AccountId: 011433970860
ContactId: b8508b5f-01c1-40f6-b82d-476d28354726
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1600760 ms
Total Talk Time (AGENT): 361735 ms
Total Talk Time (CUSTOMER): 257017 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/b8508b5f-01c1-40f6-b82d-476d28354726_20250613T18:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status and you say your name is [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, OK, thank you. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Grand Strand Medical Center.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02506178.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the day of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service, [PII]. Total charges $19,942 even.
[AGENT][NEUTRAL] Thank you. So that's [PII], the amount of $19,942 even, is that correct?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for future. You can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Yeah, let's see. uh, let me pull the most recent claim. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Waiting on the explanation of benefits to pull up one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All right. So it looks like we have processed the claim uh on [PII].
[AGENT][NEGATIVE] And the claim was denied. The denial in on this one is.
[AGENT][NEUTRAL] It looks like based on the primary explanation of benefits, the primary insurance provided full benefits. There's no benefits payable.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But $5,762 is a patient's responsibility.
[CUSTOMER][NEUTRAL] I'm
[AGENT][NEUTRAL] That's not what's indicated on the EOB we received, so we need the correct explanation and benefit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll, again, I'm at the primary OB.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Uh, how we need to submit the primary UV?
[AGENT][NEUTRAL] You can send it by mail, by fax or by fax.
[AGENT][NEUTRAL] Ex
[CUSTOMER][NEUTRAL] Can I get the fax number?
[AGENT][NEUTRAL] Sure, that is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. Shall I go to the next claim?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Is it a different member?
[CUSTOMER][NEUTRAL] Mm, just a minute. I'll look at it, yes.
[AGENT][NEUTRAL] OK, then I need to make a note on this one and to move forward to any other claims or any other members. OK, one moment.
[CUSTOMER][POSITIVE] Yeah, OK, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's gonna be one more minute.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, and what is the next policy number?
[CUSTOMER][NEUTRAL] 01648436.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and the date of [PII].
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Total charges $6,391 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me see if I can find this claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we have received the claim on [PII] and processed [PII]. We need the primary explanation of benefits to continue the processing of this claim.
[CUSTOMER][NEUTRAL] OK. Uh, shall I move to the next claim?
[AGENT][NEUTRAL] OK, I need to make a note on this one before moving forward to the next policy or member.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] 01723392.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], and the date of birth, [PII].
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] [PII]. Total charges $3,344 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] All right. Let's see.
[AGENT][NEUTRAL] OK, we received the claim on [PII], processed [PII].
[AGENT][NEGATIVE] The claim was denied. The reason for this denial is that the service was rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Uh, make it the termination date.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Termination date is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Shall I go to the next one?
[AGENT][NEUTRAL] I need to make a note.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, what's the next one?
[CUSTOMER][NEUTRAL] Mm yeah. Next 1, [PII].
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] What's the date of service and the amount of the claim.
[CUSTOMER][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the total charge is $41,754.99.
[AGENT][NEUTRAL] OK, that was [PII].
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, we received the claim [PII], processed [PII]. The claim was denied. The reason for this denial is that we need, um, OK, we received the primary EOB. Now the primary EOB did not indicate the amount applied towards the deductible co-payment and co-insurance. So we need a detailed explanation of benefits to continue the processing of these claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. So I'm on to the next one.
[AGENT][NEUTRAL] One moment, I need to make a note.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Who wants the next policy number?
[CUSTOMER][NEUTRAL] 0240
[CUSTOMER][NEUTRAL] 6232.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, may I have the name and date of birth?
[CUSTOMER][NEUTRAL] Name [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the time.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Just a minute. Um date of service [PII]. Total charge is $3790.25.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, I didn't get the month or the date. Can you repeat the month and the date?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so it looks like we received the claim [PII], processed [PII], and it was denied, um, indicating that we received the explanation of benefits, however, the explanation of benefits did not list the amounts supplied towards the deductible co-payment and coinsurance. We need a more detailed EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Shall I move to the next one?
[AGENT][NEUTRAL] Let me make a note.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What's the next policy number?
[CUSTOMER][NEUTRAL] 02472991.
[AGENT][NEUTRAL] What's your name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] What's the data service.
[CUSTOMER][NEUTRAL] Date of service. [PII].
[CUSTOMER][NEUTRAL] I think.
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] $125096 even.
[AGENT][NEUTRAL] OK, is it $125,096?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's $125,096. Is that the correct amount?
[CUSTOMER][POSITIVE] Yes. Correct.
[AGENT][NEUTRAL] OK. And you said it was uh [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Don't see that claim on file.
[CUSTOMER][NEUTRAL] OK, just a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I get your payer ID?
[AGENT][NEUTRAL] The claim needs to be submitted by mail or fax.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] May I get your mailing address?
[AGENT][NEUTRAL] The address to submit claims is [PII].
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I get the effective and termination date of the number?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Effective date on the policy is [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] Make it the patient plant type.
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Make it the time to selling limit.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] We don't have timely filing limits.
[CUSTOMER][NEUTRAL] OK, shall I move to the next one?
[AGENT][NEUTRAL] One moment, I need to make a note.
[CUSTOMER][NEUTRAL] Yeah. Yeah.
[AGENT][NEUTRAL] How many more you got?
[CUSTOMER][NEUTRAL] Last one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02217258.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, [PII] and the date of birth, [PII].
[AGENT][NEUTRAL] How much is the total charge and the amount and the date of the claim.
[CUSTOMER][NEUTRAL] Date of [PII]. Total charge is $4,822 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] OK. Um, that one is not on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I get the patient effective on termination date.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Alright, we have effective [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Make the call reference number.
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Your name
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APO.
[CUSTOMER][POSITIVE] Thank you for assistance. Have a great day.
[AGENT][POSITIVE] Oh great afternoon.
[CUSTOMER][NEUTRAL] Yeah, bye bye.