AccountId: 011433970860
ContactId: abb3cbeb-4087-4477-a5d6-ebc1769945f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 905719 ms
Total Talk Time (AGENT): 182131 ms
Total Talk Time (CUSTOMER): 278677 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/abb3cbeb-4087-4477-a5d6-ebc1769945f3_20250515T19:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. [PII] here calling from provider's office to check on the claim. How are you?
[AGENT][POSITIVE] Good, how are you?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I'm also doing good. Thank you so much for asking.
[AGENT][NEUTRAL] OK, I can help you with claim status, and I missed your name. What was that?
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] OK, sir.
[AGENT][NEUTRAL] Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you have a policy number for that patient?
[CUSTOMER][NEUTRAL] 021-71362 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII], total charge amount is $336 336.
[AGENT][NEUTRAL] And you said it was for 1018, 2024?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] It looks like you don't have a claim on file. Would you be able to resubmit that?
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] Uh yes. Actually, I hear, I can see that USC have crossed over the claim. So you have not received the claim, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Can I know the policy effective date?
[AGENT][NEUTRAL] effective date is [PII].
[CUSTOMER][NEUTRAL] [PII] to present, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And what is the timely filing limit to submit the claim?
[AGENT][NEGATIVE] And there's no timely filing limit.
[CUSTOMER][NEUTRAL] Oh, OK. One moment.
[CUSTOMER][NEUTRAL] And can I get the payer ID?
[AGENT][NEUTRAL] Yes, payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801, right?
[CUSTOMER][NEUTRAL] Can you just verify the mailing address?
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much. Can I have call reference and I do have 3 more claims for you. So can you help me with that?
[AGENT][NEUTRAL] Yes call reference is my name [PII], first initial to last name, [PII], and today's date.
[AGENT][NEUTRAL] And then give me one moment.
[CUSTOMER][POSITIVE] OK. Yeah, sure. Take your time.
[CUSTOMER][NEUTRAL] Uh let me check if it is the same provider or not. One moment.
[AGENT][NEUTRAL] OK, and then I'm ready for the policy when you have it.
[CUSTOMER][NEUTRAL] Oh yes. It's uh 02282126 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, could you repeat that one more time? Sorry about that.
[CUSTOMER][NEUTRAL] Sure. It's uh 02282126. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Date of service and bill charges.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The service is [PII]. Total charge amount is $630 even 630. This is also a crossover claim. So let me know if you have a claim on file or not. If not, let me know the policy effective date.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Uh, it looks like the uh claim was received on [PII]. Proceed [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The outpatient benefit for the calendar year had already been met by the time we received this claim, dollar amount.
[CUSTOMER][NEUTRAL] Oh, I didn't understand. Can you just, uh, tell me again the name?
[AGENT][NEUTRAL] Outpatient benefit maximum has been met.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] OK, so outpatient maximum has met.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] In dollar or is it?
[AGENT][NEUTRAL] Dollar amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do it.
[CUSTOMER][NEUTRAL] How much is the policy allowed and how much in it?
[AGENT][NEUTRAL] The dollar amount is.
[AGENT][NEUTRAL] Dollar amounts 1000.
[CUSTOMER][NEUTRAL] So 1000 is allowed.
[AGENT][NEUTRAL] There's no allowable, it's just a secondary policy.
[AGENT][NEUTRAL] So, as a secondary policy, it pays a max of 1000 for outpatient services. So that was already utilized prior to this claim.
[CUSTOMER][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] OK. I utilized.
[CUSTOMER][POSITIVE] Thank you so much. Can I have the claim number?
[AGENT][NEUTRAL] Yes, claim number is 352.
[AGENT][NEUTRAL] 9698.
[CUSTOMER][NEUTRAL] OK. Call theence will be your name. And for this, uh, one moment, let me check. For this claim, I can be patient, right?
[AGENT][NEUTRAL] We're a secondary policy so we cannot instruct on patient responsibility.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So I have to coordinate with the patient regarding this?
[AGENT][NEUTRAL] Yes, under this policy, it's not covered, so.
[AGENT][NEGATIVE] Or has been denied.
[CUSTOMER][NEUTRAL] OK. So, I mean, uh, directly I can be patient, I have to coordinate first with the patient, right?
[AGENT][NEUTRAL] Yes, like we can't instruct you on patient responsibility, correct.
[CUSTOMER][NEUTRAL] OK. One moment.
[CUSTOMER][POSITIVE] OK, thank you. Can I give you next one?
[AGENT][NEUTRAL] Yes, what's the number?
[CUSTOMER][NEUTRAL] One moment. The member ID is going to be 014818.
[CUSTOMER][NEUTRAL] 48 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Day service and bill charges.
[CUSTOMER][NEUTRAL] This service is [PII].
[CUSTOMER][NEUTRAL] Total charges are $481 481 dollars.
[AGENT][NEUTRAL] I don't have that claim on file.
[AGENT][NEUTRAL] And that just
[CUSTOMER][NEUTRAL] OK. Can I know the policy for that?
[AGENT][NEUTRAL] effective date is [PII]. It's currently active.
[CUSTOMER][NEUTRAL] OK one moment.
[CUSTOMER][POSITIVE] OK, thank you so much for that. Can I give you the next one?
[AGENT][NEUTRAL] Uh, yes, hold on one moment.
[CUSTOMER][NEUTRAL] Mm, sure.
[AGENT][NEUTRAL] OK, and the next policy number?
[CUSTOMER][NEUTRAL] One moment. 10:20 2024.
[CUSTOMER][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] And maybe
[CUSTOMER][NEUTRAL] OK. So it's going to be 02.
[CUSTOMER][NEUTRAL] 464982.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] D of service and bill charges.
[CUSTOMER][NEUTRAL] Date of service is [PII]. Bill charges are $222 even 221.
[AGENT][NEUTRAL] I don't have that claim on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Effective date is [PII] currently active.
[CUSTOMER][POSITIVE] Affected it.
[CUSTOMER][POSITIVE] Thank you. Can I give you one last?
[AGENT][NEUTRAL] Uh yeah, one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And policy number?
[CUSTOMER][NEUTRAL] 021
[CUSTOMER][NEUTRAL] 68897, M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Data service and bill charges.
[CUSTOMER][NEUTRAL] The service is [PII].
[CUSTOMER][NEUTRAL] Total charges are $481 481 dollars.
[AGENT][NEUTRAL] Uh, this claim was received on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Process [PII].
[AGENT][NEUTRAL] Uh, services were rendered after termination date. Termination date [PII].
[CUSTOMER][NEUTRAL] Because you
[CUSTOMER][NEGATIVE] They were not.
[CUSTOMER][NEUTRAL] Uh, one moment, sorry.
[CUSTOMER][NEUTRAL] OK. So, can you tell me from when to when member was active?
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. So regarding this also, before billing patient, I have to coordinate with him, then I can release claim to patient, right?
[AGENT][NEUTRAL] Um, yes, I mean, we, we denied the claim, it's not covered, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] Uh yes, claim number.
[AGENT][NEUTRAL] 3545577.
[CUSTOMER][POSITIVE] So, yeah, that's it for today, [PII]. So thank you for your help and information. Have a nice day. Bye-bye for now.
[AGENT][POSITIVE] Thanks for calling APL you too. Bye bye.
[CUSTOMER][NEUTRAL] Mhm