AccountId: 011433970860
ContactId: ae1fd893-c3f8-4fef-b9a8-5b9f4bdbdf51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 460929 ms
Total Talk Time (AGENT): 200954 ms
Total Talk Time (CUSTOMER): 95554 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/ae1fd893-c3f8-4fef-b9a8-5b9f4bdbdf51_20250213T18:16_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII] and I'm calling provider's office and I'm looking for claim information.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Actually, claim denied. I need some clarification regarding this claim.
[AGENT][NEUTRAL] OK, so you have one claim that you're needing clarification on the denial, is that correct?
[CUSTOMER][NEUTRAL] Yeah, I have only one claim.
[AGENT][POSITIVE] Yes, I can help you with that, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] Callback number we have is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, [PII]?
[CUSTOMER][NEUTRAL] 02433298 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, so any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] First name is [PII] Last name is [PII] Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the data service name that you're calling in regards to place and total bill amount.
[CUSTOMER][NEUTRAL] D of service is July, sorry.
[CUSTOMER][NEUTRAL] Uh, [PII] total bill amount is $297.
[AGENT][NEUTRAL] Thank you. And the claim number?
[CUSTOMER][NEUTRAL] 353-5921
[AGENT][NEUTRAL] I'm sorry, can you please repeat that for me, [PII]?
[CUSTOMER][NEUTRAL] Claim number is 3535921.
[AGENT][POSITIVE] Thank you. One moment please.
[AGENT][NEUTRAL] And the name of the provider group?
[CUSTOMER][NEUTRAL] Trenton Medical Center, also known as Palms Medical Group.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so yes, on this claim, one of the reasons, one of the.
[AGENT][NEUTRAL] One of the denial reasons is that office visits are not covered by the above numbered policy, the member supplemental plan does not cover office visits.
[AGENT][NEUTRAL] The other denial remark on this codes on this claim rather states to please provide copies of your explanation of benefits from your primary insurance carrier.
[AGENT][NEUTRAL] This is a supplemental policy, so we would need a primary EOB.
[CUSTOMER][NEUTRAL] So you guys need a primary.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] But we will this claim with Prime OV.
[AGENT][NEUTRAL] We didn't, we do not, I'm gonna look at the information received on this claim number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], we did not receive a primary insurance. The only thing we received for this member was the claim form.
[CUSTOMER][NEUTRAL] OK. So we need to send this uh claim form attached with the EOB, right?
[AGENT][NEUTRAL] We only need the primary insurance's explanation of benefits for this service date.
[CUSTOMER][NEUTRAL] OK. May I know the claim mailing address?
[AGENT][NEUTRAL] What do you show on file for this number?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What do you have on file for this number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No sir, that is an old mailing. No sir, that is an old mailing address. The correct claims mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm. No.
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the zip code?
[CUSTOMER][NEUTRAL] Could you please spell it for me?
[AGENT][NEUTRAL] The city is spelled as [PII]
[AGENT][NEUTRAL] The next word is [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The state is [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Correct. Again, the zip code is [PII].
[CUSTOMER][NEUTRAL] Is there any fax number?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] 23 attention claims.
[CUSTOMER][NEUTRAL] Timely filing for claims.
[AGENT][NEUTRAL] No timely filing limit?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Timely filing limit for claims is.
[AGENT][NEUTRAL] I just, [PII], I just said there is no timely filing limit.
[CUSTOMER][NEUTRAL] There's no time filing, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Give me just a second.
[CUSTOMER][NEUTRAL] May I know your name?
[AGENT][NEUTRAL] Again, my name is [PII] and you will use my name along with today's date as your call reference number and if you need a copy of this explanation of benefits, you would print that from our portal by going to secured.
[CUSTOMER][NEUTRAL] Who is better?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] My name is spelled [PII]
[CUSTOMER][NEUTRAL] Could you give me the
[AGENT][NEUTRAL] And my again my name in today's date will be your call reference number.
[CUSTOMER][POSITIVE] Thank you, [PII]. Have a nice day.
[AGENT][POSITIVE] You're welcome, [PII], and if that's all that I can help you with, thank you again for calling APL and I hope you have a nice day also.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye.