AccountId: 011433970860
ContactId: b0ee3b12-a60b-42cf-b34b-6d5bcee777a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2336010 ms
Total Talk Time (AGENT): 812600 ms
Total Talk Time (CUSTOMER): 1043723 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/b0ee3b12-a60b-42cf-b34b-6d5bcee777a0_20250122T16:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, hi, good morning. My name is [PII] calling from the provider office, Elisa.
[AGENT][POSITIVE] Good morning, [PII]. What is a good callback number, please?
[CUSTOMER][NEUTRAL] Sure. It's gonna be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yeah. 02446815 M as in Mary, L as in Lima 7.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the first name is [PII] and the last name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] All right. Thank you, [PII]. And how can I help you today?
[CUSTOMER][NEUTRAL] Yeah, uh, I, uh, the reason I'm calling is, uh, I just want to know the general claim status. I would more appreciate if you can assist me with the general or latest claims status of this member.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you with claim status today, [PII]. What is the data service?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, [PII], 1203-2024 and the bill amount is $350.55.
[AGENT][NEUTRAL] All right, thank you, [PII]. And what is the facility name?
[CUSTOMER][NEUTRAL] Nicholas Ten's Pediatrics.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] I'm checking the claim status for you.
[AGENT][POSITIVE] [PII], we did receive my pleasure. We received that claim on [PII].
[CUSTOMER][POSITIVE] Yeah, sure, definitely.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 2025 claim was processed on [PII] with a payment of $350.55 to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 350, uh, [PII], can you be a little bit slow because you seems like you're too fast.
[AGENT][POSITIVE] Oh, no, I do apologize. Sure, I can go slower.
[CUSTOMER][NEUTRAL] Yeah, can you please, uh,
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][NEUTRAL] Yeah, can you please repeat the pay amount?
[AGENT][NEUTRAL] Yes, sir. That pay amount was $350.55 and that did go to Nicholas [PII]'s Pediatrics.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And the claim number?
[AGENT][NEUTRAL] Claim number is.
[AGENT][NEUTRAL] 355.
[AGENT][NEUTRAL] 2433.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it paid through EFT or check?
[AGENT][NEUTRAL] Single paper check.
[CUSTOMER][NEUTRAL] And the single amount was $300.55. Am I right?
[AGENT][POSITIVE] $350.55. That is correct.
[CUSTOMER][NEUTRAL] OK, thank you so much, and can you please verify me again if it's paid through EFT or check?
[AGENT][NEUTRAL] Single paper check.
[CUSTOMER][NEUTRAL] Uh, and can you please give me the check number?
[AGENT][NEUTRAL] Check number 202.
[AGENT][NEUTRAL] 3197.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 970 or uh can you please uh verify me again uh in which that the uh the check was issued or cared?
[AGENT][NEUTRAL] It was issued on [PII]. It is not cleared yet.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's not yet clear, am I right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] So we need to allow some additional time, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK. And the call reference number for this member?
[AGENT][NEUTRAL] Call reference number is my name and today's date, and Mark, I spell my name. You need me to spell my name?
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] No, no, no, [PII] is correct?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] [PII]. Thank you so much, [PII]. Thank you so much, [PII]. I really appreciate it, OK. Uh, OK.
[AGENT][POSITIVE] It's been my pleasure to help you with that claim status. Anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah, can we move to the next again [PII]?
[AGENT][NEUTRAL] Sure. What is that next policy number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It's gonna be a same member and different data service.
[AGENT][NEUTRAL] OK, and what is that data service?
[CUSTOMER][NEUTRAL] Sure. Uh, the date of service is gonna be, just one, please.
[CUSTOMER][NEUTRAL] Uh, [PII] and the bill amount is $343.08.
[AGENT][NEUTRAL] OK, let me check that one for you.
[CUSTOMER][POSITIVE] Sure. Take your time.
[AGENT][NEUTRAL] Well I'm checking this, um, [PII], we do have a provider portal.
[AGENT][NEUTRAL] At [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on that portal, you do have 24/7 access to claim status, EOBs.
