AccountId: 011433970860
ContactId: b15e2cac-9e94-48a4-8c12-22cc6b0bcd97
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1849989 ms
Total Talk Time (AGENT): 552959 ms
Total Talk Time (CUSTOMER): 487041 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/b15e2cac-9e94-48a4-8c12-22cc6b0bcd97_20250401T18:14_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, my name is [PII] calling from provider's office. How are you doing today?
[AGENT][NEUTRAL] I'm doing fine, but I'm so sorry. What did you say your name was?
[CUSTOMER][NEUTRAL] My name is [PII]. It's spelled as [PII].
[AGENT][POSITIVE] OK, [PII], thank you. And how can I help you today?
[CUSTOMER][NEUTRAL] Yeah, it's for claim status. Can you please help me out?
[AGENT][NEUTRAL] Yes, you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that. So [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah, it will be [PII] it's a direct line.
[AGENT][NEUTRAL] Thank you and how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] Yeah, I have 8 claims.
[AGENT][NEUTRAL] OK, are these 8 claims for the same patient or are they, is it for 8 different patients?
[CUSTOMER][NEUTRAL] Yeah, it's for different patient.
[AGENT][NEUTRAL] OK, so one data service for 8 patients. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, before, yes, before proceed this call may be recorded for quality and training purpose. Would you like to continue?
[AGENT][NEUTRAL] Yes, that is fine. And so [PII], so first off, you will use my name and today's date as your call reference number for each one.
[AGENT][NEUTRAL] Also, any information that I provide for you on the claims will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] And lastly, if we have the claims on file, [PII] and you need a copy of the explanation of benefits, once you have the claim number, you can go to our portal and print those by going to secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Thank you for that information, but you are, you, yeah, and can you please spell your name?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII], right?
[AGENT][NEUTRAL] No, [PII]
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK, [PII], and the call will be your name and then today's date, right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] He, uh,
[CUSTOMER][NEUTRAL] It will be
[CUSTOMER][NEUTRAL] 01960608 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And your patient's name, please, and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be [PII].
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] [PII] and the bill amount will be $536 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you said the date of service is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so at this time there is not a claim on file for this number for that data service.
[CUSTOMER][NEUTRAL] The data service was [PII].
[AGENT][NEUTRAL] That is correct. 224-2025.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] No claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can you please check for the date of service for the same patient?
[CUSTOMER][NEUTRAL] The data service will be [PII].
[AGENT][NEUTRAL] Just one.
[AGENT][NEUTRAL] OK, just one moment. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $277 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so this claim is on file. This claim was received on [PII].
[AGENT][NEUTRAL] 2025.
[AGENT][NEGATIVE] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 3971.
[AGENT][NEUTRAL] And the reason for the denial?
[CUSTOMER][NEUTRAL] Yeah, can you repeat 13?
[AGENT][NEUTRAL] Uh-huh. 357.
[AGENT][NEUTRAL] 3971.
[AGENT][NEUTRAL] And the reason for the denial state's office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] The member's plan, so does not cover office visits.
[CUSTOMER][POSITIVE] OK. So we can be patient for this, right?
[AGENT][NEUTRAL] We do not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now on the claim that we did not have on file, when you do submit the claim, we will have to have a copy of the primary insurance company's explanation of benefits also.
[AGENT][NEUTRAL] Along with the claim.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Sorry, I didn't get you that.
[AGENT][NEUTRAL] With the first date of service for this number that we did not have on file.
[AGENT][NEUTRAL] You will have to send a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] So you are saying for the first claim, right? for date of service of [PII], right?
[CUSTOMER][NEUTRAL] Sorry, [PII].
[AGENT][NEUTRAL] Correct. When you submit that claim, you will also need to send us a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK, yeah, I'm just confirming the claim number for this patient data service with [PII], 3573971, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, office visit not covered under the patient plan.
[CUSTOMER][NEUTRAL] Uh, and it was received on [PII], right?
