AccountId: 011433970860
ContactId: 6b44cea1-2257-4f17-abeb-7a86acec7676
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 986140 ms
Total Talk Time (AGENT): 444561 ms
Total Talk Time (CUSTOMER): 304735 ms
Interruptions: 5
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/6b44cea1-2257-4f17-abeb-7a86acec7676_20250619T17:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm trying to check a claim status, please.
[AGENT][NEUTRAL] OK, you're needing claim status for a member, is that correct?
[CUSTOMER][POSITIVE] Correct, thank you.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And I'm so sorry, what was your first name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], thank you. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] Um, yes, policy number for the patient is 02519228.
[AGENT][POSITIVE] Thank you. One moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Uh-huh. You're welcome.
[AGENT][NEUTRAL] [PII], any information that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII] and her date of birth is um [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] That will be on [PII] and
[CUSTOMER][NEUTRAL] Let's see, total bill amount was
[CUSTOMER][NEUTRAL] Let me check that here.
[CUSTOMER][NEUTRAL] Yeah, the whole thing. OK. It says
[CUSTOMER][NEUTRAL] It's not showing that amount. That's a strange.
[CUSTOMER][NEUTRAL] Let me just one moment. OK. The total amount is $800. I'm sorry.
[AGENT][NEUTRAL] Sure, you're fine.
[AGENT][NEUTRAL] That's OK. 800 even.
[CUSTOMER][NEUTRAL] $800. Mhm, even.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] Uh,
[AGENT][NEGATIVE] Give me a second because I don't show a claim for an $800 for this data service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] See how I send it.
[AGENT][NEUTRAL] Give me just a moment. I'm looking at a few things.
[CUSTOMER][NEUTRAL] Mhm. I send it by fax just in case, right.
[AGENT][NEUTRAL] Did you send more than one claim?
[CUSTOMER][NEUTRAL] Uh, apparently, yes, because it was, it was a correct claim because, um, on the previous one, it didn't have one of the codes.
[CUSTOMER][NEUTRAL] So I sent a correct the claim adding the code that it was missing.
[AGENT][NEUTRAL] OK, so there's two different claim numbers and for the total of the 800, um, so give me a second.
[CUSTOMER][NEUTRAL] Yeah, the first one was uh claim number ending on 3384.
[AGENT][POSITIVE] Correct, and that one.
[CUSTOMER][NEUTRAL] they pay for uh for the MRI for one left MRI but we were missing the other, the right MRI so I sent a correct the claim.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you have the claim you were OK, so you already have the information for claim number 3593384.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 33.
[CUSTOMER][NEUTRAL] Yeah, that one is fine. Yeah, I'm looking for the other one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But the other one, I don't have the claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and so the other claim.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, so on the other, the most recent received information that claim number is 360.
[AGENT][NEUTRAL] 9710.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on this one for code 99204.
[AGENT][NEGATIVE] That was denied.
[AGENT][NEUTRAL] I'm so sorry. Give me just a second. I'm having trouble with one of those lines here.
[AGENT][NEUTRAL] OK, so that, that was denied what was most recently received, um.
[AGENT][NEGATIVE] Office visits are not covered.
[AGENT][NEUTRAL] By this, by the above number policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] And then on the other line items, they were all denied for the.
[AGENT][NEUTRAL] Same reason, insured's primary insurance provided full benefits.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh. I'm looking just for the code number 7313 RT modifier RT.
[AGENT][NEGATIVE] We have not received that.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] What? Again, you guys, OK, that was sent out on um [PII].
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So this one is not it.
[CUSTOMER][NEUTRAL] And it has all of the, of all of the codes.
[AGENT][NEUTRAL] Mhm, OK.
[CUSTOMER][NEUTRAL] 1234567 codes.
[CUSTOMER][NEUTRAL] 7 coats. You already paid for 1 coat?
[AGENT][NEUTRAL] I have 7.
[AGENT][NEUTRAL] I mean, on the what was the most, OK, 123.
[CUSTOMER][NEUTRAL] Uh-huh. Correct. 7.
[AGENT][NEUTRAL] OK, there were 6 codes on the most recent received.
[AGENT][NEUTRAL] And then the one code that we had already paid, that's separate, but there were 6 codes on what was most recently received.
[CUSTOMER][NEUTRAL] The LLT.
[CUSTOMER][NEUTRAL] OK. The last one,
[CUSTOMER][NEUTRAL] And there is no other maybe pending or something, cause that's strange.
[AGENT][NEUTRAL] No, ma'am, there's not.
[CUSTOMER][NEUTRAL] Nothing. OK. Let me confirm. Um, the fax number where I sent it is 877.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3659423. Is it correct?
[AGENT][NEUTRAL] That is correct and we received, OK, so yes, so this was just denied as a duplicate what we received was in a dental, it was a duplicate to previously submitted.
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] For 7:31.
[CUSTOMER][NEUTRAL] With the 6.
[AGENT][NEUTRAL] 7:31. Mhm.
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] Because you billed it separately, uh-huh, on this claim that came across as $731.
[CUSTOMER][NEUTRAL] 7:31.
[AGENT][NEUTRAL] As the build out.
[CUSTOMER][NEUTRAL] 731. OK, what's it.
[AGENT][NEUTRAL] Plus what you previously billed was 69, so that totals 800.
[CUSTOMER][NEUTRAL] OK, so I guess I have to send again um now let me ask you a question. If I'm gonna send a corrected claim again, what would, what would it be the, the claim number previous that I need to use? What is the previous um.
[CUSTOMER][NEUTRAL] Claim number that I need to use.
[CUSTOMER][NEUTRAL] The first one?
[AGENT][NEUTRAL] The very first one that you had is was only one line item.
