AccountId: 011433970860
ContactId: a6be2264-b33f-4837-8fda-7c60ecb4b3e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1516430 ms
Total Talk Time (AGENT): 361383 ms
Total Talk Time (CUSTOMER): 283580 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/a6be2264-b33f-4837-8fda-7c60ecb4b3e7_20250310T13:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. It's [PII] calling from the provider office to know the claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] I have 6 claims.
[AGENT][NEUTRAL] Are they for the same patient or 6 different patients?
[CUSTOMER][NEUTRAL] No, different, 6 different patients.
[AGENT][NEUTRAL] And one date of service each?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so [PII], you will use my name that I gave you along with today's date as your call reference number for each one. Also, any information that I provide for you will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of the explanation of benefits, you may print that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And what is the first policy number?
[CUSTOMER][NEUTRAL] The policy number is, just, wait a second.
[CUSTOMER][NEUTRAL] The policy number is 01780690.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's last name is [PII].
[CUSTOMER][NEUTRAL] Then first name is [PII] and date of birth, [PII].
[AGENT][NEUTRAL] OK, so on this policy, there is another company that you would contact for claim status, and that is Webb TPA.
[AGENT][NEUTRAL] And their phone number is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You can't give me any information about this then?
[AGENT][NEUTRAL] I'm so sorry, what was your question?
[CUSTOMER][NEUTRAL] You can't give any claim status on this account.
[AGENT][NEUTRAL] No, ma'am. No, sir. I cannot. No, sir, I cannot.
[CUSTOMER][NEUTRAL] OK. OK, no problem. I'll provide you another claim number, sorry, policy number.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Let me know when you are ready.
[AGENT][NEUTRAL] And the next policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 02549553.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] And the patient's last name is and the first name is [PII].
[CUSTOMER][NEUTRAL] And date of birth, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And what is the data service and total bill amount please?
[CUSTOMER][NEUTRAL] The date of service is [PII] and total charge amount is $21,248 even.
[AGENT][NEUTRAL] $21,248. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, so this claim was received. The received date was [PII]. The claim was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The claim number is 355-0984.
[AGENT][NEUTRAL] And this claim was denied because we are in need of the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] As per checking, we have already sent you the primary EOB multiple times.
[AGENT][NEUTRAL] Uh
[AGENT][NEGATIVE] And as for checking, we have not received it.
[CUSTOMER][NEUTRAL] OK. Can you just cross-check the fax number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That is correct and you put a one in front of it?
[AGENT][NEUTRAL] It's 18773659423 attention claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much. I'll provide another policy number.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] OK. And what is the next patient's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Yes, just wait a second. The policy.
[CUSTOMER][NEUTRAL] The policy number is 01070427.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And the uh patient's name, I'm sorry, and date of birth?
[CUSTOMER][NEUTRAL] The patient's last name is [PII] and the first name is [PII]. Date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] Just
[AGENT][NEUTRAL] Bear with me just one moment, please.
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[AGENT][NEUTRAL] And the date of service and total bill amount for her place.
[CUSTOMER][NEUTRAL] Date of service, [PII] and total charge amount is $46,688 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received, we, um,
[AGENT][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] It was received on [PII], denied on [PII]. The claim number is 355.
[AGENT][NEGATIVE] 0927. This one was also denied because we need the primary insurance company's explanation of benefits and that has not been received.
[CUSTOMER][NEUTRAL] Can you just tell me the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you. Just wait a second. I'll provide you another policy number.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, and the next.
[CUSTOMER][NEUTRAL] Let me know when you are ready.
[AGENT][POSITIVE] I am ready.
[CUSTOMER][NEUTRAL] Next policy number is 2455568.
[AGENT][NEUTRAL] OK, thank you, [PII], one moment.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's last name is [PII].
[CUSTOMER][NEUTRAL] And the first name is [PII]. Date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service, [PII], and total bill amount please.
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charge amount, $7,861 even.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And give me a moment to look at something on this one, please.
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][NEUTRAL] OK, so this claim, and it was received on 113 and denied on 114 under claim number 3551551, also in need of the primary insurance EOB.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That EOB was received on [PII], but it has not yet been reviewed. That information is in line for review.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] We.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the approximate review time is 7 to 10 business days.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 10 business days, OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And is there any other information that you need on this claim, [PII]?
[CUSTOMER][POSITIVE] No, thank you. I'll provide you with another.
[CUSTOMER][NEUTRAL] Policy number?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] OK. The policy number is 02487974 M as in Mike L as in Lima 7.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] The patient's last name is [PII] and the first name is [PII]. Date of birth, [PII].
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And the day of service and total build out for her place, [PII]?
[CUSTOMER][NEUTRAL] The date of service is [PII]. Total charge amount, $4,518 even.
[AGENT][NEUTRAL] 451 8. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so this claim was also received. The received date on it was [PII], processed and denied on [PII].
[AGENT][NEGATIVE] This claim was also denied because we are in need of the primary insurance EOB and we have not received that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We'll send you the via mailing.
[AGENT][NEUTRAL] I'm saying we do not have it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, [PII]. Just wait a second, I'll provide you the another, no.
[AGENT][NEUTRAL] And is there anything else?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then you said you have one more. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes, one more claim, last claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the last one, what is your last patient's policy number?
[CUSTOMER][NEUTRAL] The policy number is 02514350.
[AGENT][NEUTRAL] OK. 02514350. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] The last name is [PII] and the first name is [PII], and date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Date of service is [PII]. Total charge amount $6,944.65.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. So this claim was received. It was also denied for the same reason.
[AGENT][NEUTRAL] The claim number.
[AGENT][NEUTRAL] It's 3542358.
[AGENT][NEUTRAL] And it was denied because we need the primary insurance company's explanation of benefits. Give me just a moment to look at a couple of things on this policy also, please, [PII].
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, so this.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] OK, so this was it appears the primary EOB was received on [PII] and it is also in line for review. It has not yet been reviewed.
[CUSTOMER][NEUTRAL] OK. How many days it will take?
[AGENT][NEUTRAL] Again, 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much for your help.
[AGENT][POSITIVE] You're certainly very welcome. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, thank you so much, [PII].
[AGENT][POSITIVE] Well, you're very welcome and thank you again for calling APL. I hope you have a very nice day, [PII].
[CUSTOMER][NEUTRAL] Anyway.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.