AccountId: 011433970860
ContactId: a79f2296-aad2-44c5-83d9-bcdc79f1f72e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1039040 ms
Total Talk Time (AGENT): 192451 ms
Total Talk Time (CUSTOMER): 316640 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/a79f2296-aad2-44c5-83d9-bcdc79f1f72e_20250610T16:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, uh, my name is [PII] calling from Medical University Hospital Authority. I'm looking for claims.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And policy number for the patient?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 02544
[CUSTOMER][NEUTRAL] 110.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Ta of service and build charges.
[CUSTOMER][NEUTRAL] Uh, [PII] and uh charges $387 even.
[AGENT][NEUTRAL] OK, looks like we received the first claim.
[AGENT][NEUTRAL] I received 319 2025.
[AGENT][NEUTRAL] Process 320 2025.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Benefits payable under the certificate are limited to the outline on the scheduled benefits. This is not covered under the policy.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I just reconfirm the claim number which I, which we have received 35.
[CUSTOMER][NEUTRAL] 83594. Is that correct?
[AGENT][NEUTRAL] Oh, that was the duplicate.
[AGENT][NEUTRAL] So the original claim number is 3357.
[CUSTOMER][NEUTRAL] OK. Uh, can I have the original?
[AGENT][NEUTRAL] 357-8595.
[CUSTOMER][NEUTRAL] OK, so was your claim denied us? Can you repeat one more time?
[AGENT][NEUTRAL] Um, it is, let me pull it up again.
[CUSTOMER][NEGATIVE] Benefit not covered, is it?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh, so the CPT code 99204, right? One moment.
[AGENT][NEUTRAL] Yes, office visit.
[CUSTOMER][NEUTRAL] So you mean to say uh office office visit is not covered as for the member plan?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh, can I have the EOB through my fax number?
[AGENT][NEUTRAL] What's your facts?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, my fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 2174, I repeat, [PII]. Attention to my name, [PII].
[AGENT][POSITIVE] OK, I'll get that faxed over. It just takes a few minutes. Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Yes, I do have another 3 claims. So, can I have the call reference number for this number?
[AGENT][NEUTRAL] Uh, call reference is my name, [PII].
[AGENT][NEUTRAL] First initial to last name, [PII]?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Today's date?
[AGENT][NEUTRAL] Uh, give me just a moment.
[CUSTOMER][NEUTRAL] And uh the next member ID whenever you're ready.
[AGENT][NEUTRAL] Uh yeah, just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, what's the next one?
[CUSTOMER][NEUTRAL] The member ID is 02.
[CUSTOMER][NEUTRAL] 446-510.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And what was the date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII] and uh the charge is $902 even.
[AGENT][NEUTRAL] [PII], or what was the date of service again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you said 907?
[CUSTOMER][NEUTRAL] 902.
[AGENT][NEUTRAL] OK, it looks like we've received it twice. Let me pull it up.
[AGENT][NEUTRAL] I originally received on [PII]. Process [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] a copy of the
[CUSTOMER][NEUTRAL] Uh, you're, you're giving me the information about the original claim, is it?
[AGENT][NEUTRAL] Yeah, do you have claim numbers?
[CUSTOMER][NEUTRAL] Uh, no, actually, we haven't received the UOB. So can I have the duplicate claim number as well?
[AGENT][NEUTRAL] Uh duplicate claim number 358-5313.
[CUSTOMER][NEUTRAL] OK. And uh the original claim number?
[AGENT][NEUTRAL] The Original is 3583818.
[AGENT][NEUTRAL] We originally denied it with a copy of the primary EOB.
[CUSTOMER][NEUTRAL] Uh-huh. And, uh, is it?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Can I have that UB as what?
[AGENT][NEUTRAL] Same fax number?
[CUSTOMER][NEUTRAL] OK. 209.
[CUSTOMER][NEUTRAL] 225
[CUSTOMER][NEUTRAL] 2174. I repeat, [PII]. Attention to my name, [PII]. And uh is there any fax number or something so we can submit uh the primary you'll be through the fax.
[AGENT][NEUTRAL] Fax number is 877-365.
[AGENT][NEUTRAL] 942 [PII].
[CUSTOMER][NEUTRAL] Got it. Is there any time frame for that?
[AGENT][NEUTRAL] Uh, no, there's not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the call reference number remains the same, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. So, the next number whenever you're ready.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's that number?
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 38
[CUSTOMER][NEUTRAL] 9387
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name, [PII]. Date of birth, [PII].
