AccountId: 011433970860
ContactId: 70781fb7-6c72-432a-bc9a-eb66b0450257
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 714070 ms
Total Talk Time (AGENT): 223220 ms
Total Talk Time (CUSTOMER): 273493 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/70781fb7-6c72-432a-bc9a-eb66b0450257_20250410T12:54_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, ma'am. Good evening, uh, good morning. My name is [PII] calling from Pror office to checking up on claim status. I have two claims to verify. Could you please help me with that?
[AGENT][NEUTRAL] I can help you [PII] with claim status. What's the policy number?
[CUSTOMER][NEUTRAL] Uh, yes, definitely. Just give me a second here. It is 01896442.
[AGENT][NEUTRAL] 01896472
[CUSTOMER][NEUTRAL] It's 422, ma'am.
[AGENT][NEUTRAL] 422.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Member's first name is [PII] and the last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that for me, [PII], and you're checking claim status for what day?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII] and what's the total charge?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The total charge amount is uh
[CUSTOMER][NEUTRAL] $2420 even.
[AGENT][NEUTRAL] OK, $2420.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And is that for an anesthesia charge?
[CUSTOMER][NEUTRAL] Uh, just give me, let me quickly verify from my end.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Yes, ma'am. It is anesthesia charges.
[AGENT][NEUTRAL] OK, I'm showing claim received [PII] processed on [PII]. Uh, there was no payment made on this claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and it shows that the inpatient benefit for this calendar year is met, so no more benefits available.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] One second, ma'am. The impatient.
[CUSTOMER][NEUTRAL] And it
[CUSTOMER][NEUTRAL] Not covered under the patient.
[AGENT][NEUTRAL] The inpatient maximum benefit is met. It's exhausted.
[CUSTOMER][NEUTRAL] Al already met, right?
[AGENT][NEUTRAL] That's, that
[CUSTOMER][NEUTRAL] Got it, ma'am. And
[CUSTOMER][NEUTRAL] Yes, got it. And could you please tell me when the member was exhausted that inpatient benefits?
[AGENT][NEUTRAL] The policy effective date is [PII]. Policy is active. Um, would you like the claim number?
[CUSTOMER][NEUTRAL] Uh, actually, I have a claim number, ma'am. Just I need the information. Uh, the member was exhausted that, uh, inpatient benefits and just could you please confirm me the member was exhausted these benefits.
[CUSTOMER][NEUTRAL] Is there any particular date range?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] What was the last question?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEGATIVE] The, the question was actually then the member was uh exhausted their uh inpatient benefits.
[AGENT][NEUTRAL] The day that the inpatient benefits were exhausted.
[CUSTOMER][NEUTRAL] When the member we met.
[AGENT][NEUTRAL] On the [PII].
[CUSTOMER][NEUTRAL] Yes, you, you
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it, ma'am. Can we go with the next claim?
[AGENT][NEUTRAL] OK, how many claims do you have?
[CUSTOMER][NEUTRAL] I have two clients only with the same patient and actually I do have one more client. I'm one more data service with the same patient.
[AGENT][NEUTRAL] OK, so you can also check your status online at [PII], and I can help you set that account up if you would like.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so the website?
[AGENT][NEUTRAL] It's secured, that's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you mhm.
[AGENT][NEUTRAL] And let me know when you're ready and I can help you create that account.
[CUSTOMER][NEUTRAL] Yes, ma'am. Just give me a second. System was loading.
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. Yes, I just opened and it's uh asking username and I'm giving my username.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm creating my password.
[AGENT][NEUTRAL] OK, did you click on new user?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] After that?
[AGENT][NEUTRAL] And what did you, what did you click on after the new user?
[CUSTOMER][NEUTRAL] After new sir, actually, I'm an individual with APL insurance policy. I'm an employee group with the offers APL products to my employees. I'm creating.
[CUSTOMER][NEUTRAL] And I'm, I'm medical or dental provider. I'm clicking that I'm your medical or dental provider.
[AGENT][NEUTRAL] And which one did you select?
[CUSTOMER][NEUTRAL] I'm a medical or dental provider.
[AGENT][NEUTRAL] OK, you're fast and if you can verify the tax identification number that you're going to enter.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Here asking patient account number?
