AccountId: 011433970860
ContactId: 9594ce33-c0c8-4513-b31d-2358a769bfdd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 957250 ms
Total Talk Time (AGENT): 267538 ms
Total Talk Time (CUSTOMER): 364679 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/9594ce33-c0c8-4513-b31d-2358a769bfdd_20250207T20:25_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] calling from the provider office to have specific questions about the claim status and this call is being recorded for quality and training purpose. May I know your name?
[AGENT][NEUTRAL] Sure, it's [PII], last initial [PII] and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, it is [PII] and last name, [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] OK. So the policy number I have is 10,826,170 ML8.
[AGENT][NEUTRAL] OK, one moment. Looks like you have too many numbers in that. Um, do you have a copy of the card?
[CUSTOMER][NEUTRAL] OK, so I have number is 0182.
[CUSTOMER][NEUTRAL] 6170 ML 8.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Uh, verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. And you say you're calling for claim status, correct?
[CUSTOMER][POSITIVE] Yes, exactly.
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] OK. So the date of service we have here is [PII]. The total bill amount we have is $286.
[AGENT][NEUTRAL] OK, thank you. And I forgot to ask, do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes. So the callback number we have is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, and the name of the provider's office?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Mediath and the vital MD Group Holding.
[AGENT][NEUTRAL] OK, I'm sure that claim uh process is needing the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] OK. So claim is denied, right?
[AGENT][NEUTRAL] Correct, we're needing the primary EOB.
[CUSTOMER][NEUTRAL] OK. uh, can you help me with the details, uh, when you received the claim?
[AGENT][NEUTRAL] Uh, one moment.
[AGENT][POSITIVE] Perfect
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And you guys needed a primary UV via uh with uh the claim form or something else?
[AGENT][NEUTRAL] Well, you can resubmit the claim, but we still do need the primary EOB. Give me one moment. I'm looking for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I show the claim was received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 24 processes on [PII].
[AGENT][NEUTRAL] Where
[AGENT][NEUTRAL] [PII]. So receive [PII], process on [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK. And the claim number?
[AGENT][NEUTRAL] 353-594-6.
[CUSTOMER][NEUTRAL] 253-594-6, right?
[AGENT][NEUTRAL] Correct, 353-594-6.
[CUSTOMER][NEUTRAL] OK. And the fax number where we can submit the UV?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, can you help me with the 2nd claim I have?
[AGENT][NEUTRAL] Is it for the same patient or different patient?
[CUSTOMER][NEUTRAL] Different patient.
[AGENT][NEUTRAL] OK, give me one moment, please.
[CUSTOMER][NEUTRAL] Take your time, dear.
[AGENT][NEUTRAL] OK, and what's the next policy number, please?
[CUSTOMER][NEUTRAL] Uh, so the next policy number we have here is 02145415ML8.
[AGENT][NEUTRAL] And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's name, uh first name is ID is [PII] and the last name is [PII] and the date of birth is uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] OK. So the date of service is [PII], with total bill amount of $572.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And it's the same provider?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm sure that claim also processed as needing primary EOB.
[CUSTOMER][NEUTRAL] Similar as previous, right?
[AGENT][NEUTRAL] Correct. Uh, this claim received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, I need a claim number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 351-670-07.
[CUSTOMER][NEUTRAL] 351-67007, OK?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And is there anything else, Ms. [PII], I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, I have 2 more claims to check. Uh, just these things only that what is the status. And in some cases we already have sent you the UB. I just want to confirm if you guys have received or not.
[AGENT][NEUTRAL] OK. Give me one moment. And this is for different patients, correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, and what is the next policy number?
[CUSTOMER][NEUTRAL] It is 02464674 ML 7.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] So the patient's name is [PII] and the last name is [PII] and the date of service is [PII].
[AGENT][NEUTRAL] The date of birth, you mean?
[CUSTOMER][NEUTRAL] Yes, yes, sorry.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Uh, give me one moment.
[AGENT][NEUTRAL] And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] It is [PII] and the total bill amount is $158.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] I do not show we received that claim. Uh, can you verify the address it was submitted to?