[CUSTOMER][NEUTRAL] Uh, yeah, can you please repeat it again? Can you please uh repeat it again?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure. The website is secured. That's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, thank you so much. Thank you so much, [PII] I appreciate for that.
[AGENT][NEUTRAL] Mhm. Now for the state of service of 12-624.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This claim was processed.
[AGENT][NEUTRAL] On, let me get this processed date for you.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] Oh well, it was received on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. And it was paid $125.
[AGENT][NEUTRAL] And 24 cents.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To Nicholas Children's Pediatrics. That was a single payment by check.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, single payment, all right?
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And $125.24 am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] Claim number is 355.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] 242 1.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And the check number, please?
[AGENT][NEUTRAL] Check number 202.
[AGENT][NEUTRAL] 3193.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 90 and [PII] issue that it's gonna be 716. Am I right? [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. So we can move to the next again. Am I right, [PII]?
[AGENT][NEUTRAL] I'm ready. Same patient, different data service?
[CUSTOMER][NEUTRAL] Just hold please just.
[CUSTOMER][NEUTRAL] I need to check it again.
[AGENT][POSITIVE] OK. Take your time.
[CUSTOMER][NEUTRAL] I think it's gonna be, uh, no, it's gonna be, is it [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Just one please.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, [PII], yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think it's gonna be same same patient, am I right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, and the data of service is gonna be [PII] and the bill amount is.
[CUSTOMER][NEUTRAL] $671.07.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And that claim we received on 114.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Processed on 116.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With a payment of $182.53.
[AGENT][NEUTRAL] To Nicholas Children's Pediatrics.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it single for both all?
[AGENT][NEUTRAL] Single, single amount, paper check.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And 1008 uh and check number please.
[AGENT][NEUTRAL] 202
[AGENT][NEUTRAL] 3194.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the claim number please?
[AGENT][NEUTRAL] 355
[AGENT][NEUTRAL] 242 4.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] 24. OK, thank you so much, and can we move to the next again?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] Just one, please. It's gonna be, this one is gonna be different member, OK? uh [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, different member.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that policy number?
[CUSTOMER][NEUTRAL] 01935547 M as in Mary, L as in Lima 7.
[AGENT][NEUTRAL] And name and date of birth?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you. And what is that data service?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $841.41.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim mark we received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With the payment of 300.
[AGENT][NEUTRAL] $5.38.
[CUSTOMER][NEUTRAL] OK, and is it single for both?
[AGENT][NEUTRAL] Single paper check.
[CUSTOMER][NEUTRAL] OK, it's gonna be $305.30. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, the check number?
[AGENT][NEUTRAL] Check number is 202.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3278.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7. And the claim number?
[AGENT][NEUTRAL] 355.
[AGENT][NEUTRAL] 2844.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 244 so and it was the check is not still yet clear, am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, thank you so much. And we can move again to the next one, right?
[AGENT][NEUTRAL] Different patients.
[CUSTOMER][NEUTRAL] Yeah, it's gonna be a different patient.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][POSITIVE] Sure, thank you so much.
[CUSTOMER][NEUTRAL] Uh, just one please.
[CUSTOMER][NEUTRAL] The date of service is gonna be, I mean, sorry, yeah, the member ID is 01659737 [PII]
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] And the first name is [PII]. The first name is [PII]. OK, the first name is [PII], uh, the last name is [PII], and date of birth is gonna be [PII].
[AGENT][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] Thank you, and that date of service?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Sure. The date of service is gonna be [PII] and the bill amount is $414.06.
[AGENT][NEUTRAL] OK, bear with me just one second, let me check that for you.
[CUSTOMER][POSITIVE] Sure. Uh, in the meantime, on the meantime, I hope you're doing good, uh, [PII].
[AGENT][POSITIVE] Thank you. I am doing well today and I hope you are as well.
[CUSTOMER][POSITIVE] Yeah, only by the credit card. I was doing well, thanks for asking.
[AGENT][POSITIVE] Oh, great. I like to hear that.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And [PII], upon checking this claim status, we received that claim on [PII].
[AGENT][NEUTRAL] Processed and paid on [PII].
[CUSTOMER][NEUTRAL] [PII]. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, thank you so much. OK.
