AccountId: 011433970860
ContactId: a546b33d-6e13-43c5-b5a6-3bc35fc60090
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 546080 ms
Total Talk Time (AGENT): 179205 ms
Total Talk Time (CUSTOMER): 195092 ms
Interruptions: 5
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/a546b33d-6e13-43c5-b5a6-3bc35fc60090_20250121T14:18_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hello. Good morning. Myself, [PII], and I'm calling you from a provider's office to check your claim status.
[AGENT][NEUTRAL] OK, you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes, I can help you. And what was your name again? I'm sorry, I didn't understand you.
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[AGENT][NEUTRAL] OK, Dosh, thank you. And your callback number?
[CUSTOMER][NEUTRAL] Before providing me that, I would like to let you know this call is being recorded for quality and training purposes. Callback number is [PII] with extension [PII].
[AGENT][NEUTRAL] Thank you. And how many claims or do you have to check status on?
[CUSTOMER][NEUTRAL] One only.
[AGENT][NEUTRAL] Thank you. And what is that policy number?
[CUSTOMER][NEUTRAL] Uh, it is.
[CUSTOMER][NEUTRAL] 01659579 M. Mike Lima Bravo.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me your phone number one more time, please. [PII], yes, your phone number. Is it [PII]? Uh-huh.
[CUSTOMER][NEUTRAL] Phone number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] With extension [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And any information or dash that I do provide today will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] [PII] is the name. Uh, [PII] is the date of birth.
[AGENT][POSITIVE] Thank you. Data service and total bill amount.
[CUSTOMER][NEUTRAL] [PII] is the date of service, $497.26 is the bill amount.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So give me a couple of moments to look through some things.
[CUSTOMER][NEUTRAL] All right. OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so [PII], I do see that this claim was received. This claim was received [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Processed and denied.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Actually, I have a specific question about it that uh previously when we
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm sorry, I thought you needed that.
[CUSTOMER][NEUTRAL] No, no, no, I'm sorry, uh, to interrupt and uh cut the line. However, what I wanted to say is that previously we called on [PII] [PII] and uh on that call, we found that the claim has been denied uh as
[CUSTOMER][NEUTRAL] Uh, they, the insurance need the primary UB.
[CUSTOMER][NEUTRAL] Is it still the same denial as we have sent it via fax?
[AGENT][NEUTRAL] Hm
[AGENT][NEGATIVE] Mm, no. For this billed out, no. It is not the same denial.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Uh, can you verify the call reference number?
[CUSTOMER][NEUTRAL] That uh it is EVM.
[AGENT][NEUTRAL] OK, once we we may have received that and then it was re-reviewed on the same day if you sent that to us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the name of the.
[CUSTOMER][NEUTRAL] Yes, we have
[CUSTOMER][NEUTRAL] We have sent the fax on [PII].
[CUSTOMER][NEUTRAL] Under the claim number 349-6299.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm, I don't know what that claim number is. What was that claim number again?
[CUSTOMER][NEUTRAL] 349-629-9
[AGENT][NEGATIVE] OK, that claim number does not even go with the state of service.
[CUSTOMER][NEUTRAL] Uh, is there any previous claim for the same member with this claim number?
[AGENT][NEUTRAL] I see one claim number.
[AGENT][NEUTRAL] Give me a second to see what that claim number you gave me is for.
[AGENT][NEUTRAL] OK, I see that we have received, I see that claim number that you gave me.
[CUSTOMER][NEUTRAL] 349-629-99.
[AGENT][NEUTRAL] Mhm. That is correct, and it was denied for needing the explanation of benefits.
[CUSTOMER][NEUTRAL] OK. So, the claim number that we were initially talking about and this claim number that I recently gave you, these both claims are similar.
[AGENT][NEUTRAL] That was reviewed.
[AGENT][NEUTRAL] Is the one that was
[CUSTOMER][NEUTRAL] Uh, the same claim or these two different claims?
[AGENT][NEUTRAL] They're the same
[AGENT][NEUTRAL] Same plan.
[CUSTOMER][NEUTRAL] Same claims, right? So you have received the primary UB now?
[AGENT][NEUTRAL] That is correct, and it was denied under a different claim number, the one that I gave you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, you have not given me, uh, any claim number as of now. However, this is the second time I'm calling about this particular claim, so I, uh, already have a claim number. Is it the one that ends with 4844?
[AGENT][NEUTRAL] OK, I'm sorry. OK, yeah.
[AGENT][NEUTRAL] There was another one issued when we received the explanation of benefits, so the claim was processed under a different claim number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] All right. What's the claim number?
[AGENT][NEUTRAL] 352-484-4
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yes, and it has been denied as maximum benefits met, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] All right. Uh,
[CUSTOMER][NEUTRAL] And uh this has been reprocessed right after you received the primary UB.
[AGENT][NEUTRAL] And the denial, once it was when the primary insurance company's explanation of benefits was received, it was reviewed. The claim number that I just gave you was given and yes, it was.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] Uh-huh. When, when did you receive the primary UV?
[AGENT][NEUTRAL] 10:29.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much. This is the only information that I needed. Uh, also, how do you spell your name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] and my name [PII], with the excuse me, and today's date would be your call reference number and then any um if you need a copy of the other explanation of benefits, you may print that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK. Thank you so much. You have been a great help and I hope that you have a good rest of the day. Bye for now.
[AGENT][POSITIVE] I hope you do too. Thank you very much and I hope you have a nice day as well.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][POSITIVE] Oh, you're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.