AccountId: 011433970860
ContactId: aab9cf6f-9772-40f0-9f13-2877d189ce9e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 898309 ms
Total Talk Time (AGENT): 343180 ms
Total Talk Time (CUSTOMER): 183180 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/aab9cf6f-9772-40f0-9f13-2877d189ce9e_20250618T15:30_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on claims. Can you spell your name, please?
[AGENT][NEUTRAL] Uh, and I'm sorry I did not catch your name.
[CUSTOMER][NEUTRAL] It's uh [PII] initial is [PII].
[AGENT][POSITIVE] Alrighty, thank you for that, Rash, and go ahead and give me a policy number, please, sir.
[CUSTOMER][NEUTRAL] Uh, yes. Before that, can you spell your name, please?
[AGENT][NEUTRAL] I sure can. It is [PII] yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, member ID is 02249238.
[AGENT][NEUTRAL] All right, [PII], thank you for that. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please, sir.
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] Alright, thank you for that, Rash and your patient's name and date of birth today.
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Alrighty, thank you for that, Rash. Looks like [PII] is the insured on this medical supplemental plan. Now, you did say you want to check status of a claim. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Data service, please, sir.
[CUSTOMER][NEUTRAL] It's uh [PII]. Bill amount is uh $905 even.
[AGENT][NEUTRAL] Alright, right, let's see. I get that pulled up.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Well, I do see that claim in-house. It looks like there was a payment of $25 on the office visit. That is the max benefit payable under the supplemental plan.
[CUSTOMER][NEUTRAL] So $25 has been paid for which procedure code?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is that for 99204?
[AGENT][NEUTRAL] That is correct, paid on that office visit charge.
[CUSTOMER][NEUTRAL] So, maximum like uh you pay only $25 for office visit.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And may I know the name of the plan of the patient plan?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Patient plan name is Riverdale Farms.
[CUSTOMER][NEUTRAL] River day.
[AGENT][NEUTRAL] Riverdale Farms.
[CUSTOMER][NEUTRAL] Uh, sorry, can you provide me the spelling of this?
[AGENT][NEUTRAL] R I V E R D A L E, Riverdale Farms F A R M S.
[CUSTOMER][NEUTRAL] And may I know about the remaining procedure code 17,000 and 17003?
[AGENT][NEGATIVE] It's not gonna be covered because the max benefit per office visit is that $25 no matter what it's doing.
[CUSTOMER][NEUTRAL] But they are the different procedure code.
[AGENT][NEUTRAL] It doesn't matter. It, it's only the max $25 payable no matter what they have done in the office.
[CUSTOMER][NEUTRAL] All right. OK. Uh, I have one more claim. Can you check that also, please?
[AGENT][NEUTRAL] Is it the same patient?
[CUSTOMER][NEUTRAL] It's for different patient and the same provider.
[AGENT][NEUTRAL] OK, OK, well, hang on just a second for me. Let's see.
[CUSTOMER][NEUTRAL] Same facility.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, it's a different policy number. Go ahead and give me that, uh, one more other policy number, right.
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] 02249238.
[AGENT][NEUTRAL] Oh, let me get that one pulled up. Let's see. OK, what's your patient's name and date of, that's the same person.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] With that is service.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] What's your data service?
[CUSTOMER][NEUTRAL] Uh, sorry, sorry, just a minute. Uh.
[CUSTOMER][NEUTRAL] Uh, I'm sorry, Member ID is different. I really apologize. I gave you the incorrect member ID.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Uh, member ID is showing is [PII].
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] What you got one number missing. Say that one more time.
[CUSTOMER][NEUTRAL] It's 0198259.
[AGENT][NEGATIVE] There's still one number missing.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] You see anything else? That's one number short of our policy numbers.
[AGENT][NEUTRAL] It's it's supposed to be 88 numbers.
[CUSTOMER][NEUTRAL] Uh, let me reconfirm once again.
[AGENT][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Is it possible you can check with the name and date of birth?
[AGENT][NEUTRAL] It is, let me get over to that screen. Let's see. What's the uh spell the patient's last name or what is it?
[CUSTOMER][NEUTRAL] It's 01982592.