[CUSTOMER][NEUTRAL] Just give me a second there.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh. So the address we have here, it is [PII], uh sorry, [PII] OK, [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, correct. And let me give you the correct policy number to use because that policy number you gave is no longer active. So they do have an updated policy number when you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, go ahead with the number.
[AGENT][NEUTRAL] OK, it is 2502669.
[CUSTOMER][NEUTRAL] 2502669.
[AGENT][POSITIVE] Correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] And uh there is no ML and something?
[AGENT][NEUTRAL] Uh, you don't really need it. It's fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No issue. Uh, and the claim.
[CUSTOMER][NEGATIVE] Claim is not on file.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And you said the address is correct, patient is active, right?
[AGENT][NEUTRAL] Correct. Uh, effective [PII] and a policy term [PII], so they were active at the time of service.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] And, uh, can you please help me with one more claim? I just have last claim.
[AGENT][NEUTRAL] Sure, give me one quick moment, please.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Take your time, dear.
[CUSTOMER][NEUTRAL] my dad
[AGENT][NEUTRAL] OK, and what's that um next policy number, please?
[CUSTOMER][NEUTRAL] It is 02035770.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] I'm sorry, you said the policy number is 2,035,770?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. I'm not showing her under this plan. Um, and what is the patient's name again? You said it's [PII]?
[CUSTOMER][NEUTRAL] Yes. Last name is [PII]
[AGENT][NEUTRAL] [PII], OK, and the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what state is she from?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What state is she from?
[CUSTOMER][NEUTRAL] Date.
[AGENT][NEUTRAL] No, state. Mhm.
[CUSTOMER][NEUTRAL] [PII]. OK. Uh, just give me a second.
[CUSTOMER][NEUTRAL] Mhm. Patient address. She's from uh [PII].
[AGENT][NEUTRAL] Um, see.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK. Uh, when you're ready, I can give you that correct policy number.
[CUSTOMER][NEUTRAL] So are you
[CUSTOMER][NEUTRAL] OK, so the policy is incorrect, right?
[AGENT][NEUTRAL] Correct, the policy number you gave is incorrect.
[CUSTOMER][NEUTRAL] OK, provide me the correct one.
[AGENT][NEUTRAL] 2,035,270
[CUSTOMER][NEUTRAL] OK, it's 203-5270, right?
[AGENT][NEUTRAL] Yes, ma'am. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] OK, so the date of service we are looking for is [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $286 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, and I show this claim also processes needing primary EOB.
[CUSTOMER][NEUTRAL] So, uh, yeah, we already have sent the primary UB I have the notes that uh there some, um, from our side has sent the primary UB via fax. So did you guys receive that?
[AGENT][NEUTRAL] Uh, no, ma'am, we have not.
[AGENT][NEUTRAL] And can you verify the fax number?
[CUSTOMER][NEUTRAL] Uh, they did not mention that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Just give me a second. No issue. I will send it again.
[CUSTOMER][NEGATIVE] It is not on file.
[CUSTOMER][NEUTRAL] And you gave me uh the fax number previously, right?
[CUSTOMER][NEUTRAL] Will be the same section we are going to use, right?
[AGENT][NEUTRAL] Uh, it's
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][POSITIVE] OK, no issue there.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, the claim number, um, which is, uh,
[CUSTOMER][NEUTRAL] Sorry, the claim number is 3507737. Is this correct?
[AGENT][POSITIVE] Uh, that is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No issue.
[CUSTOMER][NEUTRAL] And you said it is denied for primary you be?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So yeah
[CUSTOMER][POSITIVE] So, [PII], thank you for helping me with this claim. That means a lot for me. Thank you. Have a great day. Bye-bye. Have a great weekend.
[AGENT][POSITIVE] Alright, you too. Thank you for calling APM, Ms. [PII].
[CUSTOMER][NEUTRAL] I know I need.
[CUSTOMER][NEUTRAL] I need to send all this.
[CUSTOMER][POSITIVE] Yes sir thank you have a great day bye bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye.