AccountId: 011433970860
ContactId: 8aab191c-e45b-403b-94e6-bccd57ddcc76
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2631610 ms
Total Talk Time (AGENT): 408552 ms
Total Talk Time (CUSTOMER): 392019 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/8aab191c-e45b-403b-94e6-bccd57ddcc76_20250414T15:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] calling on behalf of the provider's office to check on the claim status. Could you please help me with that?
[AGENT][NEUTRAL] Yes, ma'am. I can help you with claim status today and then whom am I talking to again?
[CUSTOMER][NEUTRAL] It is [PII] And can I have your name as well?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yeah, of course. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I do have it here the policy number that will be 02571797.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, and [PII], what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Perfect. Thank you. And then patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And the patient's name is [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, and do you have a data service and a charge amount?
[CUSTOMER][NEUTRAL] Yes, I do have it here. Theater service is 24 $2025 with the full amount of $1,228.
[AGENT][POSITIVE] OK, perfect. Just one moment.
[AGENT][NEUTRAL] OK, can I just put you on a brief hold for just a moment while I look into these claims?
[CUSTOMER][NEUTRAL] Oh yeah, sure.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][NEUTRAL] I'm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] COP.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hey buddy thank you for holding. Are you doing OK?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, sorry, just one moment longer.
[CUSTOMER][NEUTRAL] Uh-huh, sure.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 288.
[AGENT][NEUTRAL] 89
[AGENT][NEUTRAL] 4
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hey buddy, thank you for holding. So it looks like for this state of service we have paid $387.20.
[CUSTOMER][NEUTRAL] On which date?
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] You said uh 20 cents, right? 20?
[AGENT][NEUTRAL] Yes, $387.20.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 97
[CUSTOMER][NEUTRAL] OK, on which date?
[AGENT][NEUTRAL] And it looks like.
[AGENT][NEUTRAL] It would be [PII].
[CUSTOMER][NEUTRAL] OK, is it paid through check or EFT?
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] Sorry, just one second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It was paid via check.
[CUSTOMER][NEUTRAL] OK, can I have the check number?
[AGENT][NEUTRAL] Yes, just one second.
[AGENT][NEUTRAL] OK, and it looks like the check number is.
[AGENT][NEUTRAL] 203.
[AGENT][NEUTRAL] 0
[AGENT][NEUTRAL] 709.
[CUSTOMER][NEUTRAL] OK, and this is a single or about check?
[AGENT][NEUTRAL] Hold on, let me check.
[AGENT][NEUTRAL] It is a single check.
[AGENT][NEUTRAL] Are you there, [PII]?
[CUSTOMER][NEUTRAL] Hello? Can you hear me?
[AGENT][NEUTRAL] Hi. Hi, yes, are you there?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. Is it a single or bulk check?
[AGENT][NEUTRAL] It is single, ma'am.
[CUSTOMER][NEUTRAL] OK, and can you just hold for a minute here.
[AGENT][NEUTRAL] OK, you're fine.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hi.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting. I really appreciate it. Thank you so much. Yes, you said that this is a single check. So the check was sent to which address? [PII]?
[AGENT][NEUTRAL] Sorry, what was that?
[CUSTOMER][NEUTRAL] The check was sent to which address?
[AGENT][NEUTRAL] Um, it was it was paid to provider.
[AGENT][NEUTRAL] I'm not allowed to. Yes. Mhm.
[CUSTOMER][NEUTRAL] Uh, like, are you able to, OK, I'll, uh, if I, if I provide it to you, were you able to confirm?
[AGENT][NEUTRAL] Yes, it was, yes, it was page provider. Mhm.
[CUSTOMER][NEUTRAL] The address? OK.
[CUSTOMER][NEUTRAL] OK, so the address is it the [PII]?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK. And can I have the patient responsibility for this one, for this claim?
[AGENT][NEUTRAL] We do not determine patient's responsibility. This is not a guarantee of payment, it's just a verification of coverage. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK, sure. Can I have the claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, the claim number is 357.
[AGENT][NEUTRAL] 1032.
[CUSTOMER][NEUTRAL] OK, and are you able to send me the copy of EOB?
[AGENT][NEUTRAL] Um, let me double check. Um,
[AGENT][NEUTRAL] You can log into our OSC website and check claims and EOBs as well.
