AccountId: 011433970860
ContactId: a03fe9d8-d957-4302-bbfc-ac4de87fdf0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1227739 ms
Total Talk Time (AGENT): 379212 ms
Total Talk Time (CUSTOMER): 306551 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/a03fe9d8-d957-4302-bbfc-ac4de87fdf0d_20250516T18:04_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 the provider's office to check on the claim. The reason could be able to assist me with that?
[AGENT][NEUTRAL] OK [PII], did you say that you're needing to check on the denial reason for a claim, is that correct?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][POSITIVE] Yes sir, I, I mean, yes ma'am I can help you with that. Give me just one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] Uh, the member's policy number is going to be 02.
[CUSTOMER][NEUTRAL] 48, um, I'm so sorry. I just repeat that. 02462881.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] Yeah, take your time.
[AGENT][NEUTRAL] And 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 and their date of birth, [PII]?
[CUSTOMER][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Um, OK. The patient's name is [PII] and birth date is going to be [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] With the bill amount, $184 even.
[AGENT][NEUTRAL] Thank you and the claim number that you have?
[CUSTOMER][NEUTRAL] Um, just a moment.
[AGENT][NEUTRAL] That's OK. I have it.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] If
[CUSTOMER][NEUTRAL] Yeah, I have the claim number here. I'm um no, I'm so sorry. I didn't have the claim number. It's not mentioned here. Sorry for the inconvenience.
[AGENT][NEUTRAL] It's 353-718-5.
[AGENT][NEGATIVE] And that was received on [PII] and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And verify the provider facility name on this claim please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the provider's facility is Mercy Clinic, Oklahoma Communities.
[AGENT][NEUTRAL] OK, thank you, and the reason for, and excuse me, the claim number is 356.
[AGENT][NEUTRAL] 4985.
[CUSTOMER][NEUTRAL] Mhm. 3 5s.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial state office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] The members supplemental policy, [PII] does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, you can print it if you go to our portal, yes ma'am. I'm gonna give you the website where now that you have the claim number you can print it from.
[CUSTOMER][NEUTRAL] So the members
[CUSTOMER][POSITIVE] Yes, I need that.
[AGENT][POSITIVE] And the website is secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the EOB was also mailed to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, could be able to send us a copy of you be through fax?
[AGENT][NEUTRAL] Are you not, so you can't access the internet?
[CUSTOMER][NEUTRAL] Uh, on society.
[AGENT][NEUTRAL] Are you not able to access the internet to print it yourself?
[CUSTOMER][NEUTRAL] Yes, no, we, we, we have the access to internet, but we don't have the access to, um, use this website and all, so could be able to send us a copy of you will be through fax because I, uh, connected to one another agent before you she sent a fax to me.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's still loading the information.
[CUSTOMER][POSITIVE] Yeah, take your time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Does it need to be put to your attention, [PII], or is that not necessary?
[CUSTOMER][NEUTRAL] Yeah, attention to my name, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Do you want a fax number?
[AGENT][NEUTRAL] Not yet.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the fax number now, please?
[CUSTOMER][NEUTRAL] Yeah, the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I need to call that back. That is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK. That has been faxed to you, [PII]. So provided you're able to receive it, you said it should be receiving it very shortly.
[CUSTOMER][POSITIVE] Yeah, thank you so much. Uh, before that, could be able to spell your name for me? I didn't get that properly.
[AGENT][NEUTRAL] Well, you're welcome and.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] OK. You're welcome, [PII]. And again, is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] Yes, I have a few more claims with me for the same patient, but the date of services the different.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] How many dates of service total do you have, but you said you had said you had one, [PII]. How many do you have?
[CUSTOMER][NEUTRAL] I have 3 more.
[CUSTOMER][NEUTRAL] Yeah, I have 3 more.
[CUSTOMER][NEUTRAL] For the same patient.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and the same applies to all of them any information provided is a verification of benefits and not a guarantee of payment. So what is the next data service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the next date of service is [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $129 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] This claim was also received and denied for the same reasons.
[AGENT][NEUTRAL] Office says that they're not covered. The claim number is 352.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9954.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, could be able to let me know the received and processed date of this claim?
[AGENT][NEUTRAL] 11, received 1111, denied, processed 1113.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] Thank you so much for this information it's the same reason, am I right?
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I just need a copy of you before this claim too, so could be able to fax it to me?
