AccountId: 011433970860
ContactId: a9d636cd-1db9-41f1-bf58-d2cad0bd5d03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 621239 ms
Total Talk Time (AGENT): 248495 ms
Total Talk Time (CUSTOMER): 195066 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/a9d636cd-1db9-41f1-bf58-d2cad0bd5d03_20250204T17:14_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office to check claim status.
[AGENT][NEUTRAL] OK, I'll be glad to help you, but I am so sorry I did not catch your name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you for that. Go ahead and give me a good policy number.
[CUSTOMER][NEUTRAL] Your policy number is uh
[CUSTOMER][NEUTRAL] 1420528 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Alright, either my phone or your phone was breaking up. Go ahead and say that number one more time, please, ma'am.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] It's 1420.
[CUSTOMER][NEUTRAL] 528 M as in Mary, L as in Lima, 8.
[AGENT][POSITIVE] OK, thank you so much for that, [PII]. Let me get that pulled up and while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] Member name?
[AGENT][NEUTRAL] No, the return telephone call number just in case we get disconnected.
[CUSTOMER][NEUTRAL] OK. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, [PII], thank you for that. Now, what's your patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, patient name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] All right, [PII], thank you so much for all that information. Now you did say you want to check status of a claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] D of service is 95 of 2024 and charge amount is $501 even.
[AGENT][NEUTRAL] All right, [PII], thank you for that. Now hold on just a moment let me see if I can find that charge. Let's see.
[AGENT][NEUTRAL] For 501. Was that correct?
[CUSTOMER][NEUTRAL] Yes, 501.
[AGENT][NEUTRAL] Yeah, let's see.
[AGENT][NEUTRAL] Alright, 501.
[AGENT][NEUTRAL] Yeah, it looks like we have received your claim for 501 and we're receiving your claim, but we're not receiving the uh primary explanation of benefits so we can coordinate with that primary insurance carrier. So would you like for me to give you a fax number so you can fax that EOB over to APL?
[CUSTOMER][NEUTRAL] OK. What is the fax number?
[AGENT][NEUTRAL] Yes, our fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. And the last four digits, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Uh, may I get a claim number for this?
[AGENT][NEUTRAL] Yes, and make sure you write this claim number on your fax so we can identify who it goes with once it gets here or we will not be able to identify it, uh, but that claim number is 5 I'm sorry 350.
[AGENT][NEUTRAL] 8211.
[CUSTOMER][NEUTRAL] OK. Thank you. Can you check for one more patient?
[AGENT][NEUTRAL] Is it a different patient?
[CUSTOMER][NEUTRAL] Same claim
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Same patient.
[CUSTOMER][NEUTRAL] No, no, different patients.
[AGENT][NEUTRAL] OK, yeah, I'll be glad to help you, but hold on just a moment and let me get this recorded right quick, so hold on, OK?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, [PII], go ahead with your next claim the other claim number.
[CUSTOMER][NEUTRAL] Actually, I want one more clarification on the regarding previous claim. You want a fresh claim with the primary OBR or you want just a, a paper claim?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Which one do you want, ma'am?
[AGENT][NEUTRAL] So you can do the paper claim along with that uh EOB if you would like, that would be fine.
[CUSTOMER][NEUTRAL] OK, not a uh fresh clam, right? Again?
[AGENT][NEUTRAL] No, we don't, we don't have to have the, the, a fresh claim only if you want to send it, but we do have to have that EOB with that claim number written on it.
[CUSTOMER][NEUTRAL] OK. With the claim number, you want the primary OB, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that's what we need primary EOB.
[CUSTOMER][NEUTRAL] OK. Uh, OK, ma'am. One second.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. Can I tell the member ID?
[AGENT][NEUTRAL] Sure, go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Member ID is 0248, sorry, I will repeat it again. 02478769 M as in Mary, L as in Lima, number 8.
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] Alright, and your patient's name and date of birth on this one.
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] [PII]. And date of birth is [PII].
[AGENT][NEUTRAL] Oh, it looks like Daniel is a dependent. Now you want to check status of a claim. Is that correct on this one as well?
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[CUSTOMER][NEUTRAL] And the charges is 1000.
[AGENT][NEUTRAL] And you
[CUSTOMER][NEUTRAL] $1,316 even.
[AGENT][NEGATIVE] Yes ma'am, it looks like we do have that claim now this is a per calendar day benefit and patient has already maxed out that benefit, but you should have gotten this COB it's been denied.
[CUSTOMER][NEUTRAL] OK. May I know the reason for the denial and when was the denial, what is the denial date?
[AGENT][NEUTRAL] Yeah, the reason is they've maxed out the per calendar day benefit.
[CUSTOMER][NEUTRAL] OK. How many uh like uh
[CUSTOMER][POSITIVE] Patient have a benefits.
[CUSTOMER][NEUTRAL] Like is that a dollar amount or uh?
[AGENT][NEUTRAL] Yes, it's right, dollar amount. It's a dollar amount. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, ma'am. How much is the patient yearly dollar amount and how much is the patient uh met already?
[AGENT][NEUTRAL] The max that we're going to pay is $300 per calendar day for their benefit here.
[CUSTOMER][NEUTRAL] $300 right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Excluding this claim, you have already paid for this patient, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, ma'am. Thank you. May I know the call reference number for this and the claim number?
[AGENT][NEUTRAL] Well, we
[AGENT][NEUTRAL] Yes, ma'am. I say you want your claim number? It is 3501.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 968.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, ma'am. Call call reference number?
[AGENT][NEUTRAL] We do not give call reference number to, but you can use my name on today's date if you need to do so. My name is [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Can you spell your, can you spell your name?
[AGENT][NEUTRAL] I sure can, [PII]. Yes ma'am, [PII] yes. And is that all I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, nothing. Thank you. Thank you for assisting.
[AGENT][POSITIVE] Yes, ma'am, and thanks for calling APL. You as well, [PII]. Bye-bye.
[CUSTOMER][POSITIVE] Have a nice day.