[AGENT][NEUTRAL] Would you like that website? Yeah.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Uh, that's OK then. So we'll have to check from website. That's OK. That's fine. Uh, OK, then can you please help me verify this check was still outstanding, is it clear?
[CUSTOMER][POSITIVE] Oh, is it cash? I'm so sorry.
[AGENT][NEUTRAL] Um, let me see, just one second.
[AGENT][NEUTRAL] Sorry, just one moment.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so it looks like the check is not cleared yet.
[CUSTOMER][NEUTRAL] OK. But I think this is more than the 60 days, right?
[AGENT][NEUTRAL] Has it been more than 60 days?
[AGENT][NEUTRAL] No, it has not.
[AGENT][NEUTRAL] The issue date for the check was [PII].
[CUSTOMER][NEUTRAL] OK. OK, then sure. Can I, can I have the reference number and we'll move on to the next patient, [PII]. And just to confirm on that I, I forgot to come to mention, OK, on this claim here, there's no denial, right? I was paid like for the 0D 02100150 and 1110 was all paid, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So we paid $387.20 for this for claim number 357. What, so what is your question?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] I asked, like the postal code [PII], was it paid or not?
[CUSTOMER][NEUTRAL] On the.
[AGENT][NEUTRAL] Uh, 0, sorry, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] You're asking if that was paid?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is that a data service you're giving me?
[CUSTOMER][NEUTRAL] No, the procedure codes.
[CUSTOMER][NEUTRAL] X-ray 027.
[CUSTOMER][NEUTRAL] The service.
[AGENT][NEUTRAL] OK, so the service is
[CUSTOMER][NEUTRAL] Fullmar Express.
[AGENT][NEUTRAL] I'm sorry, are you on to the next?
[CUSTOMER][POSITIVE] Like the full mouth x-ray.
[AGENT][NEUTRAL] Are you on to the next policy?
[CUSTOMER][NEUTRAL] No, no, no, no, no, no, no, no, no. For this claim, the post codes, the services that was rendered, the 0 to 10, the pan the FXx wasn't paid or not under this claim?
[AGENT][NEUTRAL] OK, let me look really quick.
[AGENT][NEUTRAL] Yes, we did pay on that procedure code 0210.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How about for the 0150?
[AGENT][POSITIVE] Yes, we paid as well.
[CUSTOMER][NEUTRAL] How about for the 1110?
[AGENT][NEUTRAL] Uh yes, ma'am. We paid.
[CUSTOMER][NEUTRAL] I can have the reference number and we move on to the next one.
[AGENT][NEUTRAL] Yes, the reference number is my first name, which is [PII].
[AGENT][NEUTRAL] [PII] A [PII] E [PII]
[AGENT][NEUTRAL] Last initial [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] OK. OK, then whenever we're ready, we move on to the next one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then would you like help setting up our online account to check claim statuses?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] So our website is secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. So can you help me with one more patient?
[AGENT][POSITIVE] Yes, I can help you with one more patient.
[AGENT][NEUTRAL] Do you have the claim number?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Do you have the patient's first and last name?
[CUSTOMER][NEUTRAL] Yes. The patient's name here, that'll be [PII], [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You said [PII]. Do you mind spelling that for me?
[CUSTOMER][NEUTRAL] So should I provide the member ID number?
[AGENT][NEUTRAL] Ma'am, can you spell [PII]?
[CUSTOMER][NEUTRAL] Should I provide the
[CUSTOMER][NEUTRAL] Oh, yes, sir.
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Sorry, just one moment.
[AGENT][NEUTRAL] OK, and I'm not finding a [PII] in our system.
[CUSTOMER][NEUTRAL] Uh, [PII] Yes, you can find this patient.
[AGENT][NEUTRAL] Yes, [PII]
[CUSTOMER][NEUTRAL] OK. So you won't be able like to find the name and date of birth?
[CUSTOMER][NEUTRAL] OK, then. So if you're not able to find them, OK. And uh the member ID uh should I provide the member ID number or is it that?
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Yes, the member ID number would help a lot.
[CUSTOMER][NEUTRAL] You can find.
[CUSTOMER][NEUTRAL] I do have the member ID number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The member ID number for [PII] will be 02558868.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and then [PII]'s date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and are we checking claim status for her as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then do you have a data service?
[CUSTOMER][NEUTRAL] Yes, I do have here. The service would be on [PII] with the bill of $1,409.