[AGENT][NEUTRAL] Um, there was a benefit amount of $50.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That was paid on the 99203.
[CUSTOMER][NEUTRAL] 992. Can you please, uh, is it $50 is pay, am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, you're saying that 99203 is the claim number or which one?
[AGENT][NEUTRAL] That's, I'm sorry, that's the procedure code.
[CUSTOMER][NEUTRAL] OK. 99203. OK, got it. I got it. 99299203. And what about 73,630?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was denied as the maximum benefit for, let's see, I'm sorry, the insured's major medical coverage provided full benefits. Therefore, no benefits are payable for this procedure.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] For this PR just one please.
[CUSTOMER][NEUTRAL] Let me just hold on please.
[CUSTOMER][NEUTRAL] So you're saying that.
[CUSTOMER][NEUTRAL] Just one please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, you're saying that uh benefits are not payable for this procedure but am I right?
[AGENT][NEUTRAL] That's correct, because the primary insurance provided full benefits.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, and the claim number, please? 4.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 3551522
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. And the $50 will be paid through EFT or check?
[AGENT][NEUTRAL] Single paper check.
[CUSTOMER][NEUTRAL] Single peppers and check check number please.
[AGENT][NEUTRAL] 202.
[AGENT][NEUTRAL] 27
[CUSTOMER][NEUTRAL] Just one please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7, OK.
[AGENT][NEUTRAL] It's 202-279-5.
[CUSTOMER][NEUTRAL] 95. OK. And is it well is this this one is single amount, am I right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and is it the EOB is still not clear or it's already issue?
[AGENT][NEUTRAL] Yes, the EOB was issued at the same day as the check.
[CUSTOMER][NEUTRAL] OK, so we still did not receive the you can please, uh, at least a fax the UV for us?
[AGENT][NEUTRAL] VOBs are obtainable from our provider portal at that address that I gave you earlier.
[AGENT][NEUTRAL] The secured. [PII].
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][POSITIVE] OK, no problem, thank you so much and we can move again to the next. Am I right [PII]?
[AGENT][NEUTRAL] Yes, different patients.
[CUSTOMER][NEUTRAL] Yeah, it's gonna be a different patient at least yeah.
[AGENT][POSITIVE] All right, yeah, I'm ready.
[CUSTOMER][NEUTRAL] And once you
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Yeah, it's gonna be the member ID is gonna be 02003104 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And date of service.
[CUSTOMER][NEUTRAL] Uh, that service is gonna be.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $27.87.
[AGENT][NEUTRAL] OK, that claim we did receive on [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that denial reason is this policy provides no benefits for the treatment of conditions other than a sickness or injury.
[AGENT][NEUTRAL] The.
[CUSTOMER][NEUTRAL] So what are what are next step do I need to do for this one?
[AGENT][NEUTRAL] Um, it, there's no benefits payable, um, due to the diagnosis code. It was not diagnosed as a sickness or or an injury.
[CUSTOMER][NEUTRAL] Yeah, this one is uh the 940 to the diagnosis code, am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEGATIVE] Uh, the titles, the titles code is inappropriate, is it correct?
[AGENT][NEUTRAL] The diagnosis code is not a diagnosis code for a sickness or injury, therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, it's not for injury.
[CUSTOMER][NEUTRAL] OK. So, we still did not receive the UB. So is it the UB is already posted or
[AGENT][NEUTRAL] It is posted on the portal, yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The thing is that uh we still we are not receiving the, in the software so can you kindly uh fax to you before us, [PII].
[AGENT][POSITIVE] If you'll bear with me one moment, I'll fax that for you, OK? It'll take me a minute. Now if you want to create that account online, it's quicker that way you don't have to wait for a.
[CUSTOMER][POSITIVE] OK, thank you, sir. Sure, sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Facts, if, and I can help you create that portal address if you're interested.
[CUSTOMER][NEUTRAL] So the thing is that even though I mean that we need an EEOB to be posted in the uh this uh.
[CUSTOMER][NEUTRAL] In the software that is called sonar.
[CUSTOMER][NEUTRAL] So once you're faxed you'll be the, you'll be, will be posted in the automatically will posted in the er.
