AccountId: 011433970860
ContactId: 6c8ab03b-f0dd-4e85-8a68-c059205686ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1580180 ms
Total Talk Time (AGENT): 328616 ms
Total Talk Time (CUSTOMER): 323271 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/6c8ab03b-f0dd-4e85-8a68-c059205686ae_20250319T16:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check on claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure, ma'am. [PII]. And it's a direct line?
[AGENT][NEUTRAL] OK, and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure, ma'am. One second, I'll provide you that.
[CUSTOMER][NEUTRAL] Patient policy ID is.
[CUSTOMER][NEUTRAL] 01641442 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, and the patient, mhm, mhm.
[CUSTOMER][NEUTRAL] And patient's first name?
[CUSTOMER][NEUTRAL] I'm sorry, ma'am?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Uh patient's first name is [PII], last name is [PII], and the date of birth, [PII].
[AGENT][POSITIVE] Thank you so much. Let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] OK, ma'am.
[AGENT][NEUTRAL] OK, and then what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] [PII]. And the total amount, $1,752 and even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $630 and even.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold. What one more thing, what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Facility is Sterling Emergency Services, Myanma Beach, PA.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, it's gonna be a brief hold while I look up this claim for you, Ms. [PII], and I'll be right back.
[CUSTOMER][NEUTRAL] OK, ma'am.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have the claim.
[AGENT][NEUTRAL] The claim number is.
[AGENT][NEUTRAL] 343-726-3
[AGENT][NEUTRAL] And the claim has been denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Thank you, ma'am. And we have to submit the EOB through mailing address or fax number, ma'am?
[AGENT][NEUTRAL] Whichever way is easiest for you.
[CUSTOMER][NEUTRAL] Shall we submit the EOB through mailing address?
[AGENT][NEUTRAL] You can mail it or you can fax it either way.
[CUSTOMER][NEUTRAL] OK, ma'am. May I know the uh mailing address, please?
[AGENT][NEUTRAL] Yes, ma'am. The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Thank you, ma'am. And the pay ID is?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] Thank you so much, ma'am.
[CUSTOMER][NEUTRAL] And uh for this time, could you please provide me the received date and the denial date?
[AGENT][NEUTRAL] Yes ma'am, let me look it up real quick.
[AGENT][NEUTRAL] OK, we received the claim on [PII].
[AGENT][NEUTRAL] And processed it also on [PII].
[CUSTOMER][NEUTRAL] OK, ma'am. May I know the timely filing limit to submit the primary UB ma'am?
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][NEUTRAL] OK, ma'am. And uh for the claim need to be submitted again, may I know the time filing limit?
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][NEUTRAL] And uh for this claim, that would be all. Shall we move to the next claim?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and what's the next insured's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Oh, sure. One second.
[CUSTOMER][NEUTRAL] OK just a second, ma'am.
[CUSTOMER][NEUTRAL] Yes. Uh, the member ID number is?
[CUSTOMER][NEUTRAL] 01893439 M. Mike Lima 7. Patient first name [PII], and the last name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look that patient up.
[AGENT][NEUTRAL] OK, can you give me the patient's date of birth again, please?
[CUSTOMER][NEUTRAL] Yeah, ma'am. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome, ma'am.
[AGENT][NEUTRAL] OK, and then what is the date of service?
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Our data services [PII] and the total amount of $2,585 and even.
[AGENT][NEUTRAL] OK, and then the amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, no, ma'am. This is the first time you have submitted the claim.
[CUSTOMER][NEUTRAL] Uh, directly to
[CUSTOMER][NEUTRAL] We have submitted the claim as a primary to American public life.
[AGENT][NEUTRAL] OK, alright and then what is the name of the facility for this one?
[CUSTOMER][NEUTRAL] Uh, it's Sterling Emergency Services of Mya Beach, CA.
[AGENT][NEUTRAL] OK. I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Oh. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for calling APL and holding for me, Ms. [PII].
[AGENT][NEUTRAL] I have got the claim pulled up. The claim number is 351-762-3.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And the claim was denied because we need the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Oh, thank you, ma'am. And I know the claim receive date and the den date, please?
[AGENT][NEUTRAL] Uh, let me look for you.
[AGENT][NEUTRAL] The claim was received on [PII] and was processed on [PII].
[CUSTOMER][NEUTRAL] Thank you, ma'am. Uh, there is no active primary insurance for the patient, ma'am?
[AGENT][NEUTRAL] We don't have primary insurance. We're the secondary.
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][NEUTRAL] Oh, thank you. And uh could you please send a copy of your via fax mail or email?
[AGENT][NEUTRAL] Yes ma'am. What is your fax number?
[CUSTOMER][NEUTRAL] Yeah, ma'am. Fax number is [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on, pooter.
[AGENT][NEUTRAL] OK, Ms. [PII], I've got that fax on its way to you now.