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] OK, and as of right now there is no claim on file for data service [PII].
[CUSTOMER][NEUTRAL] No claim on 5 for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then so can I have the plan effective date.
[AGENT][NEUTRAL] Yes, the policy effective date is [PII].
[CUSTOMER][NEUTRAL] [PII]. Still active?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, policy is still active.
[CUSTOMER][NEUTRAL] Can I have the timely filing limit?
[AGENT][NEUTRAL] There is no filing limit.
[CUSTOMER][NEUTRAL] OK, then so can I have the room number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The group number is 700.
[AGENT][NEUTRAL] 55
[CUSTOMER][NEUTRAL] OK, 70055. And how about for the fee schedule?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, just one moment, OK? I'll find that for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sorry, can I put you on a brief hold really quick?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, thank you for holding. So I have that fee schedule pulled up. Would you like me to send it to you via fax?
[CUSTOMER][NEUTRAL] Uh, uh, can you just provide like which network that follows? That's the information I just need.
[CUSTOMER][NEUTRAL] By which network?
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Sorry, I'm checking now.
[AGENT][NEUTRAL] OK, so the network that they have is Carrington.
[CUSTOMER][NEUTRAL] OK. So, can I have the pay ID?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] The payer ID is 64.
[AGENT][NEUTRAL] 556.
[AGENT][NEUTRAL] Oh, sorry.
[CUSTOMER][NEUTRAL] And how can I have the mailing address?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Sorry, the payer ID is
[CUSTOMER][NEUTRAL] Yup.
[AGENT][NEUTRAL] Uh, just one moment.
[AGENT][NEUTRAL] The payer ID for APL.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] Mailing address?
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And for the
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. So you said [PII], right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. And we can build the claim with that ID number that you provided to me, right?
[AGENT][NEUTRAL] It's
[AGENT][POSITIVE] Yes, that is, that is correct.
[CUSTOMER][NEUTRAL] And the zip code you said is [PII]. OK, then for the same patient for this uh for [PII], is there any claim on file for data service [PII]?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And do you have a charge amount for that one?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the charge amount for this one, that will be.
[CUSTOMER][NEUTRAL] For [PII], it is $2,0072.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Do you have procedure codes you can provide?
[CUSTOMER][NEUTRAL] 4342.
[AGENT][NEUTRAL] Let's see, just a moment.
[AGENT][NEUTRAL] I am not seeing procedure code 4242 for this data service.
[CUSTOMER][NEUTRAL] No, 4342 and 4341.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, I am not seeing procedure code 4042 or 4041.
[CUSTOMER][NEUTRAL] No, no, no. 4342 4342.
[CUSTOMER][NEUTRAL] Can you hear me properly? 4342 and 4341.
[AGENT][NEUTRAL] Like 4041?
[CUSTOMER][NEUTRAL] No, 434343 TR.
[AGENT][NEUTRAL] 43, OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I got it. Thank you.
[AGENT][NEUTRAL] So it looks like for this policy, major services were denied as non-covered.
[CUSTOMER][NEUTRAL] So, 4342 and 4341 falls on the major.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Can I have the denial date?
[AGENT][NEUTRAL] OK, it looks like.
[AGENT][NEUTRAL] Do you want the service date?
[CUSTOMER][NEUTRAL] I want the denial date, the process date.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Sorry, my computer's thinking really quick.
[AGENT][NEUTRAL] OK, so it looks like.
[AGENT][NEUTRAL] It was [PII].
[CUSTOMER][NEUTRAL] OK. This was processed on [PII]. Can I, can I have the claim number?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, the claim number is 357.
[AGENT][NEUTRAL] 327 3.
[CUSTOMER][NEUTRAL] OK, so this uh claim was denied because this special costs was not, because this the cost was not covered.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] The one that I provided to you. You said that was denied which is not covered, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] So that means these specifics that I provided to you, it's not covered under this patient's plan.
[AGENT][NEUTRAL] It is not
[AGENT][NEUTRAL] No, because it falls under major services.
[CUSTOMER][NEGATIVE] So major services is not covered under this one.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Only preventive and basic.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] OK, then, so that's all then thank you so much for your time and your help. I really appreciate it. I hope you have a good day. Thank you so much.
[AGENT][NEUTRAL] Of course. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][NEUTRAL] OK, bye.