AccountId: 011433970860
ContactId: b3af1cfa-6719-426d-bce0-c068336dfc06
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 751880 ms
Total Talk Time (AGENT): 257356 ms
Total Talk Time (CUSTOMER): 238522 ms
Interruptions: 5
Overall Sentiment: AGENT=1.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/b3af1cfa-6719-426d-bce0-c068336dfc06_20250618T17:23_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII] calling from provider's office regarding claims.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] Yes, I can help you with that, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] Just the callback number going to be.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And [PII], how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] Uh, today I just have.
[CUSTOMER][NEUTRAL] Uh just two claims.
[AGENT][NEUTRAL] OK, are these two claims for the same patient or different patients?
[CUSTOMER][NEUTRAL] Uh, different patient but same provider.
[AGENT][POSITIVE] Yes, I can help you with this, [PII], and you will use my name.
[AGENT][NEUTRAL] And today's date as your call reference number for each one. Also [PII], any information that I provide for you on the claims will be a verification of benefits and not a guarantee of payment. And lastly, if you need if we have the claims on file and you need a copy of the explanation of benefits, once I provide you the claim numbers, you can print the explanation of benefits yourself by going to our portal.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Which is located at secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] All right, so what is your first patient's policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number for this patient is going to be.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Yes, sir. It starts with 022.
[CUSTOMER][NEUTRAL] 557
[CUSTOMER][NEUTRAL] 05 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] Yes, you're welcome.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is.
[CUSTOMER][NEUTRAL] Could be.
[CUSTOMER][NEUTRAL] [PII] and the date of birth is on [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place, [PII]?
[CUSTOMER][NEUTRAL] Yes, uh, the date of service is on.
[CUSTOMER][NEUTRAL] [PII] with the full amount of
[CUSTOMER][NEUTRAL] $190.96.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and again, you said it was [PII] for $190.96. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for her for this data service.
[CUSTOMER][POSITIVE] Wow
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] You know, because this is a
[CUSTOMER][NEUTRAL] No claim on.
[AGENT][NEUTRAL] Correct, because this is a supplemental policy to her primary insurance when the claim is submitted to APL for review, we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] OK, and uh
[CUSTOMER][NEUTRAL] Uh, may I know the timely filing?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] Oh, got you, thank you. And is it that we can send this one through fax?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, it may be.
[CUSTOMER][NEUTRAL] Got you. And may I have the fax number dear?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942-3 attention claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] June claims.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. And can we mourn for the next uh patient?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Hi, take your time.
[AGENT][NEUTRAL] OK, and your next patient's policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, the next.
[CUSTOMER][NEUTRAL] Policy number
[CUSTOMER][NEUTRAL] It's going to be.
[CUSTOMER][NEUTRAL] Um, so it's just the 60801.
[AGENT][NEUTRAL] That's our electronic payer ID number.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] One moment, let me check.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] One moment, it's gonna go. Let me check.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, the policy.
[CUSTOMER][NEUTRAL] American.
[CUSTOMER][NEUTRAL] OK. Uh, it is 016.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 184
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 46
[CUSTOMER][NEUTRAL] M [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is.
[CUSTOMER][NEUTRAL] It is uh [PII]. Date of birth is on.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] You're welcome. Yes, the date of service, [PII].
[CUSTOMER][NEUTRAL] With the amount of $189.60.
[AGENT][NEUTRAL] OK, thank you. Now give me just one moment on this one because this policy was not active for your data service. uh, let me see if the claim was received though so just one moment.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I just think you
[AGENT][NEUTRAL] OK, so we do not have a claim on file under this policy for that data service. Let me see if there's another policy that is active.
[CUSTOMER][NEUTRAL] Hmm.
[AGENT][NEUTRAL] And there he is, you just have an old policy number, so just one moment for me to get that information pulled up and I'll provide you the correct policy number.
[CUSTOMER][POSITIVE] Yes. Thank you.
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] And I'll check to see if we received the claim under that correct number.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so the correct policy number that you should have is 02563062.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This policy has an effective date of [PII].
[CUSTOMER][NEUTRAL] I'm still active right?
[AGENT][POSITIVE] Uh, that is correct.
[CUSTOMER][NEUTRAL] Is it active? Alright, thank you and um can we.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm. And then let me check to see if the, let me check to see if we've received the claim for this data service.
[AGENT][NEUTRAL] On this policy.
[CUSTOMER][POSITIVE] Ah yes, I appreciate that.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, so this claim was received under this policy and the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 2617.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial is office visits.
[AGENT][NEUTRAL] are not covered by the above numbered policy. The members supplemental policy data does not cover office visits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] Office visits does not cover.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And again, I believe uh.
[CUSTOMER][NEUTRAL] Uh, on [PII].
[CUSTOMER][NEUTRAL] Uh, we have, uh, submitted.
[CUSTOMER][NEUTRAL] A claim uh with the same member ID, sorry, uh, attaching that, uh, the primary UB, uh, did you guys receive that?
[AGENT][NEUTRAL] Uh, what is your date of service?
[AGENT][NEUTRAL] For what data service and build them outdated?
[CUSTOMER][NEUTRAL] Uh, it's the same, same data service, similar amount.
[AGENT][NEUTRAL] Uh, we've only received one claim for this member for this data service, which is the one I provided for you.
[CUSTOMER][NEUTRAL] OK, just one moment
[CUSTOMER][POSITIVE] All right, and thank you so much, dear. The address is your name and today's date.
[AGENT][POSITIVE] Yes, sir. You're very welcome.
[AGENT][POSITIVE] That is correct. Yes, sir.
[CUSTOMER][POSITIVE] Thank you so much, [PII] for all the information. I really appreciate it.
[AGENT][POSITIVE] You're welcome. Absolutely. You're very welcome, [PII]. So is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah, you.
[CUSTOMER][NEUTRAL] I don't, no, thank you.
[AGENT][POSITIVE] OK, well then thank you very much for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Uh, you too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.