AccountId: 011433970860
ContactId: 72d6152c-a85e-44dd-b276-f052f2244ac9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1254640 ms
Total Talk Time (AGENT): 466792 ms
Total Talk Time (CUSTOMER): 298462 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/72d6152c-a85e-44dd-b276-f052f2244ac9_20250131T17:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from the provider's office checking on a claim status.
[AGENT][NEUTRAL] Sure, [PII], I can help you with the claim status. Can I please have a callback number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's uh [PII].
[CUSTOMER][NEUTRAL] And uh can you spell your name for me once?
[AGENT][POSITIVE] [PII] [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] That's great.
[AGENT][NEUTRAL] And can you tell me the name of the provider's office or facility you're calling from [PII], please?
[CUSTOMER][NEUTRAL] Yeah, sure. It's uh facility Gastro Health LLC.
[AGENT][NEUTRAL] OK, and what is the number, uh, policy certificate or ID number please?
[CUSTOMER][NEUTRAL] Yeah, it's uh 14575.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] So I I I I.
[AGENT][NEUTRAL] I'm sorry, 1457.
[CUSTOMER][NEUTRAL] 5
[AGENT][POSITIVE] 5. OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Doesn't may not be enough numbers.
[AGENT][NEUTRAL] Bear with me for one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] There's
[AGENT][NEUTRAL] And do you have the patient's name and date of birth? you can verify that, please?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure, the patient's first name is [PII] and the last name is [PII] and date of birth is.
[CUSTOMER][NEUTRAL] [PII] and you want me to spell the patient's first name and last name?
[AGENT][NEUTRAL] Um, [PII] is the first name. What's, and go ahead and spell the last name please.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, that policy number that you provided me did not uh bring up that patient. It brought up a different patient and I'm sorry, go ahead and spell that last name for me one more time and a little slower please.
[CUSTOMER][NEUTRAL] Yeah, sure. It's uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said that first is C [PII] or [PII] Sierra. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, it's a [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and I believe I've located the policy. It looks like we were missing some numbers um on that policy number, so um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the date of service and the amount on the claim, and I will provide you the correct policy number.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh yeah, sure. Yeah, it's a service is on [PII].
[AGENT][NEUTRAL] Yeah that's the birthday. What's the date of service, sorry, and the amount on the claim.
[CUSTOMER][NEUTRAL] Uh, OK, the date of service is on [PII].
[CUSTOMER][NEUTRAL] And the charge amount is $542 even.
[AGENT][NEUTRAL] 542 for [PII].
[CUSTOMER][NEUTRAL] Yes, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK just one moment while I search claims please.
[CUSTOMER][NEUTRAL] OK, and uh what's the um current member ID for this one? Can you provide me uh like it would be helpful for the future claims.
[AGENT][NEUTRAL] Yeah, it looks like
[AGENT][NEUTRAL] Yeah and I'm just checking some eligibility information. It looks like the policy is not uh active any longer, but I'm just verifying that information. Bear with me for just one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So, um, this policy is no longer active, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We received your claim.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Your claim, uh received date is 9-25-24.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim was processed on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number 35.
[AGENT][NEUTRAL] 11
[AGENT][NEUTRAL] 078.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied due to the services were rendered after the policy lapsed.
[AGENT][NEUTRAL] So this policy effective date?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me know when you're ready for that.
[CUSTOMER][POSITIVE] Yeah, I'm ready.
[AGENT][NEUTRAL] OK, so the effective date is [PII].
[AGENT][NEUTRAL] And the policy term.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, it's long back.
[CUSTOMER][NEUTRAL] So, do this patient, do you have any other information about this patient? like do this patient, do you have any other secondary insurance up on file?
[AGENT][NEUTRAL] No, this policy was a secondary policy, um, so I don't show any coverage beyond that, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] there's no coverage with us um we did receive your claim a second time and was processed on [PII] as a duplicate.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, and I'll provide you that policy number it was processed under if you like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, I, I, I just want the policy number.
[AGENT][NEUTRAL] 01
[AGENT][NEUTRAL] 28.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 8799.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thanks for that. And I just want the call reference number for this one and I do have 2 more claims to check on me.
[AGENT][NEUTRAL] OK, so um the call reference number is my name in today's date?
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] My first name [PII] Last initial is [PII]
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, I got it and just give me a moment. I'll provide you the next one.
[AGENT][NEUTRAL] OK, I'm gonna go ahead and make notes on this account and then we can move on to the next one, OK? Just bear with me for one moment, thank you.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thanks.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Are you there [PII]?
[CUSTOMER][NEUTRAL] Yeah I'm there.
[AGENT][NEUTRAL] OK, you can move on to the next uh policy number when you're ready please.
[CUSTOMER][NEUTRAL] Yeah, sure. The next policy number is 024503778.
[AGENT][NEUTRAL] OK, just one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And please verify patient's name and their date of birth.
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's first, the patient's first name is uh [PII] and the last name is
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you, and go ahead with your date of service and the amount on the claim for [PII] please.
[CUSTOMER][NEUTRAL] Yeah, the data service is on.
[CUSTOMER][NEUTRAL] [PII] and the charge amount is $732 even.
[AGENT][NEUTRAL] I'm sorry, what was that date of service?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] [PII]. OK, thank you.
[AGENT][NEUTRAL] Just one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the amount on the claim was 348?
[CUSTOMER][NEUTRAL] No, it's uh 7:32, 732.
[AGENT][NEUTRAL] 0 7:32. OK, my, my apologies.
