AccountId: 011433970860
ContactId: a2532e0f-92cc-4f21-861e-b61fedf02899
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 938619 ms
Total Talk Time (AGENT): 305668 ms
Total Talk Time (CUSTOMER): 251026 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/a2532e0f-92cc-4f21-861e-b61fedf02899_20250605T15:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello, good afternoon, [PII]. My name is [PII], last name initial [PII]
[AGENT][NEUTRAL] Hi, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Yeah, I'm absolutely fine thank you so much for asking how are you?
[AGENT][POSITIVE] I'm doing well.
[AGENT][NEUTRAL] And how may I assist you today?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. So, I need your help with the claim status.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with the claim status. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, yeah, yeah, I do have two claims.
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's gonna be [PII].
[CUSTOMER][NEUTRAL] Direct line
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, so it's gonna be.
[CUSTOMER][NEUTRAL] Yeah. 01611652 M as in Mike, L as in Lima, 7.
[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] Sure. The first name gonna be [PII], last name [PII].
[CUSTOMER][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] [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] Yeah, it's gonna be [PII] with the total charged amount of $455.
[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] Oh yeah, it's [PII].
[AGENT][NEUTRAL] Um, what's the tax ID?
[CUSTOMER][NEUTRAL] Yeah, tax ID is gonna be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] So we have a claim here for your data service and with your total bill, but it's a different provider and a different tax ID. Is there any other um
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] Name for the provider that it could come up?
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Uh yeah, just a moment, let me, uh, it's can be for [PII].
[CUSTOMER][NEUTRAL] With the tax ID [PII], is that correct?
[AGENT][NEUTRAL] OK, yes, that's
[AGENT][NEUTRAL] The tax ID is not correct, but the um provider name is.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] So we can continue.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Well, hold on.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I just go you know.
[AGENT][NEUTRAL] We can't continue because it's a dish, so is it like multiple locations?
[CUSTOMER][NEUTRAL] No. Uh, it's for this single location but multiple providers.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] And what's the tax ID that you're showing?
[CUSTOMER][NEUTRAL] Uh, for this provider's [PII].
[AGENT][NEUTRAL] And what was the other option?
[AGENT][NEUTRAL] For the other, the first provider that you gave?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] OK, so that tax ID is on the claim, but it's listed under [PII]. OK, so you have everything, um.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 1329.
[CUSTOMER][NEUTRAL] 1329, all right.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the paid amount?
[AGENT][NEUTRAL] Paid a total of $38.19.
[CUSTOMER][NEUTRAL] $38. 19 cents.
[AGENT][POSITIVE] Yes, that's correct. It looks like.
[CUSTOMER][NEUTRAL] And is there any
[CUSTOMER][NEUTRAL] Uh, patient responsibility or any other denial for this claim?
[AGENT][NEUTRAL] Yes, I was gonna go over the denials with you. So it looks like um claim or uh code number 99214 was denied. Hold on one moment.
[AGENT][NEUTRAL] Because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then code 963 7.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And you said you had another claim that you needed to go over?
[CUSTOMER][NEUTRAL] Uh, yeah.
[CUSTOMER][NEUTRAL] Uh, actually, I need the payment details for this one. Can I get
[CUSTOMER][NEUTRAL] Uh, is it through check or EFT? What is the EFT number?
[AGENT][NEUTRAL] Hold on one moment. I, I understand. It's coming up. Hold on one second.
[CUSTOMER][NEUTRAL] Sort of thing, yeah.
[CUSTOMER][NEUTRAL] Yeah, alright.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So a single check, the check number is 204.
[AGENT][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 204
[AGENT][NEUTRAL] 12
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The um
[AGENT][NEUTRAL] Let's see, it was issued on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It cleared on [PII].
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] It cleared on [PII]?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And um it was mailed to address [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Uh, could you do me a favor? Could you fax me the EOB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yeah, it's gonna be 954 [PII].
[CUSTOMER][NEUTRAL] [PII] with my name on it, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Can you spell the last name for me, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Is the next claim for the same um member or policy or is it a different member?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Number.
[CUSTOMER][NEUTRAL] Yeah, it's for the same member and the same provider.
[AGENT][NEUTRAL] OK, and what's the next date of service?
[CUSTOMER][NEUTRAL] Yeah data service is gonna be.
[CUSTOMER][NEUTRAL] July
[CUSTOMER][NEUTRAL] With the billed amount of $455.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Hold on one moment, [PII]. The phone went in and out. All I heard was July and then billed them out.
[CUSTOMER][NEUTRAL] All right, yeah.
[AGENT][NEUTRAL] Um, so
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the billed amount is gonna be $455.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, is the total bill 2 $450 or $455?
[CUSTOMER][NEUTRAL] $55 455.
[AGENT][NEUTRAL] OK, so then we don't have a claim on file for your, uh, for this claim.
[CUSTOMER][NEUTRAL] OK, so as for my system, it was made on [PII].
[AGENT][NEUTRAL] So there is a claim that we received on [PII]. It is the um same provider, but it's a different total bill. If the total bill, if 455 is the only total bill, then we do not have your claim on file. That's why I was asking.
[CUSTOMER][NEUTRAL] There's a place
[CUSTOMER][NEUTRAL] yeah
[CUSTOMER][NEUTRAL] OK, so it is, is it for the same date of service?
[AGENT][NEUTRAL] Yes, of course, I searched for the date, the date of service [PII].
[CUSTOMER][NEUTRAL] All the different.
[AGENT][NEUTRAL] There is a claim here on file from your provider. The total bill is different. So if the only total bill is $455 we do not have your claim on file.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So is it uh $52.50? Is that one you received on?
[AGENT][NEUTRAL] The total that I'm showing is, is.
[AGENT][NEUTRAL] It's $450 which is why I was asking, is $455 the only total bill that it can be?
[CUSTOMER][NEUTRAL] Alright, let me check, cross check just a moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Got it, so they have.
[CUSTOMER][POSITIVE] Yeah, it's $450. Correct.
[AGENT][NEUTRAL] OK. So that claim was received. Hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] It was received on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1324.
[CUSTOMER][NEUTRAL] 1324 all right.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider, a total of $37.50.
[CUSTOMER][NEUTRAL] $37.50.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. It's 3750, right?
[AGENT][NEUTRAL] 37.50, yes, $37.50.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] I got it. So is there any denial for this one or all the CPT codes got paid?
[AGENT][NEUTRAL] Um, 99214 was denied because it was already submitted on a previous claim and office visits are not covered.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And could you provide me with the payment details?
[AGENT][NEUTRAL] Sure, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And for this one, will you need the um explanation of benefits faxed over to you as well?
[CUSTOMER][POSITIVE] Oh yeah, that would be so nice of you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it was a single check, check number 2040111.
[AGENT][NEUTRAL] The check was issued on [PII].
[AGENT][NEUTRAL] And cleared on [PII].
[CUSTOMER][NEUTRAL] All right, got it.
[CUSTOMER][POSITIVE] OK, that's it for today. Thank you so much. Can I have the reference number and your name again?
[AGENT][NEUTRAL] Yes, my name is [PII] There's no call reference number, but you can
[CUSTOMER][NEUTRAL] Alright yeah I know.
[AGENT][NEUTRAL] Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, no, thank you so much, [PII], and thank you so much for helping me out and uh, yeah, have a great day.
[AGENT][POSITIVE] Thanks for calling APL.
[AGENT][NEUTRAL] You also. Bye-bye.