, it will be.
[AGENT][POSITIVE] Yes, I'm sending you all to for you. There may be a delay on the call. I do apologize, um, but yes, I am sending you all of the explanation of benefits.
[CUSTOMER][NEUTRAL] Yes, sir. You'll be, I, I you be.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. How much time take to receive the OBYB and what is the timely filing limit?
[AGENT][NEUTRAL] There's no timely filing limit?
[AGENT][NEUTRAL] As long as the policy is active, you can file the claim at any time and I
[CUSTOMER][NEUTRAL] No, no. It is only documented but just for the claim.
[AGENT][NEUTRAL] Right, I'm just answering your question. There's no timely filing limit.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. OK. Thank you so much.
[CUSTOMER][NEUTRAL] And how much time you take to receive the via me?
[AGENT][POSITIVE] Um, I'm sending the explanation of benefits now. If you have not received them by end of day today, um, you can definitely give us a call and we'll be more than happy to resend them for you.
[CUSTOMER][NEUTRAL] On check
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much. OK, bye bye.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a good day. Bye-bye.