[CUSTOMER][NEUTRAL] my
[AGENT][NEUTRAL] Date of service and bill charges.
[CUSTOMER][NEUTRAL] Data service, [PII]. 1 moment.
[CUSTOMER][NEUTRAL] Uh, $151 even.
[AGENT][NEUTRAL] OK, looks like we received it twice. I get those pulled up.
[CUSTOMER][NEGATIVE] It is also duplicate.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. I'll just give you the claim number. Let me know whether it's uh original or duplicate.
[CUSTOMER][NEUTRAL] 358
[CUSTOMER][NEUTRAL] 4097.
[AGENT][NEUTRAL] And that's the original. We need the primary copy of the explanation of benefits.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] This is original, am I correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I give you. OK. Can I have the duplicate claim number?
[AGENT][NEUTRAL] Uh duplicate claim is
[AGENT][NEUTRAL] 3[PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, is it the same fax number? So I can, uh, uh, so we can send, submit the primary UB.
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] And can I have the UOB through my fax number, the duplicate claim UOB.
[CUSTOMER][NEUTRAL] Do you want me to repeat the fax number?
[AGENT][NEUTRAL] No, I don't need it.
[AGENT][NEUTRAL] Uh, give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Take your time. No problem.
[AGENT][NEUTRAL] OK, what was the next policy?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] The last member ID102.
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 0654.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it was 0201.
[CUSTOMER][NEUTRAL] 0654.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name, [PII]. Date of birth [PII].
[AGENT][NEUTRAL] D of service and bill charges.
[CUSTOMER][NEUTRAL] [PII] and uh the total charge is $277 even.
[AGENT][NEUTRAL] OK, looks like we've received it a few times. Let me get that pulled up. Do you have the claim numbers on this?
[CUSTOMER][NEUTRAL] Um, this is also duplicate.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK, I do have a
[CUSTOMER][NEUTRAL] Same number. I just tell you let me know whether it is duplicate original 358.
[CUSTOMER][NEUTRAL] 325 9.
[AGENT][NEUTRAL] That's the original claim.
[CUSTOMER][NEUTRAL] Mhm. Can I have the duplicate one?
[AGENT][NEUTRAL] 3584062
[CUSTOMER][NEUTRAL] I'm so sorry. 3584062?
[AGENT][NEUTRAL] Yes
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] Is it uh duplicate or non-covered charges?
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] No, this is not covered charges.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] So, this is duplicate, is it?
[AGENT][NEUTRAL] The 3584062 is the correct denial. It's not a covered service.
[CUSTOMER][NEUTRAL] Which is duplicate claim, is it?
[AGENT][NEUTRAL] It's the 2nd claim we received, yes.
[CUSTOMER][NEUTRAL] OK. And uh the original claim which I just provided the claim number, uh, is it required a primary UBS?
[AGENT][NEUTRAL] You that
[AGENT][NEGATIVE] Yes, we requested the primary explanation of benefits, but it really should have just been denied, and that's what we did on the second submission. It's not a covered benefit, so it doesn't matter if we have the primary EOB.
[AGENT][NEUTRAL] Do you need a copy of the EOB?
[CUSTOMER][NEUTRAL] So what uh
[CUSTOMER][NEUTRAL] No, no, I'm, I'm asking you like what are the information required right to process the claim right now.
[AGENT][NEUTRAL] There is no other information required. It's not a covered service.
[CUSTOMER][NEUTRAL] Not covered as per the member plan or provider contract?
[AGENT][NEUTRAL] Never plan?
[CUSTOMER][NEUTRAL] Uh, 99214 you mean to say the offices it does not cover us for the patient plan?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I have the patient plan name is?
[AGENT][NEUTRAL] Patient plan name is Medlink.
[CUSTOMER][NEUTRAL] Can you spell it out for me, MED?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, the duplicate which you gave me 4062.
[CUSTOMER][NEUTRAL] And the original claim is 3583259. Am I correct? which is noncovered as for the member plan, am I correct?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Can I have the original claim, uh UOB through my fax number?
[AGENT][POSITIVE] Yes, I'll get that sent your way.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm so sorry. Can I have the received date and the processed date as well for the original?
[AGENT][NEUTRAL] Uh, receive 41, process 42.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK. Is there anything else I can help with today?
[CUSTOMER][POSITIVE] Uh, that's all for today, [PII]. Thank you so much, uh, for the information you just provided. Uh, thank you and have a nice day. Bye-bye.
[AGENT][POSITIVE] Thanks for calling APL. You too. Bye-bye.