[CUSTOMER][NEUTRAL] So we are looking for the UOB which is all posted in the sonar.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][POSITIVE] OK, sure. Take your time. You can take your time.
[AGENT][NEUTRAL] And can I put it to your attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah, attention to this uh [PII]'s pediatric.
[CUSTOMER][NEUTRAL] And the fax number once you're ready, do let me know so that I can provide you the fax number, [PII].
[AGENT][POSITIVE] All right, thank you. Just takes a minute, so bear with me.
[CUSTOMER][POSITIVE] Sure, sure. Take your time.
[AGENT][POSITIVE] It is a lot quicker to get the EOBs from our portal if you're ever want to create that account.
[CUSTOMER][NEUTRAL] C R
[CUSTOMER][NEUTRAL] Yeah, the thing is that even though we got an EOB from the portal, but we, they are requested, we are, uh, we need the EOB from this er software.
[AGENT][NEUTRAL] And I did give you that claim number, correct?
[CUSTOMER][NEUTRAL] Yeah, uh, yeah, let me just check it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Still not yet.
[AGENT][NEUTRAL] All right. What's the fax number? I'm ready for the fax number, [PII].
[CUSTOMER][NEUTRAL] Sure, just one please.
[CUSTOMER][NEUTRAL] Uh, the fax number is gonna be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Let me just verify the fax number. I'm sending this EOB to [PII]. Is that correct?
[CUSTOMER][NEUTRAL] No, it's gonna be, it's gonna be, I mean, sorry, [PII].
[AGENT][NEUTRAL] OK, so the first three digits are [PII], not [PII].
[CUSTOMER][POSITIVE] Yeah. Yeah, yeah, correct.
[AGENT][NEUTRAL] OK. Let me just verify again. [PII]?
[CUSTOMER][POSITIVE] Yeah, correct, yeah.
[AGENT][NEUTRAL] All right, [PII], that is on the way.
[CUSTOMER][NEUTRAL] And can you please give me the uh claim number which uh.
[AGENT][NEUTRAL] The claim number for this one?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] It is 355.
[AGENT][NEUTRAL] 2713.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] 13 thank you so much and we can move to the next MRI?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] So once you already let me know so that I can provide you the member ID.
[AGENT][POSITIVE] Thank you, [PII]. I'm ready.
[CUSTOMER][NEUTRAL] 01770256
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Uh the first name is gonna be [PII] and the last name is [PII] And date of birth is gonna be
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][POSITIVE] Sure, no problem.
[CUSTOMER][NEUTRAL] The date of service is gonna be [PII] and the bill amount is $715.46.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And that claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this
[AGENT][NEUTRAL] Policy is.
[AGENT][NEGATIVE] There was no payment. It was denied. The claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The 99214 was denied as office visits are not covered under the policy, the patient's plan.
[CUSTOMER][NEUTRAL] Office visits are not covered under the patient plan number, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. And what about uh uh the two CPT 929065 and the other one?
[AGENT][NEUTRAL] The Q4006, those were denied as the insured's primary insurance provided full benefits. Therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] 296-065. Am I right?
[AGENT][NEUTRAL] 29065 and the Q 4006.
[CUSTOMER][NEUTRAL] Can you repeat the the reason, please?
[AGENT][NEUTRAL] The insured's primary insurance.
[AGENT][POSITIVE] Provided full benefits.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEGATIVE] Therefore, no benefits are payable.
[CUSTOMER][POSITIVE] OK, thank you so much and the claim number please?
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 952 9.
[CUSTOMER][NEUTRAL] OK, uh, can you please fax the U for us?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEGATIVE] We still did not receive the uh ERV.
[CUSTOMER][NEUTRAL] Uh, under the same fax number which I provide, uh, provide you earlier, OK?
[AGENT][NEUTRAL] OK, if you just give me a moment, please.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And again that fax number is [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Yeah, yeah, definitely correct.
[AGENT][POSITIVE] All right, that is on the way for you.
[CUSTOMER][POSITIVE] OK. Thank you so much. And we can move. I still have 6 more plans. Can you please finish it for me, uh, [PII]?
[AGENT][NEUTRAL] I, I certainly can, Mark.
