AccountId: 011433970860
ContactId: 938de54c-a16d-4ec3-ab65-8392ff59a641
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1601719 ms
Total Talk Time (AGENT): 240936 ms
Total Talk Time (CUSTOMER): 463686 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/938de54c-a16d-4ec3-ab65-8392ff59a641_20250506T18:54_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] calling for the copy of EOB. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] I need a telephone number in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] It's [PII]. It's a direct line.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] The policy number will be 01673475.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Hold on one moment please.
[AGENT][NEUTRAL] And the patient's name?
[CUSTOMER][NEUTRAL] The patient, the patient's first name is [PII] and the last name is [PII], and the date of birth will be [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you are needing claim status?
[CUSTOMER][NEUTRAL] I need the just a copy of you.
[AGENT][NEUTRAL] OK, I can help you with that. What date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And what is one of the procedure codes on that bill?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is one of the procedure codes on that bill?
[CUSTOMER][NEUTRAL] One of the procedure codes.
[CUSTOMER][NEUTRAL] 75 97,530.
[AGENT][NEUTRAL] OK, and you wanted one, it'll be faxed to you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, yeah, the claim has been paid. Am I right?
[AGENT][NEUTRAL] What's your
[AGENT][NEGATIVE] It was denied.
[CUSTOMER][NEUTRAL] Do you want the uh
[AGENT][NEUTRAL] It went to the deductible?
[CUSTOMER][NEUTRAL] Yeah, it's processed towards the deductable. The claim number is 356-580-9.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] I want the copy, copy of UOB.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] [PII] in attention to the patient's account number.
[AGENT][NEUTRAL] Attention to what now?
[CUSTOMER][NEUTRAL] Patient's account number.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, I'll fax that to you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And you know how much time we will receive the copy of UOB?
[AGENT][NEUTRAL] Within the next 10 to 15 minutes.
[CUSTOMER][NEUTRAL] OK, bear with me just a moment.
[CUSTOMER][NEUTRAL] And shall we move to the next claim? Can you please help me with a few more claims I have on file?
[AGENT][NEUTRAL] I can only help you with 3.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, uh, is it on a, is it a whole different policy or is it the same one?
[CUSTOMER][NEUTRAL] So I will move to the next one.
[CUSTOMER][NEGATIVE] I didn't get it.
[AGENT][NEUTRAL] Is it on a different policy or is it on the same policy?
[CUSTOMER][NEUTRAL] It's for the different member.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and you don't mind me if I give you those details.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You don't
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] You can take me from
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And it's.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The one from the provided.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Are you there? Hello?
[AGENT][NEUTRAL] I'm trying to fax you this thing on the first claim that you gave me hold on one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And what would be the call reference number for our conversation?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hold on just a moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] See
[AGENT][POSITIVE] OK, I'm ready for the next one.
[CUSTOMER][NEUTRAL] Uh, yeah, [PII], bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yeah, the next member ID will be 01838979.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I am
[AGENT][NEUTRAL] And the patient's name.
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] It sad
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Procedure code.
[CUSTOMER][NEUTRAL] Uh, procedure code will be.
[CUSTOMER][NEUTRAL] 99284.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, that claim was denied.
[AGENT][NEUTRAL] They had met their um maximum for that day.
[CUSTOMER][NEUTRAL] And I'm looking for the apple status.
[AGENT][NEUTRAL] [PII] for that day.
[CUSTOMER][NEUTRAL] Uh, [PII], I'm looking for an appeal status, not for the claim status.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] That was 55 2024.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] That was 55 of 2024.
[CUSTOMER][NEUTRAL] Yeah, 55 of 2024.
[AGENT][NEUTRAL] What's the total charge for that bill?
[CUSTOMER][NEUTRAL] $1,0008.
[AGENT][NEUTRAL] $1,008.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] I'm not seeing an appeal. I see where we denied a claim for the duplicate, but I don't see where an appeal letter was sent in.
[CUSTOMER][NEUTRAL] OK. Uh, I can help you with the, the, the date when we have sent an appeal, that we have sent an appeal on [PII].
[AGENT][NEUTRAL] I'm not showing an appeal on that particular claim.
