AccountId: 011433970860
ContactId: a0dbbca1-11cb-4656-96ce-0b9bb843160a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1352180 ms
Total Talk Time (AGENT): 406438 ms
Total Talk Time (CUSTOMER): 463455 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/a0dbbca1-11cb-4656-96ce-0b9bb843160a_20250513T17:39_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider's office to know about the claim status for youring today.
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] Yeah, I'm doing great. Thank you so much for asking that. And by the way, let me inform you one thing for starting with this call, uh, this call is being recorded for quality and training purpose. you like us to continue with this recording line.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][POSITIVE] Mhm yeah, thanks for that. I'm gonna.
[AGENT][NEUTRAL] And [PII], um, go ahead.
[CUSTOMER][NEUTRAL] Uh-huh, can you please help me with the claim status?
[AGENT][NEUTRAL] Yes. How many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah, in total I have 55 claims.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh huh, yes, good callback number is [PII]. It is a direct line?
[AGENT][NEUTRAL] Thank you. And is it all for one member or there are multiple members for the notes?
[CUSTOMER][NEUTRAL] Um, uh, multiple numbers.
[AGENT][NEUTRAL] OK, may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 01678145.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, a member's first and last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yes. Uh, date of service is [PII] and the total charge amount is 227.
[CUSTOMER][NEUTRAL] $77 even.
[AGENT][NEUTRAL] $277?
[AGENT][NEUTRAL] Is it 277 or 227?
[CUSTOMER][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] 277.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, the provider's office is skin and Cancer Associate.
[AGENT][NEUTRAL] OK, here it is.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3571255.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] I'm so sorry. Can you please explain, let me know the dinner date once again. It is [PII] or [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. It was denied due to office visits were not covered, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh-huh. OK. Thanks for that information. And also, can you please uh help me with the UB? Can you please fax the UB to our fax number?
[AGENT][NEUTRAL] Yes, so you need the EOB for all the claims we go over?
[CUSTOMER][POSITIVE] Mhm yeah that's correct.
[AGENT][NEUTRAL] OK, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Uh, [PII] fax number is [PII].
[AGENT][NEUTRAL] Attention, [PII].
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And just to confirm, [PII]?
[CUSTOMER][POSITIVE] Uh-huh, yes, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and the next member's policy number when you're ready.
[CUSTOMER][NEUTRAL] Uh, hi, yes, I would prefer that. I have one more question in this, uh, for this claim. Uh, you said this was not covered, uh, the office visits were not covered, right? Can you please, uh, let me know whether it is not covered under the member's plan or uh provider's plan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The member's policy.
[CUSTOMER][NEUTRAL] Member's policy, OK.
[CUSTOMER][POSITIVE] Yeah thanks for that uh.
[CUSTOMER][NEUTRAL] Yeah, um, and also can you please help me with the call reference number?
[AGENT][NEUTRAL] Sure, so the call reference number for the entire call will be my name and today's date.
[CUSTOMER][POSITIVE] Oh, thank you, thanks for that. Uh just give me one second, I'll provide you the next number ID.
[CUSTOMER][NEUTRAL] Yes, I'm ready with the next number ID which is [PII].
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, my first and last name is [PII]. Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and the date of service and total bills?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the charge amount is $197 even.
[AGENT][NEUTRAL] So it's [PII]?
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And would the name of the provider for this claim be the same or would it be a different provider?
[CUSTOMER][NEUTRAL] Uh, it is the same provider skin and cancer as a state.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm sure we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is 3575577.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Uh-huh. OK.
[CUSTOMER][NEUTRAL] Uh, and also, may I know whether this is under the patient plan or providers plan?
[AGENT][NEUTRAL] Um, the patient's policy.
[CUSTOMER][POSITIVE] Mhm. OK, thanks for that information.
[CUSTOMER][NEUTRAL] And can you please fax the U to our fax number?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can you please fax the UP to, to the fax number which you provided now?
[AGENT][POSITIVE] Oh, yes, I'll be sending them all to you.
