AccountId: 011433970860
ContactId: b7ad6caa-c8d3-450f-87d2-d55fdf6f26ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 946640 ms
Total Talk Time (AGENT): 287890 ms
Total Talk Time (CUSTOMER): 346471 ms
Interruptions: 8
Overall Sentiment: AGENT=1.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/b7ad6caa-c8d3-450f-87d2-d55fdf6f26ce_20250205T13:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Um, I do have a total of 3 claims.
[AGENT][NEUTRAL] OK. Is it for 3 different patients or the same patient with multiple dates of service?
[CUSTOMER][NEUTRAL] No, uh, 3 different patients.
[AGENT][POSITIVE] Yes, ma'am. I can help you. So first off, [PII], any, well go ahead and give me your callback number.
[CUSTOMER][POSITIVE] And I can help you so first off.
[CUSTOMER][NEUTRAL] Go ahead and give me a call
[CUSTOMER][POSITIVE] Sure, definitely. I can give that to you. The callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you. So OK um so I'm gonna go ahead and give you some information before we start checking the claims. First off, you will use my name that I gave you along with today's date as your call reference number for each.
[AGENT][NEUTRAL] Also, any information that I.
[CUSTOMER][NEUTRAL] So before, yeah.
[CUSTOMER][NEUTRAL] Can I just get your name, uh, for my documentation purpose?
[AGENT][NEUTRAL] You do need, did you say that you need for me to repeat that for you?
[CUSTOMER][NEUTRAL] Yeah, your name.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And also [PII], any information that is provided for you today will be a verification of benefits and not a guarantee of payment. And then lastly, if we do have the claims on file and you need a copy of the explanation of benefits, you may print that directly from our portal at secured.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what is your first patient's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] The name is [PII] it is.
[CUSTOMER][NEUTRAL] 15730001
[AGENT][NEUTRAL] 15730001, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Just one moment, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Mhm. [PII]'s name, it is.
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount for him please?
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] And the date of service is [PII] and that's for the amount of $114 even.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was received, [PII]. The received date was [PII].
[CUSTOMER][NEUTRAL] OK, so this point will receive date date.
[AGENT][NEUTRAL] The process date was [PII].
[CUSTOMER][NEUTRAL] Process
[CUSTOMER][NEUTRAL] 18
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3549365.
[CUSTOMER][NEUTRAL] The claim number
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And there was a benefit paid in the amount of $50.
[CUSTOMER][NEUTRAL] And there was a
[AGENT][NEUTRAL] And that was paid on single check.
[CUSTOMER][NEUTRAL] Single check
[AGENT][NEUTRAL] 2021922.
[CUSTOMER][NEUTRAL] And uh is that allowed in the pay the same as the $50 even?
[AGENT][NEUTRAL] This is a supplemental policy that helps with their co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Coinsurance
[CUSTOMER][NEUTRAL] So, um.
[CUSTOMER][NEUTRAL] No allowed amount just only the paid amount, right?
[AGENT][NEUTRAL] That is correct because we're not a major medical insurance company.
[AGENT][NEUTRAL] This is a supplemental policy only.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][POSITIVE] Mhm, thank you so much. And may I just know that a bulk check or single check and amount for that?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Single check again the benefit amount is $50 and the check date is the same date as the process date that I gave you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] Yes ma'am, you're welcome.
[CUSTOMER][NEUTRAL] And may I just know the check clear date?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, this check was cleared on [PII].
[CUSTOMER][POSITIVE] All right, thank you so much. And uh
[CUSTOMER][NEUTRAL] Can you please verify me with the pay to address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right. And uh
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And will you be able to uh send me, oh, as you stated earlier, for the copy of your be to just get it from the portal, right?
[AGENT][POSITIVE] That is correct. Yes, ma'am. Uh-huh.
[CUSTOMER][POSITIVE] And the portal name is secure.
