AccountId: 011433970860
ContactId: 6ca3dd0f-fe7e-42ce-b27b-3952cafda188
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 657469 ms
Total Talk Time (AGENT): 190078 ms
Total Talk Time (CUSTOMER): 370946 ms
Interruptions: 8
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/6ca3dd0f-fe7e-42ce-b27b-3952cafda188_20250210T15:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, good morning, [PII]. My name is [PII], and I need your assistance to check the claims. I'm calling from provider office.
[AGENT][NEUTRAL] OK, you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I know your initial?
[CUSTOMER][NEUTRAL] 451.
[AGENT][NEUTRAL] The first initial of my last name is [PII].
[AGENT][NEUTRAL] And what's the policy number, [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 017512
[CUSTOMER][NEUTRAL] 24
[CUSTOMER][NEUTRAL] M Mary L. Lima 8.
[AGENT][NEUTRAL] And what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII]. OK, and did you say you're checking claim status?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the date of service in charge and we can help you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For a total charge of $324 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Take your time. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] 1152.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] As you're saying, this time as easy.
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] You're seeing
[CUSTOMER][NEUTRAL] $25 for pay which you applied for.
[AGENT][NEUTRAL] And [PII], what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] OK, let uh let me.
[AGENT][NEUTRAL] What's the birth year?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] And you said you're checking claim status for [PII] for $324?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] one moment please.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] right
[AGENT][NEUTRAL] OK, so this claim was received.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Processed on [PII], uh, no payment was made on this claim.
[AGENT][NEUTRAL] The office visit fee?
[CUSTOMER][POSITIVE] Thank you for your
[AGENT][NEUTRAL] And the treatment codes are not covered by this policy, by the patient's policy.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I get the claim number in the meantime?
[AGENT][NEUTRAL] Mhm, the claim number is 354.
[AGENT][NEUTRAL] 682-6 and I didn't understand the second question.
[CUSTOMER][NEUTRAL] 3546826
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, what's the process the date? [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] 71
[AGENT][NEUTRAL] Can you hear me OK?
[CUSTOMER][POSITIVE] Yes, no, it's fine. Thank you.
[AGENT][NEUTRAL] Alright, so the claim was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And you mentioned it's under member plan, right, when the patient plan details.
[AGENT][NEUTRAL] I stated that it's not covered under the patient's policy. It's a Metlink policy.
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] Medlink, MED Med L I N K.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, what's the type within that HMO EP or something? Do you have any plant type?
[AGENT][NEUTRAL] It's just a Metlink policy.
[CUSTOMER][NEUTRAL] Of the policy type
[CUSTOMER][NEUTRAL] OK, is that the Medicare one, Medicaid one, or any other type?
[AGENT][NEUTRAL] It's just a Metin George. Nothing else is added to it. It's just a Metlink policy, secondary to the major medical policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, yeah, I do observe that. That's why I'm asking you. OK. Uh, now coming to the scenario like uh 992148, for a $30 due I have been with a secondary insurance. So with this POA, should I need to appeal or should I need to bill it as a patient responsibility itself? You're not covering, right?
[AGENT][NEUTRAL] We do not determine patients responsibility.
[CUSTOMER][NEUTRAL] Sure, uh, for my reference, would you mind to provide me your mailing address towards an uphill?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Let me note this. I got [PII] uh.
[CUSTOMER][NEUTRAL] Sorry, [PII], [PII] and the state has been the same.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I use the same fax for uh apple?
[CUSTOMER][NEUTRAL] Which I have 87736, yeah, [PII].
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Attention claims.
[CUSTOMER][NEUTRAL] of
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] And the time frame to submit the.
[CUSTOMER][NEUTRAL] What will be the time frame for an?
[AGENT][NEUTRAL] Mhm. The time frame to submit an appeal is 180 days from the date of denial.
[CUSTOMER][NEUTRAL] 180 days, right?
[AGENT][NEUTRAL] From the date of denial.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is there any chance that you can send me the UOB for this one to my fax?
[AGENT][NEUTRAL] It's already been mailed um so it's now available to download on our online service center. Let me know when you're ready for the web address.
[CUSTOMER][NEUTRAL] it is already sent to the provider just for a verification I was been asking, that's fine, uh.
[AGENT][NEUTRAL] Yes, yes, it has been.
[CUSTOMER][NEUTRAL] patient code. OK, can I know the different patient uh
[CUSTOMER][NEUTRAL] The next claim, OK, verify once the current one.
[AGENT][NEUTRAL] OK, are you wanting to check another claim status on a different person?
[CUSTOMER][NEUTRAL] Yes, for the same one, verify once. Yeah, but before leaving, one second.
[AGENT][NEUTRAL] OK, what is
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it for the same person or a different patient?
[CUSTOMER][NEGATIVE] You're not covering this hospital.
[CUSTOMER][NEUTRAL] Different patient.
[AGENT][NEUTRAL] Same policy number or different policy number?
[CUSTOMER][NEUTRAL] Everything different.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I approach?
[AGENT][POSITIVE] Mhm I'm ready.
[CUSTOMER][NEUTRAL] 013
[CUSTOMER][NEUTRAL] Sorry, 01530917, Mike Lima 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you and what's the data service in charge?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the amount?
[CUSTOMER][POSITIVE] OK thank you
[CUSTOMER][NEUTRAL] For $200 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this claim was denied, um, office visits are not covered um by the patient's policy. I do show the claim was received.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] then
[CUSTOMER][NEUTRAL] and the last name is 2619.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim number?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 354.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh S A I.
[AGENT][NEUTRAL] 6249.
[CUSTOMER][NEUTRAL] RM 123.
[CUSTOMER][NEUTRAL] 6249 is ending, right?
[AGENT][NEUTRAL] 354-624-9 is the claim number.
[CUSTOMER][NEUTRAL] The data is 2024. The total charge amount is $114 even for $114 even.
[CUSTOMER][NEUTRAL] Uh, please give me one sec, [PII], give me one sec. No, no, no, not just that. Just to, just to explain the.
[AGENT][NEUTRAL] The claim number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Uh, can I get the patient policy details?
[AGENT][NEUTRAL] It's a supplemental gap policy.
[CUSTOMER][NEUTRAL] Supplemental gap to the Medicare.
[AGENT][NEUTRAL] OK, let me repeat that. It's a Metlink policy, the same as the other one.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, OK. In this case, OK, uh, verify this you will be also submitted to the provider or not.
[AGENT][NEUTRAL] Yeah, the ELB it's mailed to the provider's office, uh, when the claim is processed, so it is now available to download online.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] If I disagree with this also, I got your payment for $6128. Can I do an appeal with the same mailing address to the same, uh, fax number also?
[AGENT][NEUTRAL] Did you say you received a payment?
[CUSTOMER][NEUTRAL] I'm not OK. I have a secondary deal as $61. So can I appeal if I disagree with you, then that is what I'm sorry we haven't received any payment for this.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, you can submit an appeal but it's not covered by the policy, so no payment is, is payable because it's not often say that they're not covered.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Just for my.
[CUSTOMER][NEUTRAL] Just for my note, OK, conclude once the claim, OK, call the time, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's my name in today's date.
[CUSTOMER][POSITIVE] Nice meeting you. Hope you have a good Monday. Bye.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day, [PII].
[CUSTOMER][NEUTRAL] Mm