AccountId: 011433970860
ContactId: b6330519-1839-499a-a272-1348d8513386
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 738559 ms
Total Talk Time (AGENT): 154749 ms
Total Talk Time (CUSTOMER): 333572 ms
Interruptions: 9
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/b6330519-1839-499a-a272-1348d8513386_20250414T15:29_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Initial of my last name is there. I am calling to you from provider office like specialties. I need general claim status.
[AGENT][NEUTRAL] OK, I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] I'm sorry, what
[CUSTOMER][NEUTRAL] [PII]. Initial last name is [PII].
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] I can't understand what you're saying. Can you say it slowly for me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] on the one.
[AGENT][NEUTRAL] Spell your name?
[CUSTOMER][NEUTRAL] Hello my name is [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yes, he's right.
[AGENT][NEUTRAL] And do you have a phone number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] That's the phone number
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yes, it's right.
[AGENT][NEUTRAL] And do you have a policy number?
[CUSTOMER][NEUTRAL] Oh, OK, I check.
[CUSTOMER][NEUTRAL] The policy number is 02556561.
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] The patient's last name is [PII] and first name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] And you were needing benefits or claim status?
[CUSTOMER][NEUTRAL] Yes, I need general claim status.
[AGENT][NEUTRAL] OK, I can look that up for you. What date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And the total bill charge?
[CUSTOMER][NEUTRAL] Oh, OK. The total bill charges amount is $176 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we do have that claim in. It was denied.
[CUSTOMER][NEGATIVE] And it was denied.
[AGENT][NEUTRAL] Benefit maximum for this data service has been met.
[CUSTOMER][NEUTRAL] Benefit maximum for this data service has been.
[CUSTOMER][NEUTRAL] Uh, OK, but, uh, the you said the maximum benefits, uh, is the pay out and as per guideline, the.
[CUSTOMER][NEUTRAL] If your patient has 4 visits per year and all visits are remaining, and you check please and the patient uh plan, uh, visits are remaining place.
[AGENT][NEUTRAL] We pay $100 per visit and it was already paid, so the max was met for that.
[CUSTOMER][NEUTRAL] 10 $0 per visit and it was already paid for the max was met for that.
[AGENT][NEUTRAL] Service.
[CUSTOMER][NEUTRAL] But they have 4 visits and plan here.
[CUSTOMER][NEUTRAL] And as the benefits, the patient plan and the all visits are remaining.
[AGENT][NEUTRAL] Right, but it's only per visit, so for that data service 117, we've already paid out the $100.
[CUSTOMER][NEUTRAL] Right, but it's only for.
[CUSTOMER][NEUTRAL] So for that day to start at [PII] we've already received the now 100 jobs.
[AGENT][NEUTRAL] It's per date of service.
[CUSTOMER][NEUTRAL] OK, I'll check. Please wait a moment.
[AGENT][NEUTRAL] So on [PII], we already paid the visit.
[AGENT][NEUTRAL] So the max is met for 11 7.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Is there anything else?
[CUSTOMER][NEUTRAL] OK, you check this in your record and the insurance for effective.
[AGENT][NEUTRAL] [PII] is the effective date.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No, I said you're checking your records and other insurance are effective.
[AGENT][NEGATIVE] I don't understand what you're talking about.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] OK. You check in your records for any other insurance are effective for our date of service.
[AGENT][POSITIVE] That policy was effective for that data service.
[CUSTOMER][POSITIVE] That policy was effective for that date of service.
[CUSTOMER][NEUTRAL] OK, no, another insurance, is that right?
[AGENT][NEGATIVE] No, not for that.
[CUSTOMER][NEGATIVE] No, not for that.
[AGENT][NEUTRAL] Data service, that's the only medical they have with us, right?
[CUSTOMER][NEUTRAL] Day the service that's the only medical they have but.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Mm, OK. You said that do not benefits, maximum benefits is pay out for this data of service.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And patients will be responsible.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, you check, please, and another claim.
[AGENT][NEUTRAL] Is this on a whole different person?
[CUSTOMER][NEUTRAL] Is this on a whole different person.
[AGENT][NEUTRAL] Same person.
[CUSTOMER][NEUTRAL] Yes, but the, the total charges amount is different, $194 even.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] This policy does not cover medical equipment. It does not cover DME.
[CUSTOMER][NEGATIVE] This policy does not cover medical equipment. It does not cover BME.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This policy is not covered for DME, is that right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And I have one more claim, same member, but different total charges. The amount is $507 even.
[AGENT][NEUTRAL] We paid $100 on that claim.
[CUSTOMER][NEUTRAL] We paid $100 on that claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim number
[AGENT][NEUTRAL] 3573658.
[CUSTOMER][NEUTRAL] 3573658. OK.
[CUSTOMER][NEUTRAL] And check number please.
[AGENT][NEUTRAL] 2031926.
[CUSTOMER][NEUTRAL] 2031926
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, you send the this UV through fax.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] OK, I checked.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] OK, I'll fax it to you.
[CUSTOMER][NEUTRAL] you know like
[CUSTOMER][NEUTRAL] OK, how many days, uh, uh, did you receive?
[AGENT][NEUTRAL] How many days will it take to fax the EOB?
[CUSTOMER][NEUTRAL] How many they they would replace the back of them.
[CUSTOMER][NEUTRAL] You send it through fax.
[AGENT][NEUTRAL] Is that what
[AGENT][NEUTRAL] It will be sent today.
[CUSTOMER][NEUTRAL] It will be here today. OK.
[CUSTOMER][NEUTRAL] OK, your name please?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And initial last name.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For address number.
[AGENT][NEUTRAL] We do not have reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] We do not have reference to the date. OK, please confirm the new claim term is filing and corrected claim term please.
[AGENT][NEGATIVE] We do not have timely filing.
[CUSTOMER][NEGATIVE] We do not have time. OK, and no time.
[AGENT][NEUTRAL] I didn't understand your question.
[CUSTOMER][NEUTRAL] And a time you calling?
[AGENT][NEGATIVE] We do not have timely filing.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] OK, thank you for your assistance.
[AGENT][POSITIVE] Thank you, Moyes for calling APL. You have a good day.
[CUSTOMER][POSITIVE] Have a nice day.
[CUSTOMER][POSITIVE] Thank you for calling. Have a nice day.