AccountId: 011433970860
ContactId: 868518cc-8ce9-4c37-939d-fb78c431bd44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1496819 ms
Total Talk Time (AGENT): 382102 ms
Total Talk Time (CUSTOMER): 479428 ms
Interruptions: 6
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/868518cc-8ce9-4c37-939d-fb78c431bd44_20250515T15:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provide to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So may I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] Hi [PII], I can help you with claim status. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. No extension it's a direct line.
[CUSTOMER][NEUTRAL] But you know then I then I then I got.
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number will be
[CUSTOMER][NEUTRAL] 1,341,910.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] 1,341,910.
[CUSTOMER][NEUTRAL] 1,341,910.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I for.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, the member's first name is [PII] and the last name is [PII], and the date of birth will be [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] I do have the date of service. The date of service is uh sorry, the date of service is [PII].
[AGENT][NEUTRAL] Do you have the total bill amount?
[CUSTOMER][NEUTRAL] Yeah, the bill amount is $63 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And you said [PII], correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] See they looking at me, see what they can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What.
[AGENT][NEUTRAL] Do you need the claim number?
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] The claim number is 3588502.
[CUSTOMER][NEUTRAL] OK, perfect. When do you guys receive the claim?
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] The rest of my.
[AGENT][NEUTRAL] It looks like we received this claim on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And it looks like this claim was denied because all payable benefits were applied to the policy deductible of $500.
[AGENT][NEUTRAL] So the amount went towards the deductible. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. How much amount was went towards the deductible?
[AGENT][NEGATIVE] The $63 that was denied went towards the deductible.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, the $63 has been, uh, is processed towards the deductible, am I right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, it's $63 even, am I right?
[AGENT][NEUTRAL] Yes, it was $63 even, or let me check, let me double check on that before I tell you the wrong thing.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah so I don't know.
[AGENT][NEGATIVE] It looks like $17.49 went to the deductible.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And then that was it, because it was totally the total charge of $63.17 dollars 49 cents was charged.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, perfect. And could you please tell me what is the annual deductible amount of the patient and how much the patient met?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] a
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It looks like for the year [PII] used her outpatient benefits um.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The amount paid was $4000 and the deductible taken was $49499.39.
[AGENT][NEUTRAL] Is what she's used so far this year and then she's also used 61 cents towards her deductible, which means her deductible has been met.
[AGENT][NEUTRAL] For this year.
[CUSTOMER][NEUTRAL] OK, well then, what's the, could you please tell me what's the annual deductible amount because I didn't get the what's the annual deductible amount.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] The deductible was $500 and she has used that up.
[CUSTOMER][NEUTRAL] OK. Uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh OK
[CUSTOMER][NEUTRAL] And was it in network directable or the out network directable?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Was it in-network deductable or out-network deductible?
[AGENT][NEUTRAL] It was her medical outpatient.
[CUSTOMER][NEUTRAL] Perfect. And could you please tell me to which address you guys mailed the copy of your payments to pay to address.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you asking if we mailed if the claim was mailed?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Uh, no, I'm asking you to verify the pay to address which you have on file.
[AGENT][NEUTRAL] Oh, certainly.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] They said go ahead.
[AGENT][NEUTRAL] It looks like it went to the provider of Kirksville Clinic Corp.
[CUSTOMER][NEUTRAL] Oh yeah, and then what's the address? It's uh
[AGENT][NEUTRAL] I do not have their address since we didn't mail them a check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Because it was denied.
[CUSTOMER][NEUTRAL] So you don't have payments mailing address on the file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if I can pull it up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Give me one moment while it pulls up.
[AGENT][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, perfect. I want this address. Yeah, perfect.
[CUSTOMER][NEUTRAL] And could you please verify me the patient's account number?
[AGENT][NEUTRAL] I do not have their account number for that. You'll have to call Kirksville Clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK and.
[AGENT][NEUTRAL] All I have is her policy number. Mhm.
[CUSTOMER][NEUTRAL] Yeah, no worries. And could you please, OK, provide me the claim number. The claim number is 3588502. Am I right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 358-850-2, yes sir.
[CUSTOMER][NEUTRAL] And could you please send me the copy of your?
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] It looks like it was sent to.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Kirk Kirksville Clinic.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So we need to take it from the provider?
[AGENT][NEUTRAL] Yes, the provider should have received one. We sent it out on the [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK, perfect. Just a second, give me a minute.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][POSITIVE] OK perfect and.
[CUSTOMER][NEUTRAL] not just
[CUSTOMER][NEUTRAL] What will be the call reference number for our conversation?
[CUSTOMER][NEUTRAL] Well I didn't hear about that.
[AGENT][NEUTRAL] You don't have a call reference number, but you can use my name and my last initial, so [PII], and today's date.
[CUSTOMER][NEUTRAL] They have.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, perfect. Can you please assist me with 3 more claims I do have on file?
[AGENT][NEUTRAL] Is it with the same patient?
[CUSTOMER][NEUTRAL] Uh, no, it's for a different patient.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And for the different provider as well.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] and uh
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Give me 1 2nd, let me put in some notes for this first patient.