[AGENT][NEUTRAL] Again, it
[AGENT][POSITIVE] Uh-huh. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] All right, so may I just know when you're ready we came on with the next member and as you stated, the call reference number is going to be your name, [PII] with today's date. Am I correct?
[AGENT][NEUTRAL] OK, one moment.
[AGENT][POSITIVE] That is correct. Yes, it is, [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and the next patient's policy number please, [PII].
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] Uh huh so the next.
[CUSTOMER][NEUTRAL] Member's ID.
[CUSTOMER][NEUTRAL] It is 021-65941.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] your patient's name please?
[CUSTOMER][NEUTRAL] Mhm. Member's name, it is [PII]. Date of birth [PII]3.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Data service and total bill amount?
[CUSTOMER][NEUTRAL] And the rate of service on the claim is 1230 2024, and that is for the amount of $197 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and again you said the data services 12-3-2024, is that correct?
[CUSTOMER][NEUTRAL] A you said the data services.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for her for that data service.
[AGENT][NEUTRAL] And because this is a supplemental.
[CUSTOMER][NEUTRAL] All right, is that OK? Can I just.
[CUSTOMER][NEUTRAL] Uh huh go ahead sorry.
[AGENT][NEUTRAL] That's OK because it is a supplemental policy to her primary insurance, we must also receive a copy of her primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Because it is a supplemental.
[CUSTOMER][NEUTRAL] OK, so is that OK? Can I just go ahead and resubmit the claim with the primary it will be?
[AGENT][NEUTRAL] You can uh go ahead and verify the address that you have for claims.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I don't have the last digits.
[CUSTOMER][NEUTRAL] Let me make a note.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Am I correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so this is your mailing address and you just, uh, want me to go ahead and resubmit this claim with the primary you'll be, am I correct?
[AGENT][NEUTRAL] That is correct because the claim is not on file.
[CUSTOMER][POSITIVE] That's great.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Can I just get the family funding limit?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No time, there's no timely filing limit?
[CUSTOMER][NEUTRAL] And may I just know uh whether you're your secondary for the member, am I correct?
[AGENT][NEUTRAL] This is secondary, yes, and we're not a major medical insurance.
[CUSTOMER][NEUTRAL] All right, can you just please uh check with members a factor and the term date?
[AGENT][NEUTRAL] There is no term date. The effective date is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] and selective, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right, thank you. Can we move on with the next member?
[AGENT][NEUTRAL] Is that all the information that you need on this number?
[CUSTOMER][NEUTRAL] Yes, so that's for this member. Can we go ahead with the next one?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and your last patient's policy number?
[CUSTOMER][NEUTRAL] OK, and your last name.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The member's ID.
[CUSTOMER][NEUTRAL] It is 02, I'm sorry, 02255496.
[AGENT][NEUTRAL] OK, thank you. One moment please, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm. And his name is [PII], sorry, [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you. Data service and total bill amount.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm, the data service on the claim, it is.
[CUSTOMER][POSITIVE] 1216 of 2024 and that's worth the amount of $172 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and there is also no claim on file for this member either for that data service.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] This is also one that we will have to have a copy of our primary or.
[CUSTOMER][NEUTRAL] Because there's also
[CUSTOMER][NEUTRAL] Copy.
[AGENT][NEUTRAL] Yeah, the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, thank you and uh can you just please provide me with the members of active state.
[AGENT][NEUTRAL] This policy has an effective date of [PII] and it is still active and there is also no timely filing limits.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] All right. And your secondary for the member as well.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And also the same mailing address [PII], OK, [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] that's correct.
[CUSTOMER][POSITIVE] All right. So that's all for the day, [PII]. Thank you so much for your assistance.
[AGENT][NEUTRAL] OK, well that's.
[AGENT][POSITIVE] Oh, you're very welcome, [PII]. So if that's all that I can help you with, thank you again for calling APL and I hope that you have a wonderful day.
[CUSTOMER][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you so much for your assistance. I wish you a good day, bye, take care.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Thank you. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.