[CUSTOMER][NEUTRAL] OK, uh, once you're ready, do let me know so that I can provide you for the next member ID, OK?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] 01816146. M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Now, that patient is not listed on this insurance.
[CUSTOMER][NEUTRAL] It's not listed on this insurance, uh.
[AGENT][NEUTRAL] It's an individual policy and she's not listed.
[CUSTOMER][NEUTRAL] OK. Uh,
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII], am I right? [PII].
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] She's, would be a dependent. She's not, this policy does not have dependent coverage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was that for newborn charges?
[CUSTOMER][NEUTRAL] So what next, yeah.
[AGENT][NEUTRAL] What was her date of birth?
[CUSTOMER][NEUTRAL] The date of birth is, yeah, it's gonna be [PII].
[CUSTOMER][NEUTRAL] So I can give you the, the policy holder, ma'am, OK?
[AGENT][NEUTRAL] With
[AGENT][NEUTRAL] OK, what's the policyholder name?
[CUSTOMER][NEUTRAL] Uh, the first name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], and the last name is [PII].
[AGENT][NEUTRAL] Yeah, so this policy is an individual policy. We do not have dependent coverage on this policy. We did not have the claim on file.
[CUSTOMER][POSITIVE] OK, thank you so much. And the member was active, am I right?
[AGENT][NEUTRAL] The policy's effective date was [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the policy is active.
[CUSTOMER][NEUTRAL] So I can refile it this claim, am I right?
[AGENT][NEUTRAL] Well, there's no coverage for that dependent unless it, was it for newborn charges, hospitalization charges?
[CUSTOMER][NEUTRAL] Yeah, I think this one is newborn.
[AGENT][NEUTRAL] Yeah, um, I would, I would resubmit that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can actually fax it to our claims department.
[CUSTOMER][NEUTRAL] OK, OK, no problem. So you, you're going to resubmit the claim, am I right?
[AGENT][NEUTRAL] Yes, you can resubmit the claim if it is for newborn charges.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] OK, thank you so much and we can move again to the next summer, right?
[AGENT][NEUTRAL] That's, uh, hang on just one second.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] No problem, yeah, take your time.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] Yeah. Uh, the member ID is [PII]. [PII].
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII] And the date of birth is [PII].
[AGENT][NEUTRAL] And date of service.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $343 343 dollars 8 cents.
[AGENT][NEUTRAL] Thank you, [PII]. That claim we received on [PII].
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With the payment
[AGENT][NEUTRAL] Of
[AGENT][NEUTRAL] $250.48.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it paid through year after your check?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Single paper check.
[CUSTOMER][NEUTRAL] OK, and the check number please?
[AGENT][NEUTRAL] 202.
[AGENT][NEUTRAL] 1480.
[CUSTOMER][NEUTRAL] And the check number is 50 $250 and I mean, single amount is 48 cents. Am I right?
[AGENT][NEUTRAL] That's right, $250.48.
[CUSTOMER][NEUTRAL] And the claim number please?
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 7851.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I want an issue that.
[AGENT][NEUTRAL] That was issued on [PII].
[CUSTOMER][NEUTRAL] And the check is not yet clear, am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, thank you so much. And once you're ready, do let me know so that we can move again to the next Ali here.
[AGENT][NEUTRAL] Oh really?
[CUSTOMER][POSITIVE] Thank you so much. It's gonna be the member ID is 02353184 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] And the name and date of birth?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII], and date of birth is [PII]. 03-03-2023.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] On [PII] and the bill amount is $544.92.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII], this claim we received on 13-25 and processed on 1725.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With the payment of $50 to provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] $50 am I right?
[AGENT][NEUTRAL] $50 even, yes, sir.
[CUSTOMER][NEUTRAL] And is it both or single?
[AGENT][NEUTRAL] Single?
[CUSTOMER][NEUTRAL] Um, is it 2 page to check or EFT?
[AGENT][NEUTRAL] Single paper check.
[CUSTOMER][NEUTRAL] Check number please.
[AGENT][NEUTRAL] That check number is 202.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1743.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 43. And the claim number, please?
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 8759.
[CUSTOMER][NEUTRAL] 5 months and check with that?