[CUSTOMER][NEUTRAL] OK, bear with me just a moment.
[AGENT][NEGATIVE] We received the claim again on [PII], but it was done as a duplicate. It was not an appeal.
[CUSTOMER][NEUTRAL] OK, so the appeal is not on file?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So, OK, bear with me just a moment.
[AGENT][NEGATIVE] I only see it was sent in twice and it was denied the first time for [PII]. The second time it was denied as a duplicate.
[CUSTOMER][NEUTRAL] OK, so what will be the original claim timely filing limit?
[AGENT][NEGATIVE] We do not have timely filing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Or what, what will be the corrected claims timely filing limit?
[AGENT][NEGATIVE] We do not have timely filing.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, for this one also, what will the mailing address to the corrected claim?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And could you please tell me the appeals mailing address?
[AGENT][NEUTRAL] That is it.
[CUSTOMER][NEUTRAL] OK, and what will the appeals uh timely filing limit?
[AGENT][NEGATIVE] We do not have timely filing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please tell me, is that you will be required while submitting an IP?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, it's not.
[CUSTOMER][NEUTRAL] Is there any specific attention to the appeals?
[AGENT][NEUTRAL] It will have to say this is an appeal or something like that or it will be done as a duplicate. It has to have an appeal letter or say appeal on it or something like that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And is there any specific form for an app?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And could you please help me with the call reference number?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name and today's date.
[CUSTOMER][NEUTRAL] That's what I
[CUSTOMER][NEUTRAL] OK, perfect. Shall we move to the next claim then?
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Did you
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] No one was.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] If it's that big.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, I
[AGENT][POSITIVE] Ready for the last one.
[CUSTOMER][NEUTRAL] Yeah, it is
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEGATIVE] My system got stuck. Give me a minute.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I don't know if that was
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Yeah, the next member ID is 1266.
[CUSTOMER][NEUTRAL] 272.
[AGENT][NEUTRAL] And the patient's name?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the data service.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] primary activation is one that activation.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the procedure code?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 93,010.
[AGENT][NEUTRAL] 93,010.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the total charge for that bill?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] $1,926 even.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 1000
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Can you repeat that, please?
[CUSTOMER][NEUTRAL] $1,926 even.
[CUSTOMER][NEUTRAL] Do you have any claim on file?
[AGENT][NEUTRAL] I'm looking, hold on one moment.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] I have that procedure code, but it's not the charge that you gave me.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. Do you have the claim on file for $1870?
[AGENT][NEUTRAL] You said it was 1920s. What's the.
[AGENT][NEUTRAL] Charge amount.
[AGENT][NEUTRAL] For the claim you're looking for.
[CUSTOMER][NEUTRAL] Yeah, that's what I said. $189,070. Do you have, I do have another bill amount, so that's why I'm giving you the second bill amount, $1870.
[AGENT][NEUTRAL] $1870.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For the same procedure code?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] No, I, I do not have either claim for that charge amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the, and let me give you the correct policy number because the policy number you gave me was canceled.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It's 01
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] 83
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 8977.
[CUSTOMER][NEUTRAL] OK, and is the patient active on the radar service?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Could you please tell me the effective date and the term date?
[AGENT][NEUTRAL] The effective date is [PII].
[AGENT][NEUTRAL] It is still active.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Are you primary or secondary?
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] What will, uh, so there will be no claim submission, no timely filing.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And claims will be go to the same address, PO box.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and oh the ice.
[CUSTOMER][NEUTRAL] Give me a moment. I lost it.
[CUSTOMER][NEUTRAL] OK, I got it back.
[CUSTOMER][NEUTRAL] And could you please help me with your pay ID?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please help me with the preferred mode of submission?
[AGENT][NEUTRAL] The what now?
[CUSTOMER][NEUTRAL] Prefer mode of submission, whether we should have submit the claim via mail or via electronic or both.
[AGENT][NEUTRAL] Either way
[AGENT][NEUTRAL] However you want to send it.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] OK, thanks for your assistance, [PII], and your name and today it will be the call reference number.
[AGENT][NEUTRAL] Reference, right.
[CUSTOMER][POSITIVE] Thanks for your assistance.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good afternoon.