[AGENT][NEUTRAL] Give me a few minutes for it to load.
[AGENT][NEUTRAL] So you all can't access the internet and set up the profile?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's a self-registering portal. It's not anything specific that someone else has to do.
[CUSTOMER][NEUTRAL] I have the access to internet but I don't have the access to use this portal and all stuff so that's why we request a copy of you will be through fax from the representative.
[AGENT][NEUTRAL] Yes, you, right, but you would just register. I know, but for future reference when you have multiple claims and you're needing them faxed because we can't fax them to you together.
[AGENT][NEUTRAL] It would be easier if you create the profile for this provider which you just follow the steps.
[AGENT][NEUTRAL] And fill in the information it asked for to so that you can create your own access.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Didn't create the idea but don't have the access for it. That's why I hope you understand.
[AGENT][NEUTRAL] I know you have to, yes ma'am, you have to set up your own profile that is something you do is what I'm trying to explain.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, could be able to let me know the portal website something you have.
[AGENT][NEUTRAL] Yes. Yes, ma'am, I had given it to you. Do you need for me to give you that again?
[CUSTOMER][NEUTRAL] Now, could you be able to confirm it again for me, please?
[AGENT][NEUTRAL] Secured. [PII].
[CUSTOMER][NEUTRAL] What is that first word? I didn't get that properly. I'm so sorry for that.
[AGENT][NEUTRAL] The keyword.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Right, and this information is still, it is still trying to load this information.
[CUSTOMER][NEUTRAL] I'll try to pull up the Ubi from this website.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] So shall we move on to the next one?
[AGENT][NEUTRAL] No, ma'am, I can't at this point cause I'm waiting on the system.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so can I get the card reference number for this call?
[AGENT][NEUTRAL] Oh, you said you have 2 more days of service for this number, is that correct? That you're needing to get the claim number for?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So again, we have to fax them one at a time, so I can't move on to that one it's trying to fax you the EOB that you're needing. So give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, that 2nd 1 has also been faxed. What is the next date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The next date of service is going to be [PII].
[CUSTOMER][NEUTRAL] With the bill amount $184.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] This claim was received [PII], denied [PII]. The claim number is 3532519, and it was denied for the same reason.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes ma'am, and I'm waiting for the EOB to load.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, and what is your next data of service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The next date of service is going to be [PII] with the bill amount $184 even.
[AGENT][NEUTRAL] This claim was received [PII] and processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3532504 and it was denied for the same reason.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. Thank you so much for this information.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So as for the patients supplement plan,
[AGENT][NEUTRAL] Still loading this information.
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So as for the patients supplementary plan, office visits are not covered, am I right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright. Thank you so much for all this information, [PII].
[AGENT][NEUTRAL] This will give me just a moment because I still have to fax you the last one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Really appreciate your patience. Thank you so much for.
[AGENT][POSITIVE] You're welcome. Like I said, if you're able to set up your own profile, it would make it much quicker, even if you have to call us to get the claim number, it would be just, uh, the whole process would be a lot easier and quicker for you to print it yourself.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah, but we
[CUSTOMER][NEUTRAL] Mhm, I, I, I understand, but we don't have the access to use this portals and all. That is why, yeah.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I know, but you have, yes, and that's what I'm saying you have to set up your own profile. You have to set that up yourself.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK. We will try.
[CUSTOMER][POSITIVE] I really appreciate you.
[AGENT][POSITIVE] OK, so all of these explanation of benefits happen on these 4 claims have been faxed to you, so provided that you're able to receive them, because I've already received a notification that one was successfully delivered, so the rest of them have also been sent.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Mhm. Thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] As well to you.
[CUSTOMER][POSITIVE] Yeah, thank you so much, [PII].
[AGENT][POSITIVE] All right. Well, you're very welcome. So again, is there anything else, [PII] that I can help you with today?
[CUSTOMER][NEUTRAL] So, can I get a call reference number for today's call?
[AGENT][NEUTRAL] Yes, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Thank you so much [PII].
[AGENT][POSITIVE] OK. Well, you're very welcome and thank you again for calling. Yes, ma'am. You're very welcome and thank you for calling [PII]. I hope you have a nice weekend.
[CUSTOMER][POSITIVE] I really appreciate your patience.
[CUSTOMER][POSITIVE] Happy weekend by [PII]. Take care.
[AGENT][POSITIVE] Thank you. Oh, you're welcome. Bye-bye.