AccountId: 011433970860
ContactId: 8aed8899-a912-4d36-a6ce-8aa129b217f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 578119 ms
Total Talk Time (AGENT): 176404 ms
Total Talk Time (CUSTOMER): 150288 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/8aed8899-a912-4d36-a6ce-8aa129b217f7_20250210T15:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is calling from Platinum Dermatology.
[AGENT][POSITIVE] Hi, [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Uh, I just need a member claim status today.
[AGENT][NEUTRAL] OK, you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Yes, I can help you with that, [PII], and what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, before that, I would like to inform you that this call is recorded for the quality and training purposes. Would you like to continue recording?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] That is fine.
[CUSTOMER][POSITIVE] Thank you so much. The member ID would be 60801.
[AGENT][NEUTRAL] OK, that is our electronic payer ID that is not the correct number.
[CUSTOMER][NEUTRAL] 01 2nd, one second. I'm sorry for that.
[AGENT][NEUTRAL] Um, that's OK.
[CUSTOMER][NEUTRAL] Yeah, start with 023.
[CUSTOMER][NEUTRAL] 15555.
[CUSTOMER][NEUTRAL] M [PII].
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK, so again, you said it's 0231 and then 45, is that correct?
[CUSTOMER][NEUTRAL] Yeah, 10231.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm yeah yeah.
[AGENT][NEUTRAL] OK, and any information that I provide for you today, [PII] 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] Yep.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, the patient, uh first name would be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the last name would be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the date of birth [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for her place.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $175 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] The received date was [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3,543,340.
[AGENT][NEUTRAL] And the reason for the denial, [PII], is that we need her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. Uh, and may I have the, may I, can I confirm the PO box address for this? Payer?
[AGENT][NEUTRAL] You can go ahead. Mhm.
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. [PII]. Is that right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. So, uh, as per checking here, we have already sent the primary you'll be on [PII].
[AGENT][NEGATIVE] We have not received, yes, so we have not received that.
[CUSTOMER][NEUTRAL] To the same address.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits for the claim number I gave you, you can print that from our portal at [PII].
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] OK, OK, uh, I logged into that, but, uh, that is asking for a claim number, sorry, it is asking for a SSN number, and we don't know.
[AGENT][NEUTRAL] Yes, sir, I gave you. Mhm. Yes, sir, but I gave, try and access it with the claim number. I gave you the, yeah, use the claim number that I gave you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] One second, let me pull up that one.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 882898289.
[CUSTOMER][NEUTRAL] Such
[CUSTOMER][NEUTRAL] OK, we got that information.
[AGENT][POSITIVE] Perfect, you were able to pull it up?
[CUSTOMER][NEGATIVE] Yeah, so the actual problem is, uh, here we have uh 70 to 80 claims, which is, uh, no response.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] The long. So if I need to check that one, I need a claim number, right?
[AGENT][NEUTRAL] If you don't have the other information that is required in order to check your data service.
[AGENT][NEUTRAL] And if we don't have a claim on.
[CUSTOMER][NEUTRAL] Yeah, but uh
[CUSTOMER][NEUTRAL] Mm, yeah, go on.
[AGENT][NEUTRAL] No, I was just gonna say and if we do have not received the claim obviously you would not be able to locate any information in the portal.
[CUSTOMER][NEUTRAL] OK, so we need to send a primary OB again.
[AGENT][NEUTRAL] Uh, for this claim, yes, so we never received that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So is there any other option uh so that we can uh find the Ubis?
[CUSTOMER][NEUTRAL] Or it is, it is the only option?
[AGENT][NEUTRAL] What do you mean? Are you talking about printing it or are you talking about submitting the primary insurance company's explanation of benefits to us?
[CUSTOMER][NEUTRAL] No, primary, uh, sorry, printing it.
[AGENT][NEUTRAL] Sending it, it may also be faxed our secured fax line at [PII].
[AGENT][NEUTRAL] And you would need to put attention claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is there any option to send up as a bulk?
[AGENT][NEGATIVE] Uh, no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got that. And your good name, please?
[AGENT][NEUTRAL] Again, my name is [PII], as I explained to you initially, [PII], you would use my name in today's date as your call reference number.
[CUSTOMER][POSITIVE] Sure, thank you, [PII].
[AGENT][POSITIVE] You are very welcome. And is there any, yes, you too. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Have a nice day.
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. Well, thank you again for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Uh, you're welcome bye bye.