[AGENT][NEUTRAL] OK, different number. OK, hang on, let me get back over to that screen. Let's see.
[AGENT][NEUTRAL] OK, that comes up. What's your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and you want to check the status of that claim as well. What date of service?
[CUSTOMER][NEUTRAL] It's uh [PII]. The amount is uh $482 even.
[AGENT][NEUTRAL] Uh, let's see. Yes, I do have that claim in for $482 but it looks like because this is just their supplemental plan, we need a copy of that primary explanation of benefits sent to APL so we can coordinate that benefit.
[CUSTOMER][NEUTRAL] OK. So, we had already sent the primary via fax.
[AGENT][NEUTRAL] Yes, you can fax out of your bill. You want a fax number?
[CUSTOMER][NEUTRAL] No, we had already sent via fax.
[AGENT][NEUTRAL] All right, well, let me do some checking. Let's see.
[AGENT][NEUTRAL] Oh, do you know when you send it, I do see 5 claims in-house so that are here in line for processing.
[CUSTOMER][NEUTRAL] It was sent on [PII]. Like, can I check if you received the UB after [PII]?
[AGENT][NEUTRAL] Yes, I see, I do see one that we get in on [PII]. Hang on, let me go and look and see if it's it. So hang on just a moment, OK?
[AGENT][NEUTRAL] I'll go over here and see if we have it. Give me just a moment though.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] 28.
[AGENT][NEUTRAL] Just bear with me while I check on these 5 claims, OK? Let's see if we have it.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] I have one more to check, so bear with me. My computer moving a little slow this morning, OK?
[CUSTOMER][POSITIVE] It's OK. Take your, take your time.
[AGENT][POSITIVE] All righty. Thank you, sir.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] it
[AGENT][NEGATIVE] OK, I looked at all 5 claims and no, sir, we have not received that EOB.
[AGENT][NEGATIVE] Did you, you said you faxed it over because we don't have anything.
[CUSTOMER][NEUTRAL] OK. Well, I can see that we had already faxed on [PII]. Uh, can you provide me your fax number once again?
[AGENT][NEUTRAL] Yes, and put attention claims department.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And make sure you're putting that policy number that you give me on it, that's 01988259, that has to be written on it.
[AGENT][NEUTRAL] And a fax number. Excuse me, it's one.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, please confirm it's [PII].
[AGENT][POSITIVE] That is correct, [PII], yes.
[CUSTOMER][NEUTRAL] And can you provide me the claim receive date and process date?
[AGENT][NEUTRAL] Yep, hold on just a second.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Uh, let's see, claim received date was [PII]. Proceed date [PII].
[CUSTOMER][NEUTRAL] And is there any time for him to send the primary UB?
[AGENT][NEUTRAL] No, sir, we do not have a timely filing limit, so you're good to get that refax at any time that you wish.
[CUSTOMER][NEUTRAL] OK. And uh I forgot to ask one thing about previous claim, the issue date and denial date. Sorry to trouble you. Can you provide me the
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh, I sure can. Let me get that pulled back up. Give me just.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Just a minute. Let's see. Oh, you're welcome.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Uh, that received date was.
[AGENT][NEUTRAL] [PII], process date to [PII].
[CUSTOMER][NEUTRAL] It's about uh [PII], right?
[AGENT][POSITIVE] That is correct. I got Louis pull Becker.
[CUSTOMER][NEUTRAL] Are you sure it is uh received on [PII].
[AGENT][NEUTRAL] Yeah, 222221. 0, you're, I'm wrong, you are so right. I'm sorry, I looked at the claim before that. Receive date [PII]. Process date [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] Because like, I can see it was uh sent on.
[CUSTOMER][NEUTRAL] It's OK. All right. I'm done with the claims. Can I get the caller reference number?
[AGENT][NEUTRAL] Uh, uh, we don't give call reference numbers, uh, [PII], but you can use my name in today's date, OK?
[CUSTOMER][POSITIVE] Uh, sure, definitely. Thank you so much for the assistance. Have a great day.
[AGENT][POSITIVE] You as well, [PII], and you have a great day and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye.