AccountId: 011433970860
ContactId: 87a7f7ce-7e15-48be-850f-a8736de4409c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1065189 ms
Total Talk Time (AGENT): 368518 ms
Total Talk Time (CUSTOMER): 342724 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/87a7f7ce-7e15-48be-850f-a8736de4409c_20250411T18:51_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from um Advanced Chiropractic Center. I emailed you guys, um, health insurance claim form with an EOB, um, on the EOB, um, remittance there were 3 clients that have you guys as a secondary, and I just received back, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A statement saying that you need to, you need a copy of explanation of benefits, but I emailed you guys that.
[CUSTOMER][NEUTRAL] I could redo it if you want, but I just wanna make sure because that.
[AGENT][NEUTRAL] OK, [PII], so you're with the provider's office and you said that you emailed a claim to APL?
[CUSTOMER][NEUTRAL] Except making
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Yeah, on
[AGENT][NEUTRAL] Yes, I can help you with this, but [PII], yes, ma'am. First off, I'm gonna need to get some information from you. Um, so what's a good callback number for you, please?
[CUSTOMER][NEUTRAL] On, uh, I can tell you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And what is, is it for one patient and multiple dates of service or different patients, you said?
[CUSTOMER][POSITIVE] Well, it looks like it's, it's so far I just got one.
[AGENT][NEUTRAL] OK, and what is that member's policy number?
[CUSTOMER][NEUTRAL] Patient with two dates of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me 1 2nd, I gotta get in.
[AGENT][NEUTRAL] Sure. OK.
[CUSTOMER][NEUTRAL] So it's 01848880.
[AGENT][NEUTRAL] OK. Give me just a moment please, [PII] to get the information pulled up on this number.
[CUSTOMER][NEUTRAL] Her name's [PII].
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] And any information that I, yes ma'am do provide for you would be a verification of benefits and not a guarantee of payment. So one moment.
[AGENT][NEUTRAL] OK. Um, and again, if you could please give me her date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and then what um you said that you emailed in what email did you send to because we, yes ma'am, because we're really, we don't accept claims via email for security purposes so I was curious as to what email you sent it to.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, I, oh, I'm sorry, not email well it's our emails but I fax, but we do it through email, sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh, OK, that's, that's fine.
[CUSTOMER][NEUTRAL] I did it on [PII].
[AGENT][NEUTRAL] Alright, so give me one moment to get the rest of the information pulled up.
[CUSTOMER][NEUTRAL] And like I said, I can resend it to you, but what happened was on one of our remittance there were 3 clients and all those 3 clients have you as their secondary so I just sent one of that and then each individual health insurance claim form.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, and what is the first data service and total bill amount?
[CUSTOMER][NEUTRAL] Um, $3725 for $55.
[AGENT][NEUTRAL] Alright, just a moment.
[AGENT][NEUTRAL] 37 for $55 is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the primary paid 25 and then you guys usually pay the other 25.
[CUSTOMER][NEUTRAL] And we write off 5.
[CUSTOMER][NEUTRAL] I don't
[AGENT][NEUTRAL] OK, and do you already have the claim number for that data service?
[CUSTOMER][NEUTRAL] Um, well, no, because you, I just.
[AGENT][NEUTRAL] It should have been on the explanation of the uh-huh.
[CUSTOMER][NEUTRAL] Oh, maybe it is on the other side.
[AGENT][NEUTRAL] The remarks are on one side.
[CUSTOMER][NEUTRAL] I have a reference
[CUSTOMER][NEUTRAL] I have a reference. OK, yes, so here's the claim number 358-562-8.
[AGENT][NEUTRAL] Yes, ma'am. All right, that is correct and I do see that it was denied stating that we were in need of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] That was for 37 and 324 dates of service. They are both on that one.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Right, but I sent that, OK.
[CUSTOMER][NEUTRAL] I'll just resend it then because.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Obviously whoever got didn't realize that that remittance had all three of the clients from each health insurance claim form except sending it.
[AGENT][NEUTRAL] OK, so did you mark for this member?
[CUSTOMER][NEUTRAL] More times I just did one.
[CUSTOMER][NEUTRAL] Can I what?
[AGENT][NEUTRAL] Is there more, OK, so I'm not understanding what you're saying. Did you highlight or indicate on there the explanation of benefits for this number for each data service?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I sent you guys one remittance on that United Healthcare remittance was 3 of our clients.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] And they were belong to you guys and then I attached.
[CUSTOMER][NEUTRAL] Their separate health insurance claim form so.
[AGENT][NEUTRAL] Let me look to see what's showing under here.
[CUSTOMER][NEUTRAL] Do you, can you see?
[CUSTOMER][NEUTRAL] OK, so for instance on [PII].
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Uh, I would have to, if that's on a different policy, I'll have to, once we're finished with this number, then I'll have to pull that number and verify the information before I'll be able to tell you anything about that.
[CUSTOMER][NEUTRAL] And I'll give you a claim number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] But then would you be able to, OK, so then would you be able to see that explanation of benefits on his?
[AGENT][NEUTRAL] I don't see that we received. OK, so on the information attached for Ms. [PII], there is only the claim form.
[CUSTOMER][NEUTRAL] That I sent over.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's the only thing I see for her.
[AGENT][NEUTRAL] I don't see, you know, there's not any explanation of benefits with that one.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, well it's attached with the other one so it's fine I'll just resend it.
[AGENT][NEUTRAL] OK, so I can, I can look at the next number. Give me just one moment. And do you have our portal website also, [PII], so for, you know, for future reference if you need to print an explanation of benefits for us, you can do that.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] By going to [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Let me see if I have that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't believe so, but you never know.