[CUSTOMER][NEUTRAL] Thank you, ma'am. And for this claim, that would be all. Shall we move to the next claim?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and how many do you have?
[CUSTOMER][NEUTRAL] I have another 5 more months.
[AGENT][NEUTRAL] You have what, what, ma'am?
[CUSTOMER][NEUTRAL] Uh, 5 more, 5 more claims.
[AGENT][NEUTRAL] 5 more? OK, and what is the next um member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, sure. My policy number is 02266050 ML 7.
[AGENT][NEUTRAL] OK. And the
[AGENT][NEUTRAL] Name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and the uh sorry, last name is, it's [PII], and the date of birth, [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] OK, ma'am.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] [PII], 2024, and the total amount, $1,752 and even.
[AGENT][NEUTRAL] OK, and then the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $216.46.
[AGENT][NEUTRAL] OK. Is it for the same facility?
[CUSTOMER][NEUTRAL] It's, yeah, man, same. Sterling emergency Services of Myanmar BPA.
[AGENT][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, thank you so much. I'm gonna put you on a hold again while I look up this claim. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding, Ms. [PII]. I've got this uh claim pulled up now also, uh, but the policy number you gave me is incorrect. Let me give you the correct policy number.
[AGENT][NEUTRAL] It is 2556471.
[AGENT][NEUTRAL] And the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh yeah, ma'am. Sorry. Uh, could you please repeat the claim information one more time, ma'am?
[AGENT][NEUTRAL] Yes ma'am, uh the claim number is 3543913.
[AGENT][NEUTRAL] The claim was processed on policy number 255.
[AGENT][NEUTRAL] 647-1.
[CUSTOMER][NEUTRAL] OK. And the claim was received and processed on?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] The claim was received on
[AGENT][NEUTRAL] [PII] and processed also on the same day, [PII].
[CUSTOMER][POSITIVE] Thank you so much, ma'am. And for this one, this uh information is requesting for primary EOB?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Uh, thank you so much, ma'am.
[CUSTOMER][NEUTRAL] And uh to the same address we need to submit, ma'am?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, thank you, ma'am. And for this claim, that would be all, ma'am. Shall we move on to the next claim?
[AGENT][NEUTRAL] OK, and what's the next member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh yeah. Policy number is 016596. 16.
[CUSTOMER][NEUTRAL] And the patient first name, [PII]. OK.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Can you repeat that um policy number?
[AGENT][NEUTRAL] Your phone went in and out.
[CUSTOMER][NEUTRAL] Yeah, ma'am. Sure.
[CUSTOMER][NEUTRAL] OK, one second. I think the patient ID number is missing some some numbers. One second.
[CUSTOMER][NEUTRAL] OK, ma'am. Uh, the ID number is [PII].
[AGENT][NEUTRAL] OK. And it's for [PII]?
[CUSTOMER][NEUTRAL] Yeah, ma'am. [PII].
[AGENT][NEUTRAL] OK, and what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me get that policy pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] A date of service is [PII] and the total amount of
[CUSTOMER][NEUTRAL] $2,774 and evening.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, we have actually submitted a claim as primary, ma'am.
[AGENT][NEUTRAL] OK. And still for Sterling, is that correct, Sterling Emergency?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, I'm gonna put you on a hold. I'm gonna look this up and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 2000.
[AGENT][NEUTRAL] 4
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me. So on this one I do not find the claim on file for the amount that you have given me.
[CUSTOMER][POSITIVE] Oh thank you so much, ma'am.
[CUSTOMER][NEUTRAL] And once again,
[CUSTOMER][NEUTRAL] May I know the timely filing limit and the patient policy effective date, ma'am, to submit the claim?
[AGENT][NEUTRAL] Yes, the effective date is
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy is active, and again, there's no timely filing limit.
[CUSTOMER][NEUTRAL] OK, ma'am. And the claim mailing address to submit the claim is?
[AGENT][NEUTRAL] It's the same that I, I gave you on the other ones.
[CUSTOMER][NEUTRAL] OK, ma'am. Thank you. And could you please check it out? Is there any rejections found, ma'am?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Is that any what, ma'am?
[CUSTOMER][NEUTRAL] Uh, is there any kind of rejection?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, ma'am. Then, uh, for this claim, that would be all. Um, could you please provide me the reference number?
[AGENT][NEUTRAL] Yes, it's on all of these it's gonna be my name and today's date.
[CUSTOMER][NEUTRAL] OK, ma'am. Could you please just spell out your name, please, for documentation purposes?
[AGENT][NEUTRAL] Yes, it's [PII] and last initial is A.
[CUSTOMER][POSITIVE] OK, ma'am. Then that would be all. Thank you so much for your assistance.
[AGENT][POSITIVE] Thank you you have a wonderful day and thanks for calling APL bye bye.