AccountId: 011433970860
ContactId: 74aa6d1f-5ef2-46c8-aa5d-d8b190348d57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 975729 ms
Total Talk Time (AGENT): 328520 ms
Total Talk Time (CUSTOMER): 235350 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/74aa6d1f-5ef2-46c8-aa5d-d8b190348d57_20250206T18:40_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from office to check on our claim status. How are you doing today?
[AGENT][NEUTRAL] I'm, I'm fine, but I didn't understand your name at all. I can barely hear you.
[CUSTOMER][NEUTRAL] I'm.
[CUSTOMER][NEUTRAL] My, my name is [PII].
[AGENT][NEUTRAL] [PII]. OK, I can hear you better now. Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII]. It's a direct call, no extension needed.
[AGENT][POSITIVE] Thank you. And how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Uh, I need to check the claim status.
[AGENT][NEUTRAL] OK, you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that. And how many claims no one do you have to check status on?
[CUSTOMER][NEUTRAL] A minute, I'll confirm you that.
[CUSTOMER][NEUTRAL] Uh, overall two claims.
[AGENT][NEUTRAL] How many?
[CUSTOMER][NEUTRAL] Two claims.
[AGENT][NEUTRAL] OK, are the claims for the same patient or two different patients?
[CUSTOMER][NEUTRAL] Two different patients.
[AGENT][POSITIVE] OK, so yes I can help you with that [PII] and a couple of things for you to know. You will use my name that I gave you along with today's date and each of your call reference numbers.
[AGENT][NEUTRAL] Also, any information that I provide for you on either claim will be a verification of benefits and not a guarantee of payment. And lastly, if we have the claims on file, [PII], and you need a copy of either explanation of benefits, you can go to our portal and print them yourself, and our portal website is secured.
[CUSTOMER][NEUTRAL] OK. Uh, could you
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And again, my name is [PII]. It is spelled [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is your, you're welcome. And what is your first patient's policy number?
[CUSTOMER][POSITIVE] Thanks for that, [PII].
[CUSTOMER][NEUTRAL] And the policy number is
[CUSTOMER][NEUTRAL] 023 02966 M as in Marco, L as in Lima, 8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And then what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The patient name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the data service and total build about, please, [PII]?
[CUSTOMER][NEUTRAL] Sure. The date of service is
[CUSTOMER][NEUTRAL] From [PII].
[CUSTOMER][NEUTRAL] And the total charge is
[CUSTOMER][NEUTRAL] $138,855. 32 cents.
[AGENT][NEUTRAL] So $138,855.32. Is that correct?
[CUSTOMER][POSITIVE] Yes, sir, yeah, that's correct.
[AGENT][NEUTRAL] OK, so I do not see a claim on file for this member for this data service under this policy. Let me see if, because this policy was not active for the data service that you're giving me.
[AGENT][NEUTRAL] This policy has an effective and a term date of [PII].
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the correct policy number that you should have for this number for your data service in question is 0249.
[AGENT][NEUTRAL] 8490.
[CUSTOMER][NEUTRAL] That's the correct policy number.
[AGENT][NEUTRAL] And this part
[AGENT][NEUTRAL] That is the correct policy number that I just gave you.
[AGENT][NEUTRAL] For the
[CUSTOMER][POSITIVE] Yeah, OK. Thanks for that.
[AGENT][NEUTRAL] Uh-huh. And this policy is active with no term date. The effective date on it is one.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And give me just one moment to get that information pulled up please.
[AGENT][NEUTRAL] And again [PII], you said that the data service is [PII], is that correct?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so we did receive this claim and process it under this correct number. The claim, the claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3493503.
[AGENT][NEUTRAL] And this claim was denied because we need a copy of the states to please provide copies of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, thanks for that. Uh, could you please tell me the claim number alone, please?
[AGENT][NEUTRAL] The claim number again is 3,493,530.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] That's 349-3530. Am I right?
[AGENT][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] 349-3503.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Could you please provide me the mailing address?