[CUSTOMER][POSITIVE] Yeah, no worries, take your time. Tell me if you're done.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, it's like.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And what is the 2nd policy number?
[CUSTOMER][NEUTRAL] 2552915.
[AGENT][NEUTRAL] Alright, one moment.
[CUSTOMER][POSITIVE] Yes, you will be on it. You you will be on it. I wanna send you.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's account, uh, the patient's name, first name is [PII] and the last name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII], OK, it's [PII].
[AGENT][NEUTRAL] I'm sorry, you said [PII]?
[CUSTOMER][POSITIVE] Perfect, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] OK. I am not showing a claim. You said [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I'm not showing a claim for that day.
[CUSTOMER][NEUTRAL] OK, so the claim is not on file for the date of service.
[AGENT][NEUTRAL] Right, if the date of service is [PII], I don't have anything on file for that.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Could you please tell me the patient active on the date of service?
[CUSTOMER][NEUTRAL] right.
[AGENT][NEUTRAL] Looks like [PII]'s account or this policy was active, is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and still active.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. Could you please tell me when was the last coordination of benefits were updated for the member?
[AGENT][NEUTRAL] When her benefits were updated, they get updated every they get updated nightly.
[CUSTOMER][NEUTRAL] They get updated?
[AGENT][NEUTRAL] Right, so.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Oopsies.
[CUSTOMER][NEUTRAL] So do you have any perfect date for them when was the last coordination of benefits updated?
[AGENT][NEUTRAL] I do not. All I see is that she has used her inpatient benefits of.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] $1,813.26.
[CUSTOMER][NEUTRAL] OK, perfect. Uh, could you please tell me, are your primary or second for the member?
[AGENT][NEUTRAL] Could you repeat that please?
[CUSTOMER][NEUTRAL] Are your primary insurance or secondary insurance for the member?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I actually like that.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It would be Aetna.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So that means you're secondary.
[AGENT][NEUTRAL] That's primary.
[CUSTOMER][NEUTRAL] And you are the secondary one. Am I right?
[AGENT][NEUTRAL] Yes, we are the secondary one. This is a secondary gap policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And could you please help me with the claim submission timely filing?
[AGENT][NEGATIVE] We do not have timely filing.
[AGENT][NEUTRAL] So you can still submit the claims.
[CUSTOMER][NEUTRAL] What would be the meeting address?
[AGENT][NEUTRAL] Mailing address is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII] in [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What will be the pay ID?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The PR ID is [PII].
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] And the preferred mode of mode of submission will be either mail or electronic. We accept both, am I right?
[AGENT][POSITIVE] You can mail it or you can even fax it to us.
[CUSTOMER][NEUTRAL] OK, and electronic submission is accepted?
[AGENT][NEUTRAL] Yes, you can, you can uh submit it electronically through secured. [PII] through the OSC.
[AGENT][NEUTRAL] For the online service center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the fax number to for the submission?
[AGENT][NEUTRAL] Our fax number is [PII].
[CUSTOMER][NEUTRAL] You mean.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then.
[CUSTOMER][NEUTRAL] OK, perfect. And could you, and the call reference number will be your name in the state. Am I right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, perfect. shall we move to the next claim?
[AGENT][NEUTRAL] OK. Give me one moment. Let me finish up my notes. OK, let me finish notes on this one real quick and then we'll get on to that 3rd 1.
[CUSTOMER][NEUTRAL] It's for the different member.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, [PII], and what is the 3rd policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02505362.
[CUSTOMER][NEUTRAL] It's.
[AGENT][NEUTRAL] Alright, let me look that up.
[AGENT][NEUTRAL] And can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] As the patient's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And do you have the date of service?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm not showing.
[AGENT][NEUTRAL] Any claims for this person?
[AGENT][NEUTRAL] Let me double check and make sure.
[AGENT][NEUTRAL] Right, I'm not showing any claims for this.
[CUSTOMER][POSITIVE] OK, perfect. So,
[CUSTOMER][NEUTRAL] OK, just a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, is the patient active on the date of service?
[AGENT][NEUTRAL] Yes, this policy was effective [PII].
[AGENT][NEUTRAL] And it lapsed on [PII]. So the policy was active during this state of service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And when was it um, [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And could you please tell me?
[CUSTOMER][NEUTRAL] Just a second. Are you primary or secondary for the member?
[AGENT][NEUTRAL] Uh, this is a dental policy, so this would be their dental policy.
[CUSTOMER][NEUTRAL] OK, so that means you're the only, uh, from my, uh, OK, you're the only one for the member, so that means you are the primary.
[AGENT][NEUTRAL] Right, we are the primary, but this is a dental insurance, not a medical for this particular policy.
[CUSTOMER][NEUTRAL] OK. Do you have any COB updates? When was the last coordination of benefits updated? Do you have any information?
[AGENT][NEUTRAL] I do not. Let me see.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, they, they currently do not have insurance through us.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and the further details will remain the same which you gave me for the previous screen.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] OK, perfect. Thanks for your assistance, [PII]. I hope you have a great day and it was a pleasure talking to you.
[AGENT][NEUTRAL] So
[AGENT][POSITIVE] All right. Thank you so much for calling APL and have a great day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.