[AGENT][NEUTRAL] Just a moment.
[AGENT][NEGATIVE] The received date was [PII] and it was denied on [PII].
[CUSTOMER][POSITIVE] Good night.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need any other information for this patient?
[CUSTOMER][NEUTRAL] No, uh, not for this patient. I'm just checking with another.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] There is no history of any.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] You have 3.
[CUSTOMER][NEUTRAL] You have previously
[AGENT][NEUTRAL] And what is your next patient's policy number, Soho?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It will be
[CUSTOMER][NEUTRAL] 01988259 ML 7.
[CUSTOMER][NEUTRAL] have any previous.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] getting a boarding device.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] nice
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] [PII] and the bill amount will be $197 even.
[CUSTOMER][NEUTRAL] Uh
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] different.
[CUSTOMER][NEUTRAL] Right then.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, this claim was also received. It was received on 227-2025.
[AGENT][NEGATIVE] Processed and denied on 3-4-2025.
[AGENT][NEUTRAL] Claim number 35734.
[CUSTOMER][NEUTRAL] Sorry, process it on.
[CUSTOMER][NEUTRAL] Received on 227 and processed on 234, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And yeah.
[AGENT][NEUTRAL] Claim number 357.
[AGENT][NEUTRAL] 07
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 77.
[CUSTOMER][NEUTRAL] 357-077-7, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] And this was denied also as office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] By the member's policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need any other information for this number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, no, and it's a patient responsibility, right?
[AGENT][NEUTRAL] Again, we do not determine patient responsibility. That is up to the provider.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And what is your next patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, just.
[CUSTOMER][NEUTRAL] 02556036 ML 7.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Todd next week and the date of birth will be [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the build one will be $277 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you said the date of service is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was also received?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Also received on [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] The night on [PII].
[AGENT][NEUTRAL] Claim number 357.
[AGENT][NEUTRAL] 0584.
[AGENT][NEGATIVE] And this was also denied as office visits are not covered.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 357-0584, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] on
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 357-058-4.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And is there any other information you need for this number?
[CUSTOMER][NEUTRAL] Yeah, I have another patient.
[AGENT][NEUTRAL] A different patient or, or you don't, are we through with Mr. [PII]? OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, it's a different patient. The member ID will be 134313. OK.
[AGENT][NEUTRAL] All right, one moment. OK, just one moment, uh, just, just one moment, so.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] We know that
[AGENT][NEUTRAL] OK, what is the next policy number?
[CUSTOMER][NEUTRAL] 1343131 ML 8.
[AGENT][NEUTRAL] 13431. OK.
[CUSTOMER][NEUTRAL] Many of them
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service and total bill amount, please.
[CUSTOMER][NEUTRAL] And you know
[CUSTOMER][NEUTRAL] [PII] and
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah, the bill amount will be $277 even.
[CUSTOMER][NEUTRAL] What's
[CUSTOMER][NEUTRAL] For CPT 021 we are.
[CUSTOMER][NEUTRAL] Go.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so this claim was also received?
[AGENT][NEUTRAL] The received date was 2.
[AGENT][NEUTRAL] 7
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 2502.
[AGENT][NEUTRAL] And this claim was also denied as office visits.
[CUSTOMER][NEUTRAL] 356,250.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] 356-2506, right?
[AGENT][NEUTRAL] No, the last number is 2.
[AGENT][NEUTRAL] Not 6.
[CUSTOMER][NEUTRAL] 256-2502.
[AGENT][NEUTRAL] OK, the number again is 3.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 56.
[AGENT][NEUTRAL] 2502.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEGATIVE] And this was also denied as office visits are not covered.
[CUSTOMER][NEUTRAL] OK, and the next patient will be.
[AGENT][NEUTRAL] OK, one moment. OK.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] We have
[AGENT][NEUTRAL] OK, and the next patient's policy number.