[CUSTOMER][NEUTRAL] I don't think I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just because I've never ever had a call.
[AGENT][NEUTRAL] It is self registering? Sure. OK.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][POSITIVE] I can get it. Well, I do about it.
[CUSTOMER][NEUTRAL] American public, yeah, I.
[AGENT][NEUTRAL] You already have that one? OK. All right.
[CUSTOMER][NEUTRAL] I have it I.
[AGENT][NEUTRAL] OK, so what
[CUSTOMER][NEUTRAL] I don't think I've ever signed up for it though.
[AGENT][NEUTRAL] But you do have OK I just wanted to make sure that you have it we try to let each of our callers know about that so.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] Um, what's the next member's, sure, what's the next member's policy number?
[CUSTOMER][POSITIVE] Yeah and I and I'll sign up for its fine.
[CUSTOMER][NEUTRAL] 3358.
[CUSTOMER][NEUTRAL] OK, let me look in his account then.
[AGENT][NEUTRAL] Yeah, I need his policy number.
[CUSTOMER][NEUTRAL] His name's [PII], yeah, that's fine.
[CUSTOMER][NEUTRAL] And his policy number is 01848864.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And same with this claim and the information provided would be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] And what is his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And I did get an explanation of benefits on his.
[CUSTOMER][NEUTRAL] It just says he's already met.
[CUSTOMER][NEUTRAL] His outpatient benefits.
[CUSTOMER][NEUTRAL] So obviously.
[AGENT][NEUTRAL] OK, and what.
[AGENT][NEUTRAL] And what's the data service in?
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Total bill amount on this claim?
[CUSTOMER][NEUTRAL] [PII] 25 $55.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said you do have that claim number as well?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] 358-562-4.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] And yes, ma'am, it does show that his outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK, so then he won't ever have you guys for the rest of the year?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Right, his outpatient benefit has been maxed for this calendar year.
[CUSTOMER][NEUTRAL] OK, so now can you see what I sent?
[CUSTOMER][NEUTRAL] On his account?
[AGENT][NEGATIVE] I mean just it's still trying to load the information.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] No, you're fine, you're fine.
[AGENT][NEUTRAL] So yes, I do. However, like I said, I can see why it was not because of the way it was submitted. It wasn't indicated that that was with for multiple. So it was like they were each claim form and his name was first on that electronic.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] medical
[AGENT][NEUTRAL] [PII] said that came like right with his claim form. So unless it was referenced on there, it was related to multiple policies. That's how it got.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I'll just resend it because there's a there's one more client on that list.
[AGENT][NEUTRAL] Overlooked.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, [PII], so I'm sure I'll be getting the same notification on him.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Let's
[AGENT][NEUTRAL] So yes, if you want to.
[AGENT][NEUTRAL] Um, now I can try and send a request to have them to reference this particular claim. What is the.
[AGENT][NEUTRAL] OK, so give me just a minute.
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][POSITIVE] It's my mistake. I'm sorry.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Oh, he's covered.
[AGENT][NEUTRAL] What is the other patient's policy number?
[CUSTOMER][NEUTRAL] Um, his would be.
[CUSTOMER][NEUTRAL] 01848865
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] And what is his date of birth name and date of birth again, please?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Um, it's
[CUSTOMER][NEUTRAL] Get it to his account. It's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the date of service and total bill amount for him?
[CUSTOMER][NEUTRAL] Um, that one was.
[CUSTOMER][NEUTRAL] [PII], $25 for $55.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah OK yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so do you want to resend and like [PII] out on the.
[AGENT][NEUTRAL] The transmittal, so, for example, mark out Mr. the other two members for Mr. [PII]'s claim, or I can try and request that they review.
[CUSTOMER][NEUTRAL] I need to talk to
[AGENT][NEUTRAL] What's on the other member's policy, the 2nd patient's policy.
[CUSTOMER][NEUTRAL] Um, if it's easier for me just to.
[CUSTOMER][NEUTRAL] Email or not sorry [PII] I can I just have to adjust everything.
[AGENT][NEUTRAL] Yeah, yeah, right.
[AGENT][NEUTRAL] Either way, I mean, I can request that they look at this other member's policy that has the explanation of benefits and see if they can index it on the other member's policy. But again, when they're, when it comes in like that, they solve it because in our imaging.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They're not
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Going through each document.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To try to figure out if there's more than one patient.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Right, OK, that makes sense. I just figured since I was figured man this.
[AGENT][NEUTRAL] I mean, not the magnitude, the multitude of.
[AGENT][NEUTRAL] Poins that we get.
[CUSTOMER][NEUTRAL] They're all on the same page. I don't have to scan, you know, more pages so I was trying to.
[CUSTOMER][NEUTRAL] Downsize it, but I can fix it and just resend it if you think that it would be easier on your end.
[AGENT][NEUTRAL] Uh, it's, it's either way. I mean, I'll be happy to send a request. It will be a little more detailed for me to do it this way, but it, it can be done.
[CUSTOMER][NEUTRAL] Uh, I'll just adjust it on my end.
[CUSTOMER][NEUTRAL] And then I'll re-fax it in two separate faxes so it doesn't come together, OK?
[AGENT][NEUTRAL] OK, and you can just reference, you know, the member's policy number, [PII], and the claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When you, when you do that, and that way it'll go on the correct policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, sounds good thank you for your time.
[AGENT][POSITIVE] OK. All right then. Oh, absolutely. You're welcome. And is there anything else that I could help you with today?
[CUSTOMER][NEGATIVE] No, no thank you.
[AGENT][POSITIVE] OK, well thank you so much for calling APL and I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Yes ma'am. Thank you. Bye bye.