[CUSTOMER][NEUTRAL] The 33, I guess, right.
[AGENT][NEUTRAL] So the claim number that you already had, mhm that was one line item.
[CUSTOMER][NEUTRAL] The first one it was?
[CUSTOMER][NEUTRAL] The 33, the one that that ends on 3384?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so I'm gonna use this 1, 33.
[AGENT][NEUTRAL] There was one line item on that claim.
[AGENT][NEUTRAL] And the other claim that we've received on 531 and on 65, that both of those were reviewed under the claim number that I gave you, the 3,609,710.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 7 uh-huh.
[AGENT][NEUTRAL] And that is showing that office visits are not covered and that the primary insurance paid full benefits on the other codes.
[CUSTOMER][NEUTRAL] Right, cause only, only they left a patient responsibility on the last two codes. Those are MRI's right and left.
[CUSTOMER][NEUTRAL] But anyway, um,
[AGENT][POSITIVE] Now, I can try, I will be happy to transfer you over to one of the um.
[CUSTOMER][NEUTRAL] I have the
[AGENT][NEGATIVE] Examiners to look at this to verify what you need to send because I'm going by what I can see in the system and it's showing that office visits aren't covered. It was duplicate information received and then the insured's primary paid full benefits, so there were no benefits payable.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That was on the most recent information that we received.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have another question. um I just um create an account over the portal and uh for some reason it just says log in and it gets loading and loading but nothing else happens. I re I send um.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The email, so they send me a code.
[CUSTOMER][NEGATIVE] I, I placed the, the code that you guys sent me and then nothing happens. It says log in and it gets loaded and loading and that's it.
[AGENT][NEUTRAL] OK. So it, it can, it takes a little time. So just be patient with it, [PII], and it should.
[AGENT][NEGATIVE] Uh, eventually load if it times out after like 5 minutes, then just try that again because if you receive the code in there it's just, it's just taking some time. Sometimes it takes a little time to even receive the email with your code.
[AGENT][NEUTRAL] So if you've entered that code and clicked.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Cement
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] You may if it still continues to spin after more than 5 minutes, then I would recommend just trying to log in again.
[AGENT][NEUTRAL] Put that in again.
[CUSTOMER][NEUTRAL] OK, yeah, it's been more than, I think it's even more than 10 minutes already and it gets loading, that, that's all it says.
[AGENT][NEUTRAL] OK, so then I would refresh. Yes. So I would refresh?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And try again.
[CUSTOMER][NEUTRAL] OK, we loaded.
[CUSTOMER][NEUTRAL] All right. So you say you're gonna transfer me over, right?
[AGENT][NEUTRAL] Yes, I can transfer you over so that you they can review those documents that you've already submitted so that you're not just submitting additional duplicates again on here.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Right. OK. Thank you. I appreciate your help.
[AGENT][NEUTRAL] OK. Well, you're welcome. And can I help you with anything else before I do that?
[CUSTOMER][POSITIVE] No, so far that that will be all for today. Thank you.
[AGENT][POSITIVE] OK, Nyra. Well, thank you for calling APL and I hope you have a very nice afternoon.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye. One moment.
[CUSTOMER][NEUTRAL] Bye. Mhm.
[CUSTOMER][NEUTRAL] Ferring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], it's [PII]. How are you?
[CUSTOMER][POSITIVE] I'm good and you?
[AGENT][NEUTRAL] I'm fine, thank you so I have a provider's office on the line um that needs to go over what was submitted on a claim before they submit.
[AGENT][NEUTRAL] Something that may be missing because she had broken the claim up to start with in two parts.
[AGENT][NEUTRAL] It's on policy number 251.
[AGENT][NEUTRAL] 9228.
[AGENT][NEUTRAL] By [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Part one.
[AGENT][NEUTRAL] And uh-huh, I think that's all there is.
[AGENT][NEUTRAL] I don't think anybody else is covered and the data service in question is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I, the lady's name on the line is [PII]
[AGENT][NEUTRAL] And her callback number, well, it's gonna be in my note, but it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] So she had she gave me claim number 3593384.
[AGENT][NEUTRAL] Because again, the total bill amount she initially gave [PII] was $800.
[AGENT][NEUTRAL] So that claim number that she gave to me we paid on that and that was for like the claim itself was 69. The other claim number that's on file for this is 3,609,710.
[AGENT][NEUTRAL] And that shows for 7:31, so that's a total of 800.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] I went over the remarks, but she thinks that there's one of the codes missing and she's gonna resubmit it again but I we denied part of this is a duplicate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For 42?
[AGENT][NEUTRAL] Which was
[AGENT][NEUTRAL] For that, uh-huh.
[AGENT][NEUTRAL] If you'll notice on Amtrak, the same claim numbers on 2 lines.
[CUSTOMER][NEUTRAL] Uh 73,130.
[AGENT][NEUTRAL] That's the $69. So before she submits, she just wanted to verify what's missing on her line items that she's looking at versus.
[AGENT][NEUTRAL] Cause she thinks there's some MRI's missing.
[CUSTOMER][NEUTRAL] OK, it, it shouldn't have been, it shouldn't have been denied it's a left and right.
[AGENT][NEUTRAL] That's what she's saying. OK. And I didn't, I mean, obviously, we don't get that deep into that, so, OK. All right. Well, are you ready for her?
[CUSTOMER][NEUTRAL] You can send her on over though.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][POSITIVE] Thank you so much. Have a good afternoon, [PII].
[CUSTOMER][POSITIVE] Alrighty you too.
[AGENT][POSITIVE] Alright, thanks. Bye bye.
[CUSTOMER][NEUTRAL] Yeah.