AccountId: 011433970860
ContactId: a18bdc9c-620e-4db6-aef9-716624ad3760
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1449560 ms
Total Talk Time (AGENT): 446431 ms
Total Talk Time (CUSTOMER): 233973 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/a18bdc9c-620e-4db6-aef9-716624ad3760_20250625T12:04_UTC.wav
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[CUSTOMER][NEUTRAL] I thought tradition
[AGENT][NEUTRAL] APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm sorry, I didn't catch your name again.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] there any claim status if you don't mind please.
[AGENT][POSITIVE] Yeah, I'm happy to check on a claim for you. What's the policy number?
[CUSTOMER][NEUTRAL] Policy number is 02324303.
[AGENT][NEUTRAL] And can I get your name for documentation, please?
[CUSTOMER][NEUTRAL] Yes, it is [PII]
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Oh is [PII].
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] And date of service?
[CUSTOMER][NEUTRAL] Uh, data service on the claim is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And build them out.
[CUSTOMER][NEUTRAL] Uh, we billed on the claim $221.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] I appreciate your patience on that. So, we did receive a claim for that date of service on [PII].
[AGENT][NEUTRAL] Uh, the claim was denied [PII]. A denials reading policy provides no benefits for charges, um.
[AGENT][NEGATIVE] No benefit for inpatient visits.
[CUSTOMER][NEUTRAL] And is there a claim number?
[AGENT][NEUTRAL] Absolutely, claim number is 342.
[AGENT][NEUTRAL] 371 7.
[CUSTOMER][NEUTRAL] And do you know why um is your web portal working correctly, the APL?
[CUSTOMER][NEUTRAL] Um, what what are working correctly.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I haven't heard of anything not working, but I will let you know that if you're a provider or group um our website did change a few weeks ago, so anybody that's had a login is needing to create new logins.
[CUSTOMER][NEGATIVE] And the issue is the tax ID stating that the tax ID is not correct.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh, really?
[CUSTOMER][NEUTRAL] So the 2, yeah, the 232 on this claim is not it's stating that.
[CUSTOMER][NEUTRAL] Um, no user was found.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] It says sign up error message and it says no user was found with this information, so and then they don't give you instructions if there is I don't see it.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK. I can definitely uh check with IT after our call and just see if anything's going on with it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I haven't heard of anything going on with it as of today so far.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I have a few more, um, and it may be the same reason if you don't mind helping me.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No, absolutely. I can double check those. What's the next policy number whenever you're ready?
[CUSTOMER][NEUTRAL] It's the same policy.
[AGENT][NEUTRAL] Oh, it's the same one. OK.
[CUSTOMER][NEUTRAL] And then how do I get a copy of the explanation of benefits?
[AGENT][NEUTRAL] Uh, do you have a fax? I can fax it to you.
[CUSTOMER][NEUTRAL] Yeah, it is.
[CUSTOMER][NEUTRAL] 513
[CUSTOMER][NEUTRAL] 9,930,810.
[AGENT][NEUTRAL] All right, and that was 513 and then did you say 9,930,810?
[CUSTOMER][NEUTRAL] Mhm 08 mhm correct.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What's the next state of service?
[CUSTOMER][NEUTRAL] Uh, it is for [PII].
[AGENT][NEUTRAL] In the build out.
[CUSTOMER][NEUTRAL] We billed $327.
[AGENT][NEUTRAL] OK. Yeah, it looks like it's reading for the same denial. Let me see when we received this here.
[AGENT][NEUTRAL] So this claim looks like it was received on [PII].
[AGENT][NEUTRAL] Processed and denied [PII].
[AGENT][NEUTRAL] And then the claim number on this is gonna be 342.
[AGENT][NEUTRAL] 4068.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, and if I could get.
[CUSTOMER][NEUTRAL] That one as well if you don't mind.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Do you have any other dates you need to check for [PII]?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] What's the next date?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] If he's in and out the hospital, yeah, he has been patient for a while.
[AGENT][NEUTRAL] Alright, [PII] in the build amount.
[CUSTOMER][NEUTRAL] $621.
[AGENT][NEUTRAL] So this one was received 226-24.
[AGENT][NEUTRAL] It looks like or excuse me, this one was received [PII] process [PII].
[AGENT][NEGATIVE] Denial is showing the same no benefits for inpatient visit.
[AGENT][NEUTRAL] And the claim number on this one is 341-6603.
[AGENT][NEUTRAL] And what's the next stage of service?
[CUSTOMER][NEUTRAL] It is 121 2024 for $221.
[AGENT][NEUTRAL] W
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So this one was received [PII], processed [PII].
[AGENT][NEUTRAL] Uh, no
[AGENT][POSITIVE] Benefit for inpatient visit.
[AGENT][NEUTRAL] And the policy or claim number, excuse me, is 341.
[AGENT][NEUTRAL] 6598.
[AGENT][NEUTRAL] Next stage of service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 121 2024 $120.
[AGENT][NEUTRAL] And it was 121 of $24 for $120 correct?
[CUSTOMER][POSITIVE] Correct. Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So this claim is received [PII], processed to [PII].
[AGENT][NEUTRAL] And it looks like the denial on this is saying.
[AGENT][NEUTRAL] Diagnostic benefits are only payable for MRI, colonoscopy, or CT.
[AGENT][NEUTRAL] So, the diagnostic testing they had was not covered.