[AGENT][NEUTRAL] Can you verify the tax ID number that you're going to enter?
[AGENT][NEUTRAL] Or that you entered
[CUSTOMER][NEUTRAL] Yeah, I already entered the tax ID number. It is [PII].
[AGENT][NEUTRAL] OK, and what patient account number did you enter?
[CUSTOMER][NEUTRAL] And he asking the patient account number.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] And I entered the yes, I entered here [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I, I'm clicking here the next option.
[CUSTOMER][NEUTRAL] And here I open create account user name password and confirm password email or remaining details.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] And here I'm creating my username and I'm alre[PII] entered my password.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And I entered the confirmed password.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And just here I entered my email address and I entered confirmed mailing address and I'm entered primary phone number here.
[AGENT][POSITIVE] Mhm. Good.
[CUSTOMER][NEUTRAL] It's here loading, ma'am. Just give me a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Here, I, I entered all the information, but actually here, uh, the submitting option is not available. When I, when I cleared the submitting option, yeah, actually, my account is successfully created.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, very good.
[AGENT][NEUTRAL] And uh
[CUSTOMER][POSITIVE] Thank you very much for this in.
[AGENT][POSITIVE] Absolutely. So.
[CUSTOMER][NEUTRAL] guidance, ma'am. Hmm.
[AGENT][NEUTRAL] So did you have, did you say you had 2 more claims for [PII]?
[CUSTOMER][NEUTRAL] Just I have only one more claim. You already provided the one in one claim and actually I do have a second claim with the same member with a different date of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that data service?
[CUSTOMER][NEUTRAL] It is [PII] and the bill amount is $1,815 even.
[AGENT][NEUTRAL] 1815.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And is this another anesthesiologist charge?
[CUSTOMER][NEUTRAL] Uh, no, it's actually 88309, uh, and it is, it is a lab coats.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm going to give you the claim number um on the website that you're on um you could choose the quick.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, I, I have the claim number here. It is 3584081, but actually the claim was denied as a not called by payer and send to correct payer. And actually the PCB is already processed and paid provide the coincidence and I mean, I mean APL needs to pay the remaining amount, so.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so we
[CUSTOMER][NEUTRAL] You should back send for the reprocess.
[AGENT][NEUTRAL] Were you able to download the ELD from that website?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so you're correct, the maximum inpatient uh benefit was exhausted.
[CUSTOMER][NEUTRAL] And actually it is in a place of service was billed with the 22 and the CPDs are 88309307305 is a lab code. There is no inpatient.
[CUSTOMER][NEUTRAL] Charges
[AGENT][NEUTRAL] Do you have a copy of the uh itemized bill or the claim form that was sent to us?
[AGENT][NEUTRAL] That you can review?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And look at the place of service?
[CUSTOMER][NEUTRAL] Yeah, actually, yeah, the place of service is [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] It is the outpatient
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] OK, but we have a hospital claim that shows the admission date of [PII], so maybe that was billed before the, yeah, so it, it is inpatient because we show an inpatient charge or date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] but actually here we bill with the [PII] and outpatient charges.
[AGENT][NEUTRAL] And so what I'm saying is because we received a hospital bill.
[AGENT][NEUTRAL] And the admission date is [PII]. That is, um, that's inpatient.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I mean I'm looking at your claim and I see that it's coded as that.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] But they were in the hospital at that time or on that day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, that's why this, uh, these benefits are exhausted, right?
[AGENT][NEUTRAL] The inpatient benefit is exhausted, yes.
[CUSTOMER][NEUTRAL] Yes, that means the remaining charges are patient responsibility.
[AGENT][NEUTRAL] We do not determine patients responsibility, but the benefit is exhausted.
[CUSTOMER][POSITIVE] Oh, got it. Thank you very much. Could you please spell out your name from my documentation?
[AGENT][NEUTRAL] It's [PII], first initial last name is [PII], and on that website, um, the explanation of benefits which you probably already have on the back of it, it'll give you the denial reason.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Um, could you please provide me the call this number, ma'am?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][NEUTRAL] It is [PII] and today's date, yeah.
[AGENT][NEUTRAL] Any other questions?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] No, no, thank you very much for that.
[AGENT][POSITIVE] Alright, well, if you have another questions, thank you for calling APL [PII] have a good day, right?