AccountId: 011433970860
ContactId: 90ad0917-1c42-4c87-afcb-fdd060761a9c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1500390 ms
Total Talk Time (AGENT): 596741 ms
Total Talk Time (CUSTOMER): 321335 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/90ad0917-1c42-4c87-afcb-fdd060761a9c_20250110T13:31_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good morning. This is [PII] calling from the provider's office to know the claim status. How are you doing today?
[AGENT][NEUTRAL] Well, I'm great. And what was your name again? I'm sorry, I didn't understand what you said.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] My name is [PII] and the will be [PII].
[AGENT][NEUTRAL] [PII] Is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII] is my name. [PII] is the last in.
[AGENT][NEUTRAL] Yes, uh-huh, OK, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And how many, uh, well, how can I help you today, [PII]?
[CUSTOMER][POSITIVE] Yeah, I have more claims. So you can help me with uh mm a claim status for every patient.
[AGENT][NEUTRAL] How many you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] And how many claims, [PII] do you have today?
[CUSTOMER][NEUTRAL] Mm, let me check, OK. Give me one moment, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh yeah. Uh, meanwhile, it is loading, OK? Uh, we won't waste time. OK, we will go with this claim and I'll let you know how many I have, OK?
[AGENT][NEUTRAL] Yeah, OK, I don't mind waiting for you to tell me how many you have.
[CUSTOMER][NEUTRAL] Yeah, yeah, I can understand.
[CUSTOMER][NEUTRAL] Are you ready?
[AGENT][NEUTRAL] Uh, yes. Did you determine how many claims you have?
[CUSTOMER][NEUTRAL] Yeah, just I'm checking. It's uh getting refreshed, OK. It is taking time to pull up here.
[AGENT][NEUTRAL] OK, go ahead. OK, so Romeo.
[CUSTOMER][NEUTRAL] Let me know when it comes, OK? Mhm.
[AGENT][NEUTRAL] OK, so any information that I provide for you today on any claim that I may check for you will be a verification of benefits and not a guarantee of payment. You will also use my name. Again, my name is [PII], and today's date as your call reference number for each.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And also Romeo, if you need a copy of an explanation of benefits, you may print that by going to our portal at secured.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the patient's policy number?
[CUSTOMER][NEUTRAL] 1432689 M for Mary, L for Lima,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is uh [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] Then why you
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] What is your date of service place and total bill amount?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And total charges bill amount is $72,205 even.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you said the data service. Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK, so this policy, Sam was not even active, there is no claim on file under the.
[CUSTOMER][NEUTRAL] Yeah, I'm there.
[CUSTOMER][NEUTRAL] Your voice is getting breaking between uh [PII].
[AGENT][NEUTRAL] This policy, this policy has an effective date of [PII].
[AGENT][NEUTRAL] Yes, sir. I, I'm sorry, and there's nothing I can do about it, [PII], unfortunately, I'm the um there's some severe weather where I'm located.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, I can understand that. Yup.
[AGENT][NEGATIVE] It's affecting my service.
[CUSTOMER][NEUTRAL] Mhm. OK, now it's proper. OK. What was you saying? Uh, go ahead.
[AGENT][NEUTRAL] There is no claim on file under this policy for this member. This policy was not active for the data service that you gave me.
[AGENT][NEUTRAL] This policy had actually terminated back on [PII]. Let me look under another policy for the member.
[AGENT][NEUTRAL] The correct policy number that you should have for this member.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] 02431041.
[CUSTOMER][NEUTRAL] 0243
[AGENT][NEUTRAL] And this policy has an effective date?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Could you tell me once again the policy date?
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] The policy number, I'm gonna start from the beginning again. 02431041.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just a.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Over.
[AGENT][NEUTRAL] OK, and give me the date of service again, uh Romeo and total bill amount.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm, yes, yes, I can see here.
[AGENT][NEUTRAL] [PII] and the total bill amount?
[CUSTOMER][NEUTRAL] $72,205 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] If you want, I have even the claim number with me. If you're not pulling up.
[AGENT][NEUTRAL] Oh, I thought you needed to claim status.
[CUSTOMER][NEUTRAL] Yes, general claim insurance if there is a denied, denied reason is a paid, paid reason.
[AGENT][NEUTRAL] OK. We do not have a claim on file for this number.
