AccountId: 011433970860
ContactId: 9c585b8d-4535-4704-8dde-b2e510c9bea7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 637020 ms
Total Talk Time (AGENT): 225439 ms
Total Talk Time (CUSTOMER): 178892 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/9c585b8d-4535-4704-8dde-b2e510c9bea7_20250311T17:43_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes ma'am. I'm just calling to check benefits for a patient.
[AGENT][NEUTRAL] OK, you're needing benefit information only you do not need eligibility, is that correct?
[CUSTOMER][NEUTRAL] Or I'm sorry, I need the eligibility information I I apologize.
[AGENT][NEUTRAL] That's OK. You, so do you need both? You need eligibility and benefits?
[CUSTOMER][NEUTRAL] Just eligibility.
[AGENT][POSITIVE] OK, yes ma'am. I can help you with that. And who am I speaking with please?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm with NMed Health.
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Member's policy number it is 02456511.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you one moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can bring me any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on the supplemental policy, [PII], and this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And [PII], if you all do file a claim with us, we will also have to have a copy of his primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a portal in which you should be able to check claim status for us and our website for the portal is [PII].
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] We have filed a claim to it. We actually filed a claim in May and I'm not able to pull it up on your secured website.
[AGENT][NEUTRAL] OK, so are you needing claim status?
[CUSTOMER][NEUTRAL] Um, that too, I just wanted to make sure it was in effect before I did all the claim status stuff. Um, I can call a different number if that's like a different person. I don't mind.
[AGENT][NEUTRAL] No, it isn't. No, no. I can help you with that.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Data service it is an ending data service of [PII], um, and it would be starting.
[AGENT][NEUTRAL] That's the data service on the claim? OK, wait, let's.
[CUSTOMER][NEUTRAL] It is [PII], sorry.
[AGENT][NEUTRAL] Go ahead. What is
[AGENT][NEUTRAL] What's the date of service or the?
[CUSTOMER][NEUTRAL] It is [PII]. It's like a um radiation oncology um like monthly claim.
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Total bill amount of the claim it's $36,295. His primary adjusted to his balance with you guys as 203,950.
[AGENT][NEUTRAL] $2,039.50.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Is that correct? OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], is that correct? The [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, we do not have a claim on file for him.
[AGENT][NEUTRAL] For that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now that would have been why you would not be able to, when was the claim submitted?
[CUSTOMER][NEUTRAL] It was submitted [PII].
[AGENT][NEUTRAL] OK, so here we go. Give me just a second.
[AGENT][NEUTRAL] So this has the date range starting on [PII], not [PII].
[AGENT][NEUTRAL] According to the claim we received. OK, so that claim was received and processed.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] The claim number is 3,462,670.
[CUSTOMER][NEUTRAL] 346.
[AGENT][NEUTRAL] Um, and actually let me look at one thing on here.
[AGENT][NEUTRAL] OK, so [PII] that. I was about to give you some incorrect information, [PII]. What I initially said was correct. We have not received a claim from the provider for this data service.
[AGENT][NEUTRAL] For these dates of service, I should say.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, for that then, since it is passed the first data service we do have proof of like where it was sent out on the [PII], but if we were to rebuild it, it would deny us timely more than likely because it's been over a year since data service.
[AGENT][NEGATIVE] We do not have a timely, well, we do not have a timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So just make sure to include the primary insurance company's explanation of benefits.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Along with the claim.
[CUSTOMER][NEUTRAL] OK, I will go ahead and get that. Can I file it on this website?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] No, you're not gonna be able to do that. You can either um submit it electronically or you can submit it to our fax, secure fax line and the fax number is [PII].
[AGENT][NEUTRAL] 3659423 attention claims.
[AGENT][NEUTRAL] And I do wanna look at one thing on.
[AGENT][NEUTRAL] While I still have you on the line.
[CUSTOMER][NEUTRAL] Oh sure.
[CUSTOMER][NEUTRAL] I'm looking to see too I have claims from.
[CUSTOMER][NEUTRAL] Um, April as well. I wanted to see if you guys had.
[CUSTOMER][NEUTRAL] That as well.
[AGENT][NEUTRAL] And what is the date?
[CUSTOMER][NEUTRAL] Because I'm not showing a payment from you guys on that claim either.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it would be around 32 as the total charges as well.
[CUSTOMER][NEUTRAL] 32,000, not [PII] I'm sorry.
[AGENT][NEUTRAL] Do you have a total bill [PII]t?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, total charges $32,0062 and the um patient portion that was sent to you guys $889.88.
[AGENT][NEUTRAL] I haven't located it yet. I'm still looking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I do not see a claim. I've checked several dates of service within that range.
[CUSTOMER][NEUTRAL] OK, um, then I will just fax these individually to you all because I'm looking at, I do have.
[CUSTOMER][NEUTRAL] One from this year that paid by you guys, so one that I have that I don't have a remit for you guys I'll just re-fax.
[AGENT][NEUTRAL] OK, well that'll be fine again we do not, there is no timely filing limit with us.
[CUSTOMER][POSITIVE] That is lovely. I appreciate that so much thank you and I will go ahead and get those.
[AGENT][NEUTRAL] Well, you are certainly.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right over.
[AGENT][NEUTRAL] OK, [PII], well, thank you, um, again for calling APL. Is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] Um, no, do you have a reference number for your calls?
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK, and what was your first name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Alrighty thank you so much, [PII].
[AGENT][POSITIVE] Well, you are certainly very welcome and thank you again for calling APL. I hope you have a wonderful afternoon, [PII].
[CUSTOMER][POSITIVE] Thank you.