[AGENT][NEUTRAL] And the claim number on that one is 341-6612.
[CUSTOMER][NEUTRAL] And I'm sorry, what was the reason again?
[AGENT][NEUTRAL] Uh, diagnostic benefits, not payable, um, so it was not a covered test for their plan.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] And then I'm ready for the next one you are.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It is 121 2024 for $677.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this one was received on [PII], processed [PII].
[AGENT][NEGATIVE] Uh, no benefit for inpatient visits.
[AGENT][NEUTRAL] And the claim number on this is gonna be 341-6610.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'll skip some of these diag I mean these hospital lists.
[CUSTOMER][NEUTRAL] But I can't because I need the EUB.
[CUSTOMER][NEUTRAL] Uh, but now you're gonna say the same thing with all of them.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] I think that you'll be in the claim number but.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Whenever you're ready.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It is 2:21.
[CUSTOMER][NEUTRAL] 2024 for $621.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 221 of 24.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] 221, 2024.
[AGENT][NEUTRAL] There's no claim for 221 24.
[CUSTOMER][NEUTRAL] 0 12124. I apologize.
[AGENT][NEUTRAL] Oh, that's OK.
[AGENT][NEUTRAL] And what was the build amount again? I'm sorry.
[CUSTOMER][NEUTRAL] 621.
[AGENT][NEUTRAL] 621.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is also inpatient visits are not covered.
[AGENT][NEUTRAL] And do you need the received and processed date on them as well?
[CUSTOMER][NEUTRAL] If you don't mind.
[AGENT][POSITIVE] Yeah, not a problem.
[AGENT][NEUTRAL] This was received [PII] of 24, process 226 of 24, and the claim number 3416582.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm, next day.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 122 2024.
[CUSTOMER][NEUTRAL] $319.
[AGENT][NEUTRAL] This was received 29 of 24, processed 226 of 24.
[AGENT][NEGATIVE] Same denial, no benefit for inpatient office visits.
[AGENT][NEUTRAL] And then it looks like 341-658-9 is gonna be the claim number.
[AGENT][POSITIVE] And I'm ready for the next.
[CUSTOMER][NEUTRAL] And just to make sure you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You don't mind faxing these, do you?
[AGENT][POSITIVE] No, I'm I'm copying them all. I'm gonna fax them all at once to you.
[CUSTOMER][NEUTRAL] Uh thank you. I just wanted to double check.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, the next one is 122 2024 for 624.
[CUSTOMER][NEUTRAL] I'm sorry, $677.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cardiologist maybe this one OK.
[CUSTOMER][NEUTRAL] It's impatient, I don't know.
[AGENT][NEUTRAL] This was received 29 of 24, processed 226 24.
[AGENT][NEGATIVE] Looks like the denials benefits, uh, no benefit for inpatient visit, and the claim number is 341.
[AGENT][NEUTRAL] 658 5.
[AGENT][POSITIVE] And I'm ready for the next when you are.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 123 2024 for $319.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This was received on 29-24.
[AGENT][NEUTRAL] Process 227 of 24.
[AGENT][NEGATIVE] No benefit for inpatient visits.
[AGENT][NEUTRAL] And the claim number is 341.
[AGENT][NEUTRAL] 6608.
[AGENT][NEUTRAL] And the next whenever you're ready.
[CUSTOMER][NEUTRAL] 121 2024 for $236.
[AGENT][NEUTRAL] This claim has received 29 of 24.
[AGENT][NEUTRAL] Process 226 of 24.
[AGENT][NEGATIVE] Uh, it looks like it was denied. The diagnostic testing performed was not a covered benefit.
[AGENT][NEUTRAL] And the claim number was 3416623.
[CUSTOMER][NEUTRAL] And the next one is 122 24.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For $345.
[AGENT][NEUTRAL] Alright, this was received on 29 of 24. Proceed 226 of 24.
[AGENT][NEGATIVE] It was denied, showing the diagnostic testing performed was not a covered benefit, and the claim number 341.
[AGENT][NEUTRAL] 661 7.
[CUSTOMER][NEUTRAL] Next one is 122 2024.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For $180.
[AGENT][NEUTRAL] This one was received 29 of 24 and then processed 226 of 24.
[AGENT][NEGATIVE] Looks like diagnostic testing performed was not covered.
[AGENT][NEUTRAL] And then the claim number for this was 3416614.
[CUSTOMER][NEUTRAL] And then we're good, um, the rest of them I think I'll just wait and see if I can get portal access to.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] That's too many, um.
[CUSTOMER][NEUTRAL] So do I need to call IT myself or?
[AGENT][NEUTRAL] No, no, no. I will check with them to see if there's an ongoing issue. If you continue to have issues uh later in the day, just give us a call back. I'm just gonna call over to them and report it to see if it's a known issue going on.
[CUSTOMER][NEUTRAL] OK perfect um now how just wait until later today and call back and see if it's been cleared.
[AGENT][POSITIVE] Yeah, see if, see if you're still having issues or not. Hopefully it'll clear up if it's something that's going on online. Absolutely.
[CUSTOMER][POSITIVE] Yeah, it does happen. Alright, I appreciate your help. Thank you so much for your help.
[AGENT][POSITIVE] You're welcome. I hope you have a good rest of your day.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] You too thanks bye.
[AGENT][NEUTRAL] Bye-bye.