[CUSTOMER][NEUTRAL] 02444692 ML 7.
[AGENT][NEUTRAL] OK. OK, your voice cut out so I did not hear the number.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 02444692 ML 7.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] So Hon, can you hear me?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Data service and total bill amount, please.
[CUSTOMER][NEUTRAL] [PII] and the bill amount will be $277 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, uh.
[AGENT][NEUTRAL] OK, and this claim was also received. The received date was [PII].
[AGENT][NEUTRAL] Denied on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 2447.
[AGENT][NEGATIVE] And it was denied because
[CUSTOMER][NEUTRAL] 356.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] 3562447, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it was denied for the same reason, office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is that all of the information you needed for this number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The next patient will be.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK. And the next policy number?
[CUSTOMER][NEUTRAL] 02496464 ML 8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Name of the patient, [PII] and the date of birth will be [PII].
[AGENT][POSITIVE] Thank you. So the service and total bill amount.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] $277 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was also received.
[AGENT][NEUTRAL] The received date is [PII].
[AGENT][NEUTRAL] Denied on [PII].
[AGENT][NEUTRAL] Claim number 356.
[AGENT][NEUTRAL] 351 6.
[AGENT][NEUTRAL] And this claim was also denied that the office visits are not covered.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need any other information?
[CUSTOMER][NEUTRAL] And it it was just.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and it's for the same patient for data data service for [PII].
[AGENT][NEUTRAL] Alright, well just
[AGENT][NEUTRAL] All right, just one moment then.
[AGENT][NEUTRAL] And what was the state of service and total bill amount for the same patient?
[CUSTOMER][NEUTRAL] [PII] and the rate of service will be $277 even.
[AGENT][NEUTRAL] 2 11 2025 also for 277.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] Denied on [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 1093.
[CUSTOMER][NEUTRAL] 3571093, right?
[AGENT][NEUTRAL] 3571093
[AGENT][NEUTRAL] The reason for the denial on this states these services were rendered after coverage was terminated.
[AGENT][NEUTRAL] The policy termed as of [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any secondary insurance for this patient?
[AGENT][NEUTRAL] We are the supplemental policy, but for this data services, you would have to reach out to the member. This policy was not active with our company.
[AGENT][NEUTRAL] At that time, I would not know about other coverage for that data service.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need any other information on this number?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] No, I have last patient.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK. And the last patient's policy number?
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 826104 ML 8.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be [PII], sorry, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And that bill amount will be $197 even.
[AGENT][NEUTRAL] 197.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was also received.
[AGENT][NEUTRAL] The receive date on this is 116.
[AGENT][NEUTRAL] It was denied on [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Claim number 355.
[AGENT][NEUTRAL] 3170.
[AGENT][NEUTRAL] And this claim, the, the reason for the denial also is that office visits are not covered.
[CUSTOMER][NEUTRAL] 3,553,170, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] 355-3170. OK.
[AGENT][POSITIVE] No, no, no, no, no, no, 3, yes, I'm so sorry. Yes, you're correct. 355-3170. That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That, yeah, thank you so much, [PII], and the call will be today's date and your name, right?
[AGENT][NEUTRAL] Well
[AGENT][POSITIVE] That is correct. And is there anything else, [PII], that I can help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No, [PII], thank you so much. And we can get the EOB in portal, right?
[AGENT][POSITIVE] That is correct. Yes, sir. Yes, sir. That is correct.
[CUSTOMER][NEUTRAL] With the claim number?
[CUSTOMER][POSITIVE] Oh yeah. Yeah. Yeah, thank you so much, [PII]. Have a nice day.
[AGENT][POSITIVE] OK. Oh, you're welcome. And so again, yes, you too, so if that's all I can help you with. Thank you again for calling APL.
[CUSTOMER][POSITIVE] Yeah, thank you so much. Bye-bye.
[AGENT][POSITIVE] Uh, you're welcome. Bye-bye.