[AGENT][NEUTRAL] With APL for this bill amount, Romeo, for that data service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have the claim number with the same date of service.
[AGENT][NEUTRAL] OK, but that's
[CUSTOMER][NEUTRAL] And with the same bill amount?
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] 351-447-8.
[AGENT][NEUTRAL] OK, that is not for that data service.
[AGENT][NEUTRAL] So you have an and you have a claim number not matching the data service that you're providing for me.
[AGENT][NEUTRAL] You gave me a date of service of [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And that claim does not match that data service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So what is the correct date of service so that I can verify that that is the correct claim?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, give me one moment.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK, so the claim number you gave me has that as the date of.
[AGENT][NEUTRAL] Service.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that claim was, yes, that claim was initially denied in because we were in need of the primary insurance company's explanation of benefits. And give me one moment to look at another claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We did receive.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Another claim?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And give me one moment. Mhm.
[CUSTOMER][POSITIVE] Yes, take your time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for data service 816.
[AGENT][NEUTRAL] What is the actual bill amount for that data service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] $72,205 even.
[AGENT][NEUTRAL] OK, this claim was
[AGENT][NEGATIVE] Denied.
[CUSTOMER][NEUTRAL] OK. Can I know the reason claim received on?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Claim received on?
[AGENT][NEUTRAL] [PII], processing.
[CUSTOMER][NEUTRAL] Claim received
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] This claim was received and processed on the same date, [PII].
[CUSTOMER][NEUTRAL] Yeah, go.
[CUSTOMER][NEUTRAL] What was the date?
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] And denied on
[AGENT][NEUTRAL] The same day.
[AGENT][NEUTRAL] Actually, there was a partial, there was a benefit paid on this on this claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The benefit amount paid was $500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Single check.
[CUSTOMER][NEUTRAL] There was a
[CUSTOMER][NEUTRAL] Wait a minute.
[AGENT][NEUTRAL] 201.
[CUSTOMER][NEUTRAL] There was, this claim has been paid finally?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] There was a $500 benefit paid on this claim.
[CUSTOMER][NEUTRAL] OK, wait a moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, what is the allowed amount?
[AGENT][NEUTRAL] I will read you the remarks on this claim. This claim has an outpatient per calendar day maximum benefit of $500 and with that payment with this check, the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] OK. What is the allowed amount?
[AGENT][NEUTRAL] Romeo, I just gave you the maximum calendar, maximum benefit per calendar day on this plan. This is not a major medical insurance company.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So there's not an allowed per se amount. This policy has a maximum outpatient benefit maximum.
[AGENT][NEUTRAL] Of $500 per calendar day for covered outpatient services, that benefit was paid for the facility charge on [PII] for the [PII] data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then there is uh no other uh need to pay, right?
[AGENT][NEUTRAL] The other two claims, the other two remarks state the insured's major medical coverage provided full benefits. There are no benefits for payable for this procedure. That was for the procedure on [PII] and then on [PII]. It states benefits are payable only if your major medical insurance provider provides benefits.
[AGENT][NEUTRAL] If this claim is later paid by your major medical insurance, please send me an explanation of benefits showing the benefits were paid.
[CUSTOMER][NEUTRAL] OK, I can understand. Uh, if the patient is holding any other insurances?
[AGENT][NEUTRAL] This is a supplemental policy to your primary insurance.
[CUSTOMER][NEUTRAL] So the primary you'll be with, you have a primary will be with you?
[AGENT][NEGATIVE] The information we received does not show that the primary insurance company paid anything on that date of service.
[AGENT][NEUTRAL] For that specific amount.
[CUSTOMER][NEUTRAL] OK, to send the primary UB, what is the claim mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Could you please be slow, [PII]?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. And the state is [PII]. The zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Once again, uh, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry. Say that again.
[CUSTOMER][NEUTRAL] Can I, can you send me the zip code?
[AGENT][NEUTRAL] Again, the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And who is the primary?
[AGENT][NEUTRAL] You're asking me who her primary insurance is or his, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, yes, yes.
[AGENT][NEUTRAL] The only information I can provide you.
[AGENT][NEUTRAL] For this group shows Cigna.
[CUSTOMER][NEUTRAL] OK. And can I have the
[AGENT][NEUTRAL] You would have to contact the member to get.
