AccountId: 011433970860
ContactId: a39f0200-546c-45ef-a78d-c20721ca07c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 592650 ms
Total Talk Time (AGENT): 146606 ms
Total Talk Time (CUSTOMER): 244825 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/a39f0200-546c-45ef-a78d-c20721ca07c3_20250305T16:23_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for Midwife [PII] I verified the being this call is made for additional information about the denial. Please know the call will be monitored and recorded for quality and training purposes, and could you please spell your name for me?
[AGENT][NEUTRAL] That's [PII]. And Ms. [PII], I need the name of the facility you're calling from again, and I need a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I do, I do know.
[CUSTOMER][NEUTRAL] Mhm. Facility name Medvise LLC and callback number is [PII] and that's a direct line.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number, Miss?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Policy number, uh, member ID that is 01986343.
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][POSITIVE] Thank you, one moment. Let's see.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK. And do you have a claim number or you have um the date of service?
[CUSTOMER][NEUTRAL] Um, I don't have the claim number. Uh, shall I put the data service? I'm sorry.
[AGENT][NEUTRAL] Go ahead with the date of service if you don't have the claim number.
[CUSTOMER][NEUTRAL] Mhm. November 20, mhm. November 25, 2024 and the bill amount is $50 even.
[AGENT][NEUTRAL] OK, let me see if I can find this claim, one moment.
[AGENT][NEUTRAL] And for future you can check claim status online through our website at [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Uh, you said $50 is the remaining or is that the total charge?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mm, oh, I'm sorry, just a moment please. I just need to verify here.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. And yes, uh, the total amount was $264.57.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] huh
[CUSTOMER][NEUTRAL] Lucy.
[AGENT][NEUTRAL] One moment, I'm waiting on the ELV.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, looks like we received the claim on [PII]. We processed on the [PII].
[AGENT][NEUTRAL] And let's see, looks like it was denied. Let me get the denial reason. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The our reason is that let's see. OK, so it looks like we're needing the um explanation of benefits that matches the information of the claim.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] We have
[CUSTOMER][NEUTRAL] OK. But we have already as the uh EOB Prime OB.
[AGENT][NEGATIVE] It's not matching the information.
[CUSTOMER][NEUTRAL] Could it be
[CUSTOMER][NEUTRAL] Um, but, uh, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, all right. So, um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 9083.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Hold on. So the submitted UB was uh invalid and we need to submit the UP, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The night for.
[CUSTOMER][NEUTRAL] The uh primary OB, right? So you are the secondary for this patient, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Uh, may I know when will you become, uh, so, uh, when
[CUSTOMER][NEUTRAL] Uh, you become secondary for this patient. I know that date?
[AGENT][NEUTRAL] OK, the, yeah, the effective date, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK. And uh the, OK. So the, uh, do you, uh
[CUSTOMER][NEUTRAL] Have the primary uh pay uh member ID claim mailing address, family filing limit. I, I do have the member ID. Are you able to verify that with me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You will have to contact the primary to do that. Um, we don't have their information. We only, yeah, we probably have just who is it, like the name of the company, but we don't have any other information besides that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Huh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] We need to submit as an appeal, right?
[AGENT][NEUTRAL] No, we need the explanation of benefits from the primary insurance with the correct information. That's all we need to continue the processing of the claim.
[CUSTOMER][NEUTRAL] Yes, so we need to submit an appeal with the OB, right?
[AGENT][NEUTRAL] You don't need an appeal. We just, mm, we just need this a copy of the explanation of benefits. That's all we need.
[CUSTOMER][NEUTRAL] With the primary
[CUSTOMER][NEUTRAL] We just need to, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is there any uh specific timely filing limit for submitting the UB?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] My mailing address for submitting that one is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] City, [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And uh the claim number I have here is 356-535-6, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] And I'm ready for, uh, just a moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, and I'm ready for the reference number.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. And uh actually,
[CUSTOMER][NEUTRAL] The receive date is [PII], right?
[AGENT][NEUTRAL] Um, let me get that. That's not on the EOB. One moment.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][POSITIVE] All right. Thank you so much for your assistance and have a great day, sir. Bye for now.
[AGENT][POSITIVE] You. You as well. Thank you for calling APL. bye-bye, Miss [PII].
[CUSTOMER][NEUTRAL] I