[CUSTOMER][POSITIVE] OK, thanks for that.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[AGENT][NEUTRAL] Alright, and the next member's policy number when you're ready.
[CUSTOMER][NEUTRAL] Yes, I'm ready with the next policy number which is 01699452 M for Mike L for Lima 8.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the first and last name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah, our date of service is [PII] with $933 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] Alright, so I'm not showing a claim on file for that data service.
[CUSTOMER][NEUTRAL] Uh, but we had this claim on [PII] through electronically.
[AGENT][NEUTRAL] OK, so what payer ID?
[CUSTOMER][NEUTRAL] Yeah, the payer ID is 60801.
[AGENT][NEUTRAL] All right, so we have not received the claim, but there is no timely filing, um, so you can submit the claim for processing.
[AGENT][NEUTRAL] Now, this, you know what, hold on one second, because this particular policy number wasn't effective. It was this policy terms on [PII]. There is an active policy. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That has been active since [PII]. Let me see if the claim is on there.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it is.
[AGENT][NEUTRAL] All right, so under the active policy, there is a claim, um, claim, well, it was received on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 357-077-9.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on the policy.
[CUSTOMER][NEUTRAL] Hm thanks for that and may I know whether this is also under the
[CUSTOMER][NEUTRAL] Providers or members plan?
[AGENT][NEUTRAL] No, these are all the members' policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, on this policy.
[CUSTOMER][NEUTRAL] Mhm, thanks for that. Uh just give me one second, I'll pull up the next number ID.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm, yeah, I'm ready with the next number ID.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just.
[AGENT][NEUTRAL] OK, and the next numbers policy number?
[CUSTOMER][NEUTRAL] Yeah, the next policy number is 60801.
[AGENT][NEUTRAL] So for that, that's our payer ID?
[CUSTOMER][NEUTRAL] Uh-huh, that is.
[AGENT][NEUTRAL] Do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Uh, hi, yes, I had to have available that. I'm just seeing that.
[AGENT][NEUTRAL] Do you see
[AGENT][NEUTRAL] Do you see anywhere on the card that says in hospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Mhm, yes, outpatient benefit certificate number, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh-huh, yeah, the member ID is.
[CUSTOMER][NEUTRAL] 02451768 M. M for Mike L for Lima 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, I remembers first and last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and total bills?
[CUSTOMER][NEUTRAL] Uh, you.
[CUSTOMER][NEUTRAL] Mhm, yeah, the date of service is.
[CUSTOMER][NEUTRAL] I'm so sorry, it is [PII] and total charge amount is $197 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what was the date of birth again? I'm sorry for the member.
[CUSTOMER][NEUTRAL] Yeah, the date of birth is [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] I was
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, I just located the claim it's coming up now. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm, OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim number is 3546891.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm so sorry, can you please repeat the claim number once again? I missed in the middle.
[AGENT][NEUTRAL] 3546891.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And also on [PII], the claim was paid out on to the provider.
[AGENT][NEUTRAL] A total of $50.
[CUSTOMER][NEUTRAL] Mhm, OK.
[AGENT][NEUTRAL] Did you need the check information?
[CUSTOMER][NEUTRAL] Yeah, that's correct. Uh, can you please help me the allowed amount and the short number?
[AGENT][NEUTRAL] Alright, so the
[AGENT][NEUTRAL] The allowed amount
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh, yes.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the allowed amount for the specialist office visit is up to $50 per visit with a max of 4 visits per calendar year. So the max for that would be $50.
[CUSTOMER][NEUTRAL] Mhm, OK.
[CUSTOMER][POSITIVE] Got it. Thanks for that.
[AGENT][NEUTRAL] You're welcome, um, hold on one moment for the check information.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, so check number 2,021,040 was a single check?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] It was issued on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mailed to [PII].
[CUSTOMER][NEUTRAL] Mhm. OK. Thanks for that information. And may I know whether the check has been cashed?
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] Yes, the check cleared on [PII].