[AGENT][NEUTRAL] 1725.
[CUSTOMER][NEUTRAL] I'm still not yet clear, am I right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, thank you so much and we can move again to the next one right? uh, OK, thank you so much.
[AGENT][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The next, this one, please.
[CUSTOMER][NEUTRAL] The next member ID is gonna be 02006254.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the first name is [PII], and the last name is [PII]. And the date of birth is gonna be [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Uh, [PII] and the bill amount is $968 and I mean $68 even.
[AGENT][NEUTRAL] All right, this claim was received on [PII] and processed on [PII] with the payment of 100.
[AGENT][NEUTRAL] $79.73.
[CUSTOMER][NEUTRAL] OK, is it paid through EFT or check?
[AGENT][NEUTRAL] A single paper check.
[CUSTOMER][NEUTRAL] Tech number please.
[AGENT][NEUTRAL] Check number is 202.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me, I apologize. 1510.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] 1510.
[CUSTOMER][NEUTRAL] Just one, please, and.
[CUSTOMER][NEUTRAL] Claim number please.
[AGENT][NEUTRAL] Claim number is 354.
[AGENT][NEUTRAL] 8195.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 95 and issue that.
[AGENT][NEUTRAL] Issued on 16-25.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][POSITIVE] And we can move again to the next summer, right?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][POSITIVE] Thank you so much and it's gonna be.
[CUSTOMER][NEUTRAL] Just one please. The member ID is gonna be 02141247 [PII].
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII]. Uh, the date of birth is [PII].
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] [PII] and the date of uh the bill amount is $350.55.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That claim was received on [PII].
[AGENT][NEUTRAL] 25 and processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And paid
[AGENT][NEUTRAL] $120.62.
[CUSTOMER][NEUTRAL] OK, and is it paid to EFT or check?
[AGENT][NEUTRAL] Single paper check.
[CUSTOMER][NEUTRAL] Check number please.
[AGENT][NEUTRAL] Check number is 202.
[AGENT][NEUTRAL] 1475.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 78
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 46.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 446 and issue that.
[AGENT][NEUTRAL] 1625.
[CUSTOMER][POSITIVE] 25, thank you so much and.
[CUSTOMER][POSITIVE] We can move again to the next time, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, this one is gonna, uh, I think this one is gonna be last, uh, [PII].
[AGENT][POSITIVE] OK, not a problem.
[CUSTOMER][POSITIVE] Thank you so much once. OK. And the member ID is gonna be 02006254.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, we already did a claim for him, didn't we?
[CUSTOMER][NEUTRAL] Yeah, I think this one is gonna be the data service is different.
[AGENT][NEUTRAL] Different date.
[AGENT][NEUTRAL] OK, what's the data service.
[CUSTOMER][NEUTRAL] On [PII] and the bill amount is $931.86.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What did you say the bill amount? Do you mind repeating the bill amount?
[CUSTOMER][NEUTRAL] Sure, definitely I can repeat the bill amount just one please.
[CUSTOMER][NEUTRAL] Uh, $931.86. 931.86.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Yes, thank you. I appreciate you repeating that for me.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] [PII] that claim we received on 16-25.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Process on 1625.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And with a payment of $406.46.
[CUSTOMER][NEUTRAL] OK, is it paid through yes your uh.
[AGENT][NEUTRAL] Single paper check. Yes, sir.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the check number.
[AGENT][NEUTRAL] The check number is 202.
[AGENT][NEUTRAL] 1509.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 09. And the claim number?
[AGENT][NEUTRAL] Claim number 354.
[AGENT][NEUTRAL] 8185.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 85 and issue that please.
[AGENT][NEUTRAL] 1625.
[CUSTOMER][NEUTRAL] And the check is not yet clear, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much, uh, [PII]. I appreciate for your time and the information uh that you have given me. Once again, thank you. Have a wonderful rest of the day. Take care. God bless you. All right.
[AGENT][POSITIVE] God bless you too, [PII]. It was a pleasure to assist you with that claim status and thank you for calling APL. Have a wonderful day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Sure. You too. Have a wonderful rest of day, OK?
[AGENT][POSITIVE] Thank you. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.