AccountId: 011433970860
ContactId: aef28f32-ed22-4910-85a4-0a9fcbad0351
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406540 ms
Total Talk Time (AGENT): 124574 ms
Total Talk Time (CUSTOMER): 112916 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/aef28f32-ed22-4910-85a4-0a9fcbad0351_20250131T20:49_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] Yes, uh, this is [PII] calling from the provider's office to check on a claim status for a patient. And also, could you spell your name again?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you have one patient that you're needing claim status on, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, I can help you with that for us and what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] Yes, um, policy number is 01866.
[CUSTOMER][NEUTRAL] 995 M as in Mary, L as in Lima.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, uh, patient name is it's, uh,
[CUSTOMER][NEUTRAL] [PII], and date of birth [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Yes, I'm looking for the data service for [PII].
[CUSTOMER][NEUTRAL] And it's billed for just a second.
[CUSTOMER][NEUTRAL] Yep, it's bill for $6,556 even.
[CUSTOMER][NEUTRAL] 88,510.
[AGENT][NEUTRAL] Thank you and you said the data services 46 of 2024, is that also correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] H 0
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was received for.
[AGENT][NEUTRAL] And the received date for this claim is going to be.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The received date was [PII] and processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is
[CUSTOMER][NEGATIVE] and denied on.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Could you repeat that denied date again?
[AGENT][NEUTRAL] OK, let me go back to that information.
[AGENT][NEUTRAL] Received 99, processed and denied on [PII].
[CUSTOMER][NEUTRAL] Of [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Claim number is 3504539.
[CUSTOMER][NEUTRAL] OK, and the claim.
[AGENT][NEUTRAL] And the reason for the dinner.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Uh yes, please, go ahead.
[AGENT][NEUTRAL] The reason for the denials is states to please provide copies of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Denied for primary will be right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, uh, and also could you provide me which insurance is having as a primary for this patient?
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][NEUTRAL] This representative.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] For her employer it shows it to be UMR.
[CUSTOMER][NEUTRAL] Oh, just a second, I'm uh OK.
[AGENT][NEUTRAL] UMR.
[CUSTOMER][NEUTRAL] Yeah, um
[CUSTOMER][NEUTRAL] Got it, got it, got it. Uh, you are more with the member ID?
[AGENT][NEUTRAL] I do not have that information. You would have to contact the number for that.
[AGENT][NEUTRAL] We are only the supplemental insurance.
[CUSTOMER][NEUTRAL] Oh, OK. And also when was the COB updated last by the patient?
[AGENT][NEUTRAL] We are not a primary, we are not a major medical insurance company.
[AGENT][NEGATIVE] There is no coordination of benefits with that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits for us, you may print that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Got it thank you so much and the call reference number?
[AGENT][NEUTRAL] It would be my name along with today's date.
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] To that's it. Thank you, [PII]. Thank you so much for your information. So have a good day.
[AGENT][POSITIVE] Yes, sir. OK, for us, you're very welcome. Yes, sir, you too, and thank you again for calling APL. I hope you have a nice weekend as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah. Bye-bye. Have a good weekend.
[AGENT][NEUTRAL] Bye bye.