[CUSTOMER][POSITIVE] OK, OK, thanks for that.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Uh, so you stated that, uh,
[CUSTOMER][NEUTRAL] Uh, the claim has been paid $50.50 dollars, right? Oh.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, it is, it has been paid up to the max, so.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] How much, oh.
[AGENT][NEUTRAL] Can you repeat your question, please?
[CUSTOMER][NEUTRAL] repeat
[CUSTOMER][NEUTRAL] Yes, so you stated that uh the claim has been paid, paid $50 as per the visit, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh-huh. OK. Thanks for that information. Uh, just give me one second. I'll have, I'll provide you the next member ID.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 1234 OK.
[CUSTOMER][NEUTRAL] Yeah, I'm ready with the next member ID. This is with the different, different provider.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the member ID is, um, shall I?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] It is 02563946.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes. And the first and last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and the date of service and total bills?
[CUSTOMER][NEUTRAL] Yeah, the date of service and total bill amount is [PII] at $876.15.
[AGENT][NEUTRAL] Hey, can you repeat the amount again? I'm sorry.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh-huh, it is $876.15.
[AGENT][NEUTRAL] Th[PII] that was [PII] for [PII].
[CUSTOMER][NEUTRAL] Uh, no, the date of service is [PII].
[AGENT][NEUTRAL] I'm sorry, [PII]
[AGENT][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] But it's for [PII], correct?
[CUSTOMER][POSITIVE] Mhm, yes, that's correct.
[AGENT][NEUTRAL] The reason I'm asking is because I'm not showing any claims on file. Let me see if there's another policy. Hold on one moment. Oh no, this is the only policy. Um, so we haven't received the claim on file for [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] This policy has been active since [PII], so you can file the claim um at any time because the policy was active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so you're outing that you did not receive any claim?
[AGENT][NEUTRAL] Correct, there is no claim on file for date of service [PII].
[CUSTOMER][NEUTRAL] Mhm, but we have we will the claim on [PII], so can you please check again?
[AGENT][NEUTRAL] Are you saying [PII] or [PII]?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII], but we billed this claim on [PII].
[AGENT][NEUTRAL] OK, do you have a claim number?
[CUSTOMER][NEUTRAL] Mhm, I know we do not have any uh information of the claim.
[AGENT][NEUTRAL] OK, the reason I'm asking is because when I put that date in, any claim with that date will populate and it's blank. So we do not have this claim on file, but you can still file for it.
[CUSTOMER][POSITIVE] Oh, OK, thanks for that.
[CUSTOMER][NEUTRAL] Mhm, can you please, uh, let me know the payer ID, uh, payer ID which is 64556 is the correct payer ID or uh it's.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Um, no, our pay ID is 60801.
[CUSTOMER][NEUTRAL] Mhm. And also can you please help me with the mailing address?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] Oh, OK, thanks for that.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh-huh. And also, uh, can you please fax the fax this all to, to the fax number?
[AGENT][POSITIVE] Yes, as I stated, I'll be sending all of these to you.
[CUSTOMER][POSITIVE] Mhm. OK, thanks for that information.
[AGENT][NEUTRAL] You're welcome. Was there anything else?
[CUSTOMER][NEUTRAL] Will be your name and date, right?
[AGENT][NEUTRAL] I'm sorry, the phone went in and out. I didn't hear what you were saying.
[CUSTOMER][NEUTRAL] Uh, no, nothing else.
[CUSTOMER][NEUTRAL] Mhm. You said that the call reference number will be your first, your name and uh today's date, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Uh-huh. OK, thanks for that. I wish you a great day. Bye bye for now.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah. Bye-bye for now.
[AGENT][POSITIVE] Alright, well thank you for calling APL. Is there anything else I can help with?
[CUSTOMER][POSITIVE] Uh, no, nothing else. Thanks so much for this wonderful help. I wish you a great day.
[AGENT][POSITIVE] Alright, well have a great evening.
[AGENT][POSITIVE] You also. Thank you. Bye-bye.