AccountId: 011433970860
ContactId: 9233459f-6023-4c5f-9df8-90b655e611fe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 754419 ms
Total Talk Time (AGENT): 126690 ms
Total Talk Time (CUSTOMER): 380395 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/9233459f-6023-4c5f-9df8-90b655e611fe_20250626T12:35_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is uh [PII]'s office. Yeah, I'm just looking for a claim status. Uh, could you please help me for me?
[AGENT][NEUTRAL] Happy to check on a claim, [PII]. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Let me go into that.
[CUSTOMER][NEUTRAL] Yeah, sure, um, yes.
[CUSTOMER][NEUTRAL] Yeah, the policy ID number, it's um
[CUSTOMER][NEUTRAL] One second, let me go ahead to put that. It's um
[CUSTOMER][NEUTRAL] 022 039 27 M as in Mike. L as in Lima, 8.
[AGENT][NEUTRAL] Thank you. And for documentation, do you have a good callback number, please?
[CUSTOMER][NEUTRAL] Yeah, sure. One second. Yeah, I'm just going to provide that information to you. OK. Mm.
[CUSTOMER][NEUTRAL] Yeah, the callback number, it's uh
[CUSTOMER][NEUTRAL] Let me go into to provide that. The callback number is 4452760343.
[AGENT][NEUTRAL] Thank you. And patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Uh, yes, the patient's first name, it's uh
[CUSTOMER][NEUTRAL] Uh, the patient's first name is [PII] and last name it's uh [PII] uh. And date of birth it's [PII].
[AGENT][NEUTRAL] A to service.
[AGENT][NEUTRAL] Do you have a data service?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Uh, yeah, date of service, it's uh it's [PII].
[AGENT][NEUTRAL] Fill them out.
[CUSTOMER][NEUTRAL] Sure, let me go into that. One second.
[CUSTOMER][NEUTRAL] Yeah, sure. The bill amount is um
[CUSTOMER][NEUTRAL] It's $164.87.
[AGENT][NEUTRAL] Do you have a different amount after the primary you paid left over?
[CUSTOMER][NEUTRAL] You have a different
[CUSTOMER][NEUTRAL] Um, no, actually, uh, for this claim, I can see here, OK, uh, as upon checking this claim, um,
[CUSTOMER][NEUTRAL] Let me clear that one thing about that one second. Uh, I do have the claim numbers also here. Uh, the claim has been denied. OK. Mm, let me go to clear that. Yes, it is like an uh remaining amount showing that $1,648 OK? Let me going to clear that. One second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] As per checking up on my side, I can see the bill amount is 100 it's like $164.87. It is like an uh someone that is allowed and denied. OK. So I, it has been denied for uh the maximum benefit of existence. In this case, I can see, uh, it is like we can, we will send the letter to the patient of COV update who is the primary insurance.
[CUSTOMER][NEUTRAL] So, have you received any COP update from patient?
[AGENT][NEUTRAL] Is the bill out $1,064?
[CUSTOMER][NEUTRAL] Is it
[AGENT][NEUTRAL] 1064.
[CUSTOMER][NEUTRAL] Oh no, the total bill.
[CUSTOMER][NEUTRAL] Yes, uh, the, the total bill amount is $81,885.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK, so the only claim we have on file for that date of service is for $1,064.87.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And that was denied requesting the EOB from the primary.
[CUSTOMER][NEUTRAL] Yeah, uh, so that case, have you, or, uh, that this case, we will previously, I can check that, uh, missing your primary will be, uh, may I know who is the primary insurance and uh we will send the letter to the patient as well, right now at uh on [PII]. Have you received any COB update from patient?
[CUSTOMER][NEUTRAL] Before that, may I know your good name?
[AGENT][NEUTRAL] No, we have
[AGENT][NEUTRAL] No, we, no, we have not. And my name is [PII]. It[PII] [PII] H. We don't have the member's primary insurance. You would have to contact them.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, Mr. [PII].
[CUSTOMER][NEUTRAL] OK, is this the patient have updated any COB recently?
[AGENT][NEGATIVE] No, there's no coordination of benefits, no.
[CUSTOMER][NEUTRAL] It does this.
