AccountId: 011433970860
ContactId: 94949dab-6d34-49e8-aa19-aa5ab204743d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1834310 ms
Total Talk Time (AGENT): 416117 ms
Total Talk Time (CUSTOMER): 565496 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/94949dab-6d34-49e8-aa19-aa5ab204743d_20250116T18:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from provider office. And sir, this call may be recorded for quality and training purposes. Uh, I have a question on a claim, so could you please help me with that?
[AGENT][POSITIVE] I'm happy to check on a claim for you today, [PII]. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, the patient's policy number, it's 01618382 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] And may I have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it is uh
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you. Data service?
[CUSTOMER][NEUTRAL] Your data service it is uh.
[CUSTOMER][NEUTRAL] November 5, 20 September 5, 2024 with the bill amount of $500 even.
[AGENT][POSITIVE] OK, thank you for that.
[AGENT][NEUTRAL] Claim was received on [PII]. Claim was denied. We requested an explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Uh, yeah, actually we faxed this primary will be on um [PII].
[AGENT][NEUTRAL] I'm not showing anything unfortunately on file, [PII], you can resend it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Can you provide me the proper fax number?
[AGENT][NEUTRAL] The fax number should be [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK and um.
[CUSTOMER][NEUTRAL] Yeah, the claim number which is which I have it's uh 351-5204, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] 351-5204. OK. Uh, sir, can you please, uh, you have a few more claims. Can you help me with them also, please?
[AGENT][NEUTRAL] Yeah, same patient or different?
[CUSTOMER][NEUTRAL] Different patients.
[AGENT][NEUTRAL] All right, thank you. One moment, let me just notate this account and then we can check the next one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And while sending the uh the appeal like uh for the primary be what will be the attention for the fax?
[AGENT][NEUTRAL] It's just attention to claims.
[CUSTOMER][NEUTRAL] Claims, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Hey [PII], what's the next policy number?
[CUSTOMER][NEUTRAL] Yeah, the next policy number it is um 47784 sorry sorry it's 02455016 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] Name of the patient and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name it's uh [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that. And then what is the date of service?
[CUSTOMER][NEUTRAL] Yeah, here the date of service it is uh.
[CUSTOMER][NEUTRAL] [PII] with the bill amount of $500 even.
[AGENT][NEUTRAL] Do you have an amount after the primary?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Do you have an amount after the primary?
[CUSTOMER][NEUTRAL] Yeah it is uh 255.53.
[AGENT][NEUTRAL] So, it looks like we did receive this claim on [PII].
[AGENT][NEUTRAL] A benefit payment was sent in the amount of $255.53.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This was processed on [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And uh for the payment details?
[AGENT][NEUTRAL] It's a single check.
[AGENT][NEUTRAL] Check number 2019423.
[CUSTOMER][NEUTRAL] OK. And check date?
[AGENT][POSITIVE] This was issued [PII]. Check still shows outstanding.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] 3543752.
[CUSTOMER][NEUTRAL] 52
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Shall we move for the next uh patient.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK. Let's see uh next policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So the next policy number it is 02337101 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Thank you for that. Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name it is uh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Days, it's spelled [PII] and the date of birth it is [PII].
[AGENT][NEUTRAL] Uh, data service.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] With the bill amount of uh.
[CUSTOMER][NEUTRAL] $500 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This claim, it looks like was received on [PII], was denied [PII] for a request of the EOB from the primary.
[CUSTOMER][NEUTRAL] Yeah, and we fax this primary will be on uh [PII].
[AGENT][NEGATIVE] I don't show any EOB on file. It would need to be resent.
[CUSTOMER][NEUTRAL] OK, I just want to reconfirm the claim number. It is uh 3469371, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you so much. Uh, let's move for the next one whenever you're ready.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Alright, what's the next policy number?
[CUSTOMER][NEUTRAL] That is uh
[CUSTOMER][NEUTRAL] Um, 02464248 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name, it is um
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] on date of birth is [PII].
[AGENT][NEUTRAL] Data service
[CUSTOMER][NEUTRAL] It is August, sorry.
