AccountId: 011433970860
ContactId: 974283f3-3f6a-4a7e-b529-3a829224469e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1192390 ms
Total Talk Time (AGENT): 381575 ms
Total Talk Time (CUSTOMER): 177577 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/974283f3-3f6a-4a7e-b529-3a829224469e_20250324T17:04_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from provider office. I want to know the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] I have 2 claims.
[AGENT][NEUTRAL] OK, your two claims are patient or deficient?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII], are your claims for the same patient.
[CUSTOMER][NEUTRAL] No, different.
[AGENT][POSITIVE] Yes, I can help you with both. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so [PII], thank you for that and you will use my name along with today's date as your call reference number for each one.
[AGENT][NEUTRAL] Also, any information that I provide for you on the claims that I check will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of the explanation of benefits, you may print them by going to our portal at [PII].
[AGENT][NEUTRAL] And what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] It's 02049543.
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And what is your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Total bill amount is
[CUSTOMER][NEUTRAL] 369.25 cents.
[AGENT][NEUTRAL] I'm so sorry, can you please repeat the amount?
[CUSTOMER][NEUTRAL] It's 369.25 cents.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] The claim was received.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 3558952.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] And the reason for the denial on the claim, [PII], states, I'm sorry, [PII].
[AGENT][NEUTRAL] States all benefits, excuse me, all payable benefits were applied to the policy deductible $500.
[AGENT][NEUTRAL] The supplemental policy had a $500 deductible and all benefits were applied towards that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The primary is applied deductible on the claim.
[AGENT][NEUTRAL] There is also a deductible on the, there is a deductible on the supplemental policy, and the benefits on this plan were applied to the deductible.
[CUSTOMER][NEUTRAL] On APL
[AGENT][NEUTRAL] On this policy.
[CUSTOMER][NEUTRAL] So the APL is, APL is not covered the Medicaid USA deductible?
[AGENT][NEUTRAL] Correct, it has this plan also has a deductible that has to be met, a $500 deductible.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][POSITIVE] And benefits were applied to that.
[CUSTOMER][NEUTRAL] Yeah, the claim was denied as noncovered.
[CUSTOMER][NEUTRAL] As you say.
[AGENT][NEUTRAL] the specific remark again.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] States all payable benefits paid to the policy deductible $500. That is the remark on this claim.
[CUSTOMER][NEGATIVE] Yeah, your voice is not audible.
[CUSTOMER][NEUTRAL] The AP is not covered the deductible of the primary.
[AGENT][NEUTRAL] This plan is designed to help with the deductibles, co-pays, and co-insurance amounts of coverage services. This supplemental policy also has a deductible to be met.
[AGENT][NEUTRAL] So the benefits were applied towards the $500 deductible on this policy.
[CUSTOMER][NEUTRAL] The doctor already met.
[AGENT][NEUTRAL] All payable benefits were applied to the policy deductible.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And is there any additional information you need on this one, [PII]? I mean, [PII], before we move, I'm sorry, I keep wanting to call you [PII], [PII]. I apologize, [PII], before we move on.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you need any other
[AGENT][NEUTRAL] Their information on this one?
[CUSTOMER][POSITIVE] Yes, I want uh
[CUSTOMER][NEUTRAL] Can you please uh
[CUSTOMER][POSITIVE] Thank you for this.
[AGENT][NEUTRAL] Can you print? I gave you our website for you to print the, yes sir, you can print the explanation of benefits now that you have the claim number directly from our portal.
[CUSTOMER][NEUTRAL] Yeah, can you
[CUSTOMER][NEUTRAL] Can you please repeat the website?
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEGATIVE] Your voice is not audible right now.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] See
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] The words [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's uh [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] No, that is not correct.
[AGENT][NEUTRAL] The first word is secured.
[CUSTOMER][NEUTRAL] OK, can you please repeat?
[CUSTOMER][POSITIVE] [PII]
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][POSITIVE] Secured.
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir. Do you need for me to spell that word for you, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] But we don't have access for this website.
[AGENT][NEUTRAL] It's a self registering portal.
[CUSTOMER][NEUTRAL] No, there is no extra showing.
[AGENT][NEUTRAL] Just a moment, please.
[CUSTOMER][NEUTRAL] Can you please fax if it is possible?
[AGENT][POSITIVE] I will fax it to you as soon as it loads.
[AGENT][NEUTRAL] It's loading.
[AGENT][NEUTRAL] Does the fax need to have your name?
[AGENT][NEUTRAL] on it.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK. Just a moment. When it loads, I'll be happy to fax that to you.
[AGENT][NEUTRAL] You can go ahead while it's loading still. And what is the fax number, [PII], that you want this sent to?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Say that again, please.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. And you said that was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And is there any in the
[AGENT][NEUTRAL] Has been faxed to you. Is there anything else on this you need information on?
[CUSTOMER][NEUTRAL] Yeah, the claim was registered that night.
[CUSTOMER][NEUTRAL] Because the deductibles are met.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, I've read you the remark.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How much time it will take for the UV?
[AGENT][NEUTRAL] As I explained, it has been faxed.
[AGENT][NEUTRAL] So as long as it takes to come through on your end, it's already faxed.
[CUSTOMER][NEUTRAL] Already effects.
[CUSTOMER][NEUTRAL] Can you please spell your name, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And as I explained, you would use my name and today's date is your call reference number for each one.
[AGENT][NEUTRAL] What is your next patient's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Allow me a minute.
[CUSTOMER][NEUTRAL] Yeah, that's 025383, sorry, it's 025384441.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your patient's name and date of birth.
[CUSTOMER][NEUTRAL] The patient name is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] is [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount is, sorry.
[AGENT][NEUTRAL] OK, just one moment. We're not, yes, sir, just a moment.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] What is the data of service and total bill amount?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $153. 83 cents.
[AGENT][NEUTRAL] 153.83. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, so this claim was received date is [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 3565048.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] And the reason for the denial states durable medical equipment DME.
[AGENT][NEGATIVE] is not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And patient policy is active now?
[AGENT][NEUTRAL] It is, yes, sir.
[CUSTOMER][NEUTRAL] And when the effective rate?
[AGENT][NEUTRAL] 91 of 24.
[CUSTOMER][NEUTRAL] GM is not covered under the patient policy, OK?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Allow me a minute. Let me check if you have received previous payment or not.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Do you need this explanation of benefits also fax? Yeah.
[CUSTOMER][NEUTRAL] Yeah, you can send.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] And the other one, I did receive notification that the other fax was successfully delivered. The first one that I sent to you says it was successfully delivered.
[CUSTOMER][NEUTRAL] No, I think.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you. You can send this.
[AGENT][NEUTRAL] OK, so just a moment, please.
[AGENT][NEUTRAL] OK. So I have also faxed this one to you as well, [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. And is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] No, no. Thank you, sir.
[AGENT][POSITIVE] Well, you're very welcome. And thank you again for calling APL. I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Mm, bye-bye.