[AGENT][NEUTRAL] What address do you have for claims?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Tell me what address you have.
[AGENT][NEUTRAL] On file.
[CUSTOMER][NEUTRAL] Uh, I have on file, I have [PII] City.
[CUSTOMER][NEUTRAL] [PII]. And ZIP code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Could you please provide me the fax number attention?
[AGENT][NEUTRAL] [PII] attention claim.
[CUSTOMER][NEUTRAL] Could you please provide me the plan name?
[AGENT][NEUTRAL] Supplemental med link. This is not major medical insurance.
[CUSTOMER][NEUTRAL] Could you please provide me the group number?
[AGENT][NEUTRAL] The group number for this member is 21152.
[CUSTOMER][NEUTRAL] Could you please tell me the timely filing limit?
[AGENT][NEGATIVE] There is no timely filing limit?
[AGENT][NEUTRAL] And is there any other information on this particular claim that I can help you with before we move to the next member?
[CUSTOMER][NEUTRAL] Mhm. Yeah. A minute, um.
[CUSTOMER][NEUTRAL] OK. Uh, you said that the call reference number will be your name on today's date. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Thanks for that, [PII]. Uh, could you please help me with the other client?
[AGENT][NEUTRAL] Yes, what is the next patient policy number?
[CUSTOMER][NEUTRAL] Yeah, uh a minute.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, the policy number SB.
[CUSTOMER][NEUTRAL] 2 sorry for that. That's 02457148.
[AGENT][NEUTRAL] 02457148, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] The patient name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] The date of service is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] What is the date again?
[CUSTOMER][NEUTRAL] Yeah, [PII]. Yeah. It starts from [PII]. The total charge is gonna be 32,000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 9 $32,969 even.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] on
[AGENT][NEUTRAL] And again, you said beginning [PII], is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Through 4:13. OK. So this claim once received?
[CUSTOMER][NEUTRAL] No, no, 433.
[AGENT][NEUTRAL] You said 41 to 413. Is that correct?
[CUSTOMER][NEUTRAL] No, no, 412,430.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this claim was received 5-28-2024.
[AGENT][NEUTRAL] Processed and denied on 63-2024.
[AGENT][NEUTRAL] The claim number is 346.
[AGENT][NEUTRAL] 3078.
[AGENT][NEUTRAL] This claim was denied?
[AGENT][NEUTRAL] It states kinesiology, speech, or occupational therapy are not covered benefits under this policy.
[CUSTOMER][NEUTRAL] A minute
[CUSTOMER][NEUTRAL] Uh, it is non-covered as per patient plan or provider contract. It's.
[AGENT][POSITIVE] That is correct. Patient.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Uh, what is the reason for non-covered it for the
[CUSTOMER][NEUTRAL] Uh, provided the sort of contract or the DX code is not cover or the
[AGENT][NEUTRAL] I read you the denial remark.
[CUSTOMER][NEUTRAL] When what's the exit?
[AGENT][NEUTRAL] That we, this is not major medical insurance, yes or no, and this is not major medical insurance. This is a supplemental policy only, and the supplemental policy does not cover kinesiology, speech, or occupational therapy.
[CUSTOMER][NEUTRAL] No, I'm asking.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this is also uh the same policy number for this claim also, right?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] No, uh, I'm asking that the call reference number is the same, right?
[AGENT][NEUTRAL] Policy number?
[AGENT][NEUTRAL] Is that what you said?
[CUSTOMER][NEUTRAL] No, uh, call reference, no, no. The call reference number is the same.
[AGENT][POSITIVE] Yes, call reference number. Yes, it is. That is correct.
[CUSTOMER][POSITIVE] OK. Uh, thanks for that. Thanks for your assistance. Have a great day.
[AGENT][POSITIVE] OK. Well, you're so, yes, you're very welcome, and if that's all I can help you with, thank you again for calling APL and I hope you have a nice afternoon also.
[CUSTOMER][POSITIVE] Thank you. Have a great day.
[AGENT][POSITIVE] You're welcome. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.