[CUSTOMER][NEUTRAL] The first date of service for this member it is [PII] with a bill amount of $90 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] This claim is received [PII]. Claim was denied [PII], requesting EOB for the primary insurance.
[CUSTOMER][NEUTRAL] Can you help me with the claim number for this?
[AGENT][NEUTRAL] 354-3556
[CUSTOMER][NEUTRAL] 354-355-6 right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and this is also for the primary OB. Let me check actually this one also and uh there's one more date of service that is for [PII] with the bill amount of uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $850 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Do you have an amount after the primary?
[CUSTOMER][NEUTRAL] Yeah, it is $150.
[AGENT][NEUTRAL] 150. 1 moment.
[AGENT][NEUTRAL] So it looks like we received this claim on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $150. This was processed [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Uh, payment details?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Single check, check number is 2017408 issued [PII].
[CUSTOMER][NEUTRAL] Just want to reconfirm [PII], right? Is this the check number?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] It's going to be 353-866-0.
[CUSTOMER][NEUTRAL] 353-866-60
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, got it, um.
[CUSTOMER][POSITIVE] Let's move for the next one.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Patient, next patient.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the next policy number?
[CUSTOMER][NEUTRAL] The policy number is 02337081 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name it's uh [PII]. Date of birth is uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that data service.
[CUSTOMER][NEUTRAL] Yeah, the date of service it is uh.
[CUSTOMER][NEUTRAL] [PII] with the bill amount of $375 even.
[AGENT][NEUTRAL] Alright, so it looks like we did receive this claim [PII]. Claim was denied or requesting primary EOB. Claim was processed [PII].
[CUSTOMER][NEUTRAL] The claim number.
[AGENT][NEUTRAL] It's going to be 354-3650.
[CUSTOMER][NEUTRAL] 354-3650, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let me provide you the next.
[CUSTOMER][NEUTRAL] Patient.
[CUSTOMER][NEUTRAL] Let me know when you're ready for the next member ID.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It's 01167962.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] any.
[CUSTOMER][NEUTRAL] True like you. Date of birth is [PII].
[AGENT][POSITIVE] Thank you. And date of service?
[CUSTOMER][NEUTRAL] [PII] bill amount is $375 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] This claim is received [PII].
[AGENT][NEGATIVE] Claim was denied. Policy provides no benefit for the treatment of conditions other than sickness or injury. Claim was denied [PII].
[CUSTOMER][NEUTRAL] So like what is the meaning of that? Can you please help me with this?
[AGENT][NEUTRAL] The policy does not provide any sort of treatment for the condition that the patient was seen for.
[CUSTOMER][NEUTRAL] So it means like uh seeing for like this CPT like this services is not covered under patients plan?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK and uh what you said the statement like I just want to note down that information please.
[AGENT][NEUTRAL] The denial reason?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Policy provides.
[AGENT][NEGATIVE] No benefit
[AGENT][NEUTRAL] For treatment.
[AGENT][NEUTRAL] Of conditions.
[AGENT][NEUTRAL] Other than sickness or injury.
[CUSTOMER][NEUTRAL] Other than
[AGENT][NEGATIVE] Sickness.
[AGENT][NEUTRAL] Or injury.
[CUSTOMER][NEGATIVE] Sickness.
[CUSTOMER][NEUTRAL] Sickness or injury.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. And this CPD is not covered under member benefit plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and it's up to patient responsibility, so this one.
[AGENT][NEUTRAL] We're not able to advise on patient responsibility, that would be up to the facility provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Can you help me with the claim number?
[AGENT][NEUTRAL] That would be 354-7334.
[CUSTOMER][NEUTRAL] All right, just a minute.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So the next member ID it's 02337162.
[AGENT][NEUTRAL] 0233.
[CUSTOMER][NEUTRAL] 02337162
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] May I have the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. Date of birth it's uh [PII].
[AGENT][NEUTRAL] And data service?
[CUSTOMER][NEUTRAL] It is [PII] with a bill amount of $450 even.