[CUSTOMER][POSITIVE] Oh, no problem.
[AGENT][NEUTRAL] OK, just give me one moment to pull a claim image please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna verify it's your claim.
[AGENT][NEUTRAL] OK, 732 for data service [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] OK, so I do have that claim details for you, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim received date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim process date [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number is 35.
[AGENT][NEUTRAL] 31
[AGENT][NEUTRAL] 791
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied on that [PII] finalized uh claim date. The office visit is not covered under this plan.
[AGENT][NEUTRAL] And also the um primary insurance uh explanation of benefits that was a uh.
[AGENT][NEUTRAL] Uh, submitted with the claim indicates there was no, uh, co-insurance or deductible amount.
[CUSTOMER][NEUTRAL] Yeah, it's uh co-pay.
[AGENT][NEUTRAL] It appears that
[AGENT][NEUTRAL] The co-pay for which service?
[CUSTOMER][NEUTRAL] It's for just give a moment let me check.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So the office visit again is not covered, so the offices it's not covered, yeah, it shows that $90 copayment unfortunately the office visit isn't covered under this plan then the additional services that were, uh, submitted uh indicate that the primary insurance paid in full. So this policy is a limited supplemental benefit plan and it doesn't cover office visits and if the primary insurance pays in full, this policy does not pay a benefit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's for office.
[CUSTOMER][POSITIVE] OK, thanks for that information and just give me a second, let me document this one.
[AGENT][NEUTRAL] Certainly, and I'll do the same and then we can move on to your next, OK?
[CUSTOMER][NEUTRAL] Yeah, tell me when you're ready.
[AGENT][NEUTRAL] OK, just give me one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, we can move on to that next one when you're ready please.
[CUSTOMER][NEUTRAL] Yeah, sure, just give me a moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm gonna place you on a brief hold, [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah, actually, uh, the next one.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] I'm ready. Uh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the next one on our number ID is 2337118.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And please verify patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that and go ahead with the date of service and the amount on the claim please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] The data service is on [PII], and the charge amount is $3,915 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And just give me one moment.
[AGENT][NEUTRAL] OK I'm gonna pull that claim image so just bear with me for one moment while I do that please.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Are you waiting to go?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] You gotta go.
[AGENT][NEUTRAL] Um, discount anyway, um.
[AGENT][NEUTRAL] She
[AGENT][NEUTRAL] I need a change.
[AGENT][NEUTRAL] No, I don't. I'm sure my back.
[AGENT][NEUTRAL] It doesn't check.
[AGENT][NEUTRAL] I don't have another one
[AGENT][NEGATIVE] What doesn't wanna go.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] The one that
[AGENT][NEUTRAL] Oh, that's kind of.
[AGENT][NEGATIVE] I want to know what that fucking.
[AGENT][NEUTRAL] Um, just Bank of America, I guess, or American Express.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] OK, thank you so much, uh, [PII] so um it does appear.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The the claim and that claim amount was 39153915, is that right?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I have that claim received date.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim process on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number 35.
[AGENT][NEUTRAL] 20
[AGENT][NEUTRAL] 129.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And uh the claim was denied um due to the services uh.
[AGENT][NEUTRAL] The preventative services or this policy covers illness um and or accident diagnosis. It does not have any uh preventative or wellness benefits.
[AGENT][NEGATIVE] So the service was denied um is not covered um due to it wasn't an accident or sickness diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So there's no screening.
[AGENT][NEUTRAL] Benefit, no screening.
[CUSTOMER][NEUTRAL] OK. So these services are not covered under the patient's plan, right?
[AGENT][NEUTRAL] Right, not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no problem. And I just, I just want the UOB to be fax like, uh, we recently like upon this one we have requested the UOB, but we haven't received yet. So can you fax us IOB.
[AGENT][NEUTRAL] This EOB for [PII]? OK, what's the fax number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's 615.
[CUSTOMER][NEUTRAL] 639
[CUSTOMER][NEUTRAL] 7088
[AGENT][NEUTRAL] And to your attention, [PII]?
[CUSTOMER][POSITIVE] Yes, I think to be there.
[AGENT][NEUTRAL] OK, [PII] and that's your fax, correct?
[CUSTOMER][NEUTRAL] Uh, just give me a second. Like I mistakenly provided the wrong number. I just provided the name and the one it's yeah.
[AGENT][NEUTRAL] Yeah, that was your phone number.
[AGENT][NEUTRAL] Just wanna be sure it's correct facts. OK, go ahead when you're ready.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's 615-777.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 353 6.
[AGENT][NEUTRAL] [PII] and that's the fact.
[CUSTOMER][POSITIVE] Yeah, yeah, it's good.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is the only explanation of benefits you need is for [PII], is that right?
[CUSTOMER][NEUTRAL] Yeah, I stop them. I got it in the bottom.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and do you have any other questions?
[CUSTOMER][NEUTRAL] No, I just want the call reference number for this one.
[AGENT][NEUTRAL] Certainly the call reference number is the same for each uh inquiry. It's Roxy R O X Y my name last initial [PII] and then today's date.
[AGENT][POSITIVE] And I'm sending that fax over to you now you should receive it in a few minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure. And don't forget to attention to my name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, attention [PII], right.
[CUSTOMER][POSITIVE] Yeah, OK, thanks for that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a great rest of your day and a great weekend.
[CUSTOMER][NEUTRAL] Yeah, you too, bye bye.
[AGENT][POSITIVE] Thank you bye bye.