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Primary member, uh, primary member ID?
[AGENT][NEUTRAL] Uh, no, you'll have to contact the primary insured if you don't have that information.
[CUSTOMER][NEUTRAL] OK, just allow me one moment, OK?
[AGENT][NEUTRAL] Uh-huh. I don't have that.
[CUSTOMER][NEUTRAL] Do you have any fax number?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Once again, 877365.
[AGENT][NEUTRAL] Attention plan.
[AGENT][NEUTRAL] Mhm. 942 3.
[AGENT][NEUTRAL] Attention claims.
[CUSTOMER][NEUTRAL] OK. I do have um what is the primary OB I'm faxing it to you.
[CUSTOMER][NEUTRAL] Just allow me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I will fax you this EOB so you can see the remarks for each of the lines on this one until you can get your portal set up at the [PII]. What is your fax number, [PII]?
[CUSTOMER][NEUTRAL] What are you faxing me?
[AGENT][NEUTRAL] The explanation of benefits that has the full remarks on it for this claim for this member?
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] OK. Uh, for the APL? You're asking about the APL?
[AGENT][NEUTRAL] I was offering to fax you the explanation of benefits from APL so that you can see what the remarks are for this member. I gave you the website to set up your profile.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To be able to have access to the for this yourself, but I will send you this one so that you can see the specific benefit, uh, excuse me, specific remarks.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Does it need to be put to your attention?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And again, your fax number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] 40
[CUSTOMER][NEUTRAL] 40361.
[CUSTOMER][NEUTRAL] How much time it takes to receive?
[AGENT][NEUTRAL] As long as it takes to transmit, I have just faxed it to you and I am working on making my note for this policy, and again, the policy number that I gave you 02431041 is the one that you will need for this data service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim number that I also gave you 3,541,480?
[CUSTOMER][NEUTRAL] No, you didn't give me the claim number.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Yes 351.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm. No. 354.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] 1480.
[CUSTOMER][POSITIVE] OK, 3541486. Mhm. Thank you.
[AGENT][NEUTRAL] You're welcome. So give me just a couple, I'm gonna need a couple of minutes to make all of my notes on this one before. Is this the only one that you have today?
[CUSTOMER][NEUTRAL] Yeah, yeah, I have only one, make it cash.
[AGENT][NEUTRAL] OK, so, OK, so give me just a moment to finish making my notes though.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] From [PII].
[CUSTOMER][NEUTRAL] To [PII].
[CUSTOMER][NEUTRAL] The total.
[CUSTOMER][NEUTRAL] I mean
[AGENT][POSITIVE] OK. So, um, that again has been sent to you, so you should be receiving that provided that you're able to receive it very soon. And is there anything else that I can help you with this morning, [PII]?
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Oh yeah, let me see, [PII], one minute, one minute.
[AGENT][NEGATIVE] Pardon me.
[CUSTOMER][NEUTRAL] Mhm. Sorry.
[AGENT][NEUTRAL] I'm sorry, I didn't understand what you said.
[CUSTOMER][NEUTRAL] Give me one moment to check up and have another one. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] How is the weather there?
[AGENT][POSITIVE] And it's uh, I just received a notification, Romeo, that the fax was successfully sent.
[CUSTOMER][NEUTRAL] OK, let me check.
[CUSTOMER][POSITIVE] It is upgraded on.
[AGENT][POSITIVE] And it may take a few more moments for it to actually, you know, be received, but it says it was a successfully sent.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so much, [PII].
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And again, is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] Uh, can I have the call reference number?
[AGENT][NEUTRAL] My name in today's date?
[CUSTOMER][NEUTRAL] Yeah, you have already said. Sorry.
[AGENT][NEUTRAL] That's OK. We've talked about a lot on our phone call today.
[CUSTOMER][NEUTRAL] Can I have the uh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] But can I have the member's effective date and time date?
[AGENT][NEUTRAL] Yes, the effective date on this policy is [PII] and it is active. There is no term date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You are certainly very welcome. And again, anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, at the moment, no, nothing much. Thank you so much.
[AGENT][POSITIVE] OK. Well then, thank you again, [PII] for calling APL and I hope you have a very nice weekend.
[CUSTOMER][NEUTRAL] Yeah, you too. Bye for now.
[AGENT][POSITIVE] All right, thank you. Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yes