[CUSTOMER][NEUTRAL] Uh, COB, may, may I know the last to see when was the last COB was updated?
[AGENT][NEGATIVE] There is no coordination of benefits.
[CUSTOMER][NEUTRAL] No, no, what my, my question is, uh, is this the patient has previously, uh, update the COP, right? There is no, never COP submitted, right?
[AGENT][NEUTRAL] Right, because there is no coordination of benefits.
[CUSTOMER][NEUTRAL] One second, let me talk about this.
[CUSTOMER][NEUTRAL] And you may also know, don't know who is the primary insurance, right?
[AGENT][NEUTRAL] Correct, we don't have that information.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] OK, thank you so much. And uh yeah. Actually, I do have uh the, the, the, the same scenario. I do have additionally 3 claims. Could you please help me for me?
[AGENT][NEUTRAL] Are they all the same patient?
[CUSTOMER][NEUTRAL] No, no, it is for different patient, different patient and different and product.
[CUSTOMER][NEUTRAL] May I have the call reference number for this one?
[AGENT][NEUTRAL] That's my name with today's date.
[CUSTOMER][NEUTRAL] Uh, it's like your name and today's date, right? Uh, one second. It's [PII], right? It's [PII] H. What is your last initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII], right?
[AGENT][NEUTRAL] [PII] [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Today's date. Uh, yeah, yeah, thank you so much for, uh, just giving me that information. OK, shall we move on with another claim?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] I'm going to put it that.
[CUSTOMER][NEUTRAL] Yeah, the next claim, uh, just, uh, for that, uh.
[CUSTOMER][NEUTRAL] Let me go into provide the information to you right now.
[CUSTOMER][NEUTRAL] OK. Let me go to provide the information for this one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, you have the member's ID so let me go to put that. It's um,
[CUSTOMER][NEUTRAL] It's 72942083.
[AGENT][NEUTRAL] It doesn't come up as a valid policy number. Do you have their name or social or claim number?
[CUSTOMER][NEUTRAL] Yeah, yeah, I do have the social, yes, I do have the name and uh yeah, the name is uh [PII]. OK. And birth date it's like [PII], and I do have the claim number here.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] Uh, the claim number is A as in Alpha, Q as in Quebec U as in Uniform 000193420004.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Spell the patient's last name.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The patient's last name, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The last the I just, you're just asking for last name, right? The first name I'm just going to say it's it's, it's [PII] and last name is [PII], it's like [PII].
[AGENT][NEUTRAL] Yeah, I
[AGENT][NEUTRAL] OK, and then spell the first name, please.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, we are on the same page right now.
[AGENT][NEUTRAL] I need the first name, please, so I can find the patient's policy. Spell the first name?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm, yeah, sure. Do you want the first name? One second. Yeah, uh, it's the first name. It's, uh, it's [PII].
[AGENT][NEUTRAL] I need you to spell it, please. I can't, I can't understand what I need you to spell it.
[CUSTOMER][NEUTRAL] Uh, OK. Do you want to spell it right? One second. I just select it fully, right. It's first name, it's uh it's [PII]. It's [PII]. This is the first name and last name it's uh it's, it's about [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII]. It's it's [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] Don't even
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, nothing came up under that name. Do you have their social? Do you want me to try that?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mm, no, one second. All right.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] You will like it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, one minute. Let me go to check one second.
[CUSTOMER][NEUTRAL] Oh man you know.
[CUSTOMER][NEUTRAL] Yeah, the last name it's uh [PII], OK, and first name it's [PII].
[CUSTOMER][NEUTRAL] It's uh it is like an, um, it, it is a, I think it is a patient, the guarantor name, it's [PII].
[CUSTOMER][NEUTRAL] To get in that name.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Nothing's coming up under that name, so I'm not able to find a patient plan.
[CUSTOMER][NEUTRAL] So this member ID is handed from your side?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The ID that you gave me doesn't come up as a valid member ID, so I'm not able to find a patient policy.
[CUSTOMER][NEUTRAL] Have you pull up the uh have you pulled up that uh member ID first to you?
[AGENT][NEGATIVE] The member ID doesn't come up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sure. Sure, thank you so much. Yeah. Have a good day. Thank you.
[AGENT][NEUTRAL] You too. Bye bye.