[CUSTOMER][NEUTRAL] Just
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEUTRAL] Looks like the claim was denied [PII] requesting the primary EOB.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And we faxed this on [PII]. Did you receive that one?
[AGENT][NEUTRAL] I don't show anything on file.
[CUSTOMER][NEUTRAL] Can you please, I just want to reconfirm the claim number it's 3443572. Is that right?
[AGENT][POSITIVE] Mhm. That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let me give you the next one.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Next policy number when you're ready.
[CUSTOMER][NEUTRAL] Yeah, it is 02460301, M as in Mike.
[CUSTOMER][NEUTRAL] L as in Lima, 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Da service it is uh.
[CUSTOMER][NEUTRAL] [PII] bill amount is $500 even.
[AGENT][NEUTRAL] This claim is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Received it looks like [PII].
[AGENT][NEUTRAL] Process [PII] denied for the primary EOB.
[CUSTOMER][NEUTRAL] And we faxed it on [PII]. Did you receive that one?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, just want to confirm the claim number is 3443438, right?
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me give you the next one, just a minute.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Go ahead with the policy number when you're ready.
[CUSTOMER][NEUTRAL] Yeah, the policy number is 021.
[CUSTOMER][NEUTRAL] 00356.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII]
[CUSTOMER][NEUTRAL] Perd date of birth it's uh [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Yeah, here the date of service it is uh [PII] build amount it's $150 build amount is $500 even.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Claim is received on [PII].
[AGENT][NEUTRAL] Claim was denied on [PII], requesting the primary EOB.
[CUSTOMER][NEUTRAL] And uh did you receive that one because we submitted on um [PII] we faxed it.
[AGENT][NEGATIVE] Not showing anything on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim number is 3422234, right?
[AGENT][NEUTRAL] 342-235-9
[CUSTOMER][NEUTRAL] I just, sorry, can you repeat one more time?
[AGENT][NEUTRAL] 342.
[AGENT][NEUTRAL] 2359.
[CUSTOMER][NEUTRAL] OK, 342-235-9.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a minute.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me give you the next one, just a minute.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Just a minute. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, the next member ID it is 01841211 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] Sorry, [PII], I need you to repeat that one more time.
[CUSTOMER][NEUTRAL] Yeah, sure, no problem. It is 01841211, M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name it's uh [PII], date of birth it's uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service?
[CUSTOMER][NEUTRAL] Yeah, it is uh [PII] build amount $500 even.
[AGENT][NEUTRAL] Claim is received on [PII].
[AGENT][NEUTRAL] Claim was denied on [PII], requesting the primary EOB.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, actually, in this one we faxed it on [PII]. Did you receive that fax?
[AGENT][NEUTRAL] I'm not showing anything on file.
[CUSTOMER][NEUTRAL] Can you give me the claim number?
[AGENT][NEUTRAL] Claim number is 352-3380.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Uh, no, you'll be.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And here we go, here we go, the last one, just a minute.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, 95.
[CUSTOMER][NEUTRAL] Yeah, so the next member ID it is um 018.
[CUSTOMER][NEUTRAL] 26,170 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name, it is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Yeah, data service it is uh.
[CUSTOMER][NEUTRAL] [PII] with the amount of $3500 even.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Claim was received on [PII]. Claim was denied [PII].
[AGENT][NEUTRAL] Denial was requesting primary EOB. I'm not showing anything on file for that.
[CUSTOMER][NEUTRAL] And claim number?
[AGENT][NEUTRAL] 351-5509.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And for the call reference number I should use your name [PII] and today's date, right?
[AGENT][POSITIVE] Yes, that is correct, [PII].
[CUSTOMER][NEUTRAL] Uh, I just want to reconfirm the fax number 11 more time. It is uh 877.
[CUSTOMER][NEUTRAL] 3659423 right and the attention claims.
[AGENT][POSITIVE] Correct, yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] All right, got it. Thank you, sir. Have a great day, stay safe and bye for now.
[AGENT][NEUTRAL] You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.