AccountId: 011433970860
ContactId: a2a0a896-b10f-4d0f-9e54-ff68d3751fb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 595710 ms
Total Talk Time (AGENT): 218843 ms
Total Talk Time (CUSTOMER): 197169 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/a2a0a896-b10f-4d0f-9e54-ff68d3751fb9_20250516T14:59_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from forest office to take the claim. And can you please spell your name for document purpose?
[AGENT][NEUTRAL] [PII], and can you spell your name?
[CUSTOMER][NEUTRAL] Sure. My name is [PII], spelled as [PII], last [PII]. And may I know your last initial?
[AGENT][NEUTRAL] Also, [PII].
[AGENT][NEUTRAL] And [PII], what is your uh callback number please?
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][NEUTRAL] OK, thank you. And you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh 1 patient, 3 claims.
[AGENT][NEUTRAL] Yes sir, I can help you with those, and you will use my name along with today's date as each call reference number. Also any information that is provided on any of the claims will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file once I give you the excuse me, the claim number, you if you need a copy of the explanation of benefits, you can print those by going to our portal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Which is located at secured.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. Uh, thank you.
[AGENT][NEUTRAL] Alright, and what is the member's policy number please?
[CUSTOMER][NEUTRAL] Uh, the member policy number is
[CUSTOMER][NEUTRAL] 02493393 M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], what is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] So, the patient name is
[CUSTOMER][NEUTRAL] [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and the date of first date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] The first date of service is going to be [PII]. And the total charge amount for the claim is $324 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so sure this claim was received. It was received on [PII].
[AGENT][NEGATIVE] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 358-6144.
[AGENT][NEGATIVE] And again, this was denied. The reason for the denial state office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] The member supplemental policy, Sharif does not cover office visits.
[CUSTOMER][NEUTRAL] OK. So you're telling that uh service is not covered under the patient plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, patient plan type is supplement plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEGATIVE] my office it's not good and the patient plan.
[CUSTOMER][NEUTRAL] OK. It was denied on [PII], correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. May I know whether this UOB has sent to the provider address?
[AGENT][NEUTRAL] It has been.
[AGENT][NEUTRAL] And you may also print.
[CUSTOMER][NEUTRAL] When
[AGENT][NEUTRAL] The claim was processed on the [PII]. It would have mailed out on the [PII].
[CUSTOMER][NEUTRAL] OK. And uh as I stated that we can download the UB from the portal. Also, I just wanted to know whether you have access to submit the UB via fax.
[AGENT][NEUTRAL] You can.
[AGENT][NEUTRAL] You can't, do you not have access to the Internet?
[CUSTOMER][NEUTRAL] No, I do not have. I already tried to do that.
[AGENT][NEGATIVE] OK, so it has, it has been mailed, but it has not had time to yet be received. That was just mailed last Friday.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] When the you you sent? What is the date?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It typically takes about 10 business days to be received.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, that means just just my address [PII].
[CUSTOMER][NEUTRAL] No problem. OK. Can I move to the next date of service?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK, the next date of service is.
[CUSTOMER][NEUTRAL] [PII] of this year, [PII]. Total charge amount $661 even.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was also received the same date and also processed on [PII] received 47, process 48.
[AGENT][NEUTRAL] The claim number is 3.
[CUSTOMER][NEUTRAL] Denied for the same reason?
[AGENT][NEUTRAL] Yes, so this one actually has 2 denial remarks.
[AGENT][NEUTRAL] First off, the claim number is 358-6133.
[CUSTOMER][NEUTRAL] Nothing.
[AGENT][NEGATIVE] And yes, office visits, the office visit was denied is not being covered.
[AGENT][NEUTRAL] And then the only other code is that the primary insurance paid full benefits.
[AGENT][NEGATIVE] On code 93,000 so there were no benefits payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then you'll be sent on [PII], right?
[AGENT][NEUTRAL] That would be correct.
[CUSTOMER][POSITIVE] Perfect. OK. And can I move to the last
[AGENT][POSITIVE] Yes, sir. I'm ready.
[CUSTOMER][NEUTRAL] D7.
[CUSTOMER][NEUTRAL] OK. The date of service is [PII], and total bill amount is $599 even. And this is also offers with the claim. So I think it is the same scenario I just the claim.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 6
[AGENT][NEUTRAL] OK, so this claim was also received. The receive date on it was also [PII] and processed on [PII], and yes sir, the denial is the same and the claim number is 3586132.
[CUSTOMER][NEUTRAL] Same day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 23586132, right?
[AGENT][NEUTRAL] 358-613-2. That is correct.
[CUSTOMER][NEUTRAL] Sorry, it was just coming in and out. Come again?
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] 23586132.
[AGENT][NEUTRAL] 358-6132.
[CUSTOMER][NEUTRAL] 12
[CUSTOMER][POSITIVE] OK. OK. Thank you so much for correcting me. And
[AGENT][POSITIVE] You're welcome. Yes, sir.
[CUSTOMER][NEUTRAL] That's it for today. And you said the call different number is your name and sir, right?
[AGENT][POSITIVE] Yes sir, that is also correct. And is there anything else that I could help you with today, [PII]?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Oh, thank you very much. Uh, you already assisted.
[AGENT][POSITIVE] OK. Well, you're very welcome and
[CUSTOMER][NEUTRAL] Uh, that's it for today.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] You too. Have a great weekend. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.