AccountId: 011433970860
ContactId: 7e04ea5d-fa44-4de0-b1b0-587c52e77dfe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1097609 ms
Total Talk Time (AGENT): 387590 ms
Total Talk Time (CUSTOMER): 340333 ms
Interruptions: 8
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/7e04ea5d-fa44-4de0-b1b0-587c52e77dfe_20250328T20:39_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] Yeah, hi, this is [PII] calling from provider's office. I want to check the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Yeah, sure. It's 02252690. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And [PII] any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Yes, I do like the 194.
[CUSTOMER][NEUTRAL] I took it and then I want to see.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yeah, sure. The date of service is on [PII] and the total charge amount is $1,073 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I was we ship to principle of these.
[CUSTOMER][NEUTRAL] 1235.
[AGENT][NEUTRAL] And you did say 10 7 20 $24 for $1,073. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] The received date is [PII].
[CUSTOMER][NEUTRAL] this is
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] The claim number is.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that, that claim was received. That's the information on the duplicate claim. Do you need the original claim information, [PII]?
[CUSTOMER][NEUTRAL] Yes. Yeah, yes, I need the claim information.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so the original claim information.
[AGENT][NEUTRAL] The original claim was received on [PII] excuse me, [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 3531899.
[AGENT][NEUTRAL] And the rea and this claim was denied.
[AGENT][NEUTRAL] The reason for the denial states we have received the primary explanation of benefits that was submitted with your claim.
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] However, the explanation of benefits received does not list the amounts applied to the deductible, co-pay, or co-insurance. Please submit a a more detailed explanation of benefits that shows these amounts for further consideration of your claim.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] So the primary has been allowed and applied towards patients responsibility that is deductible.
[AGENT][NEUTRAL] OK. The we need a more detailed explanation of benefits from the primary insurance. The one that we received did not show.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The amounts applied to the deductible copay or co-insurance, so we need that detailed.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK. So, OK, so we have to uh submit through electronically or fax.
[AGENT][NEUTRAL] You may fax it, and I can give you our secured fax line.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] What is the
[CUSTOMER][NEUTRAL] Yeah, can you give me the fax number?
[AGENT][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] [PII] 3.
[AGENT][NEUTRAL] Attention claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits that I just read these remarks from [PII], you can print that by going to our portal.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] And our portal website is is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And I have another patient to check, so can you please check that?
[AGENT][NEUTRAL] How many patients do you have? You had said you had one.
[CUSTOMER][NEUTRAL] No, I have a total 5 claims.
[AGENT][NEUTRAL] OK, so the website that I just gave you for our portal that would apply to all of them also any information that I provide would be a verification of benefits and not a guarantee of payment and my name and today's date will be what you would use for your call reference number for each.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So you, that is all the information that you need for this number?
[CUSTOMER][NEUTRAL] And next.
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] 244
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the next policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's 01994411 M as in Mike, L as in Lima, number 7.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] 30 to the full.
[AGENT][NEUTRAL] And your patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's um [PII].
[CUSTOMER][NEUTRAL] [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Data service and total bill amount please.
[CUSTOMER][NEUTRAL] In [PII] and the total charge amount is $348 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] A better medical school.
[AGENT][NEUTRAL] OK, this claim was also received. It was received on [PII].
[AGENT][NEGATIVE] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 3267.
[CUSTOMER][NEUTRAL] family.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial on this claim states office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] The member's plan does not cover office visits, Mark?
[CUSTOMER][NEUTRAL] Non-core under patients plan, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And do you need any other information on this number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's you. And can you please fax the will be to provide my fax number?
[AGENT][NEUTRAL] So you do not have the ability to print?
[CUSTOMER][NEUTRAL] $200.
[CUSTOMER][POSITIVE] Yeah, I have the hotel. Thanks for that. And next we'll move to the next question.
[AGENT][NEUTRAL] You do, OK. So give me just a moment then.
[CUSTOMER][NEUTRAL] I39 and I.
[CUSTOMER][NEUTRAL] It should be the one.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and the next patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The next member policy number, it is 01820389 M as in Mike, L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you, [PII], one moment.
[AGENT][NEUTRAL] And the date of service, I'm sorry, your patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] Yeah, sure. It's um
[CUSTOMER][NEUTRAL] I[PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And the date of service and total bill amount for her?
[CUSTOMER][NEUTRAL] Yeah, the date of service is on [PII] and the total charge amount is, it's uh $3,915 even.
[AGENT][NEUTRAL] 3915.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][POSITIVE] Yes you can live.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] It's gonna be fun.
[CUSTOMER][NEUTRAL] And they all.
[CUSTOMER][NEUTRAL] And I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] is 1,222.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so one moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] The received date was [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] What it.
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3565604.
[AGENT][NEUTRAL] And the reason for the denial on this claim, Mark?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] States
[AGENT][NEUTRAL] The maximum benefit payable for this date of service has been met.
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][NEUTRAL] So may I know the, where the last date of service my beverages has been exhausted.
[AGENT][NEUTRAL] The same data service?
[CUSTOMER][NEUTRAL] It has been exist. Yeah, so it has been exist in dollar amount or in
[AGENT][NEUTRAL] Yes, it was on the same date of service.
[AGENT][NEUTRAL] Dollar amount.
[CUSTOMER][NEUTRAL] Dollar amount or in mhm.
[AGENT][NEUTRAL] And the benefit maximum per calendar day for covered outpatient services is $500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And is there any other information that you need on this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And OK, yeah, OK. And next we move to the next question.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and your next
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank so much.
[CUSTOMER][NEUTRAL] Yeah, the next policy number.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] It's 01829142, M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's um [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Yeah, sure. It's um [PII] and the total charge amount is $245 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] You said this claim was also received. The received date was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3565553.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the denial state office visits are not covered by the above numbered policy.
[AGENT][NEGATIVE] The member's plan does not cover all that's correct.
[CUSTOMER][NEUTRAL] And the patient's plan.
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you.
[AGENT][NEUTRAL] OK, you're very welcome. And did you have one more? Or was that the last one?
[CUSTOMER][NEUTRAL] Yeah, no, that's it.
[AGENT][NEUTRAL] That's the last one.
[CUSTOMER][POSITIVE] Mhm, yeah, that's it. That's it for the day. Yeah, that's it for the day. Thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome. So if that is all then that I can help you with today, [PII], thank you for calling APL and I hope that you have a great weekend.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, bye-bye.
[AGENT][NEUTRAL] Mm bye bye.