AccountId: 011433970860
ContactId: ba4884f9-f625-44db-a28b-a726a7246fd3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 971200 ms
Total Talk Time (AGENT): 385066 ms
Total Talk Time (CUSTOMER): 203109 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/ba4884f9-f625-44db-a28b-a726a7246fd3_20250213T20:14_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] Um, yes, sir, I just wanted to see if I could check on a couple of claims.
[AGENT][NEUTRAL] OK, you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And are they for this, is it the same patient and multiple dates of service or different patients?
[CUSTOMER][NEUTRAL] Same patient.
[AGENT][POSITIVE] Yes ma'am, I can help you. And who am I speaking with please?
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][NEUTRAL] Thank you. And [PII] do you say your name with or without an [PII]?
[CUSTOMER][NEUTRAL] With
[AGENT][NEUTRAL] OK, thank you. And your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII]?
[CUSTOMER][NEUTRAL] 02510727
[AGENT][POSITIVE] Thank you, one moment please.
[AGENT][NEUTRAL] Is there any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is your first date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] The first day of service is [PII] total amounts 392.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, and you said 392. Is that correct?
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[AGENT][NEUTRAL] OK, I do not have a claim on file for her for that data service and that total bill amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me just one moment on this one, please.
[AGENT][NEUTRAL] Bear with me just a moment, sir. I'm sorry.
[CUSTOMER][POSITIVE] That's good.
[AGENT][NEUTRAL] OK, yes, that is correct. We do not have a claim on file for her for data service with that with a billed amount of 392.
[CUSTOMER][NEUTRAL] Can you see if you have any claims for dates of service from 8:15 to 103?
[AGENT][NEUTRAL] You'll have to give me each data service that you need checked.
[CUSTOMER][NEUTRAL] Alright, next date of service is [PII].
[AGENT][NEUTRAL] And are they all
[AGENT][NEUTRAL] And are they for different bill amounts?
[CUSTOMER][NEUTRAL] Um, potentially I'm not sure. I, I'll have to open each of them to let you know.
[AGENT][NEUTRAL] OK, and so the next state of service again was what?
[CUSTOMER][NEUTRAL] 819, this one is for 392.
[AGENT][NEUTRAL] [PII] 1920 24 for 392.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so this claim was received. The received date was [PII] and it was processed on [PII].
[AGENT][NEUTRAL] Claim number is 355.
[AGENT][NEUTRAL] 9365.
[AGENT][NEUTRAL] And there was a benefit issued in the amount of $78.40.
[AGENT][NEUTRAL] On single check, 2025957.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need any other information on this one?
[CUSTOMER][NEUTRAL] On that, no, no, ma'am.
[AGENT][NEUTRAL] OK, and the next date of service, [PII]?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This also.
[CUSTOMER][NEUTRAL] The same, the [PII].
[AGENT][NEUTRAL] OK, and you did say [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] OK, are you needing the received dates and process dates or do you just need the claim numbers and the status?
[CUSTOMER][NEUTRAL] If I get, I don't even need the claim number right now. If I can just get the status because I've, I've had to send these multiple times. So now at this point I just wanna know that you guys even got it so that the claim that I know the claim is going to process and I'll just allow more time for that to happen.
[AGENT][NEUTRAL] OK, so, uh, well, I might as well give you the if it's been processed, I might as well give you the claim number and the denial remark or the status of it if I'm checking each data service to verify that it was received if it's been processed.
[AGENT][NEUTRAL] And if you need a copy of any of the explanation of benefits for the ones that we have claims on file for there you can print those from our portal by going to [PII].
[AGENT][NEUTRAL] So we did receive this one for 828-2024.
[AGENT][NEUTRAL] And the claim number is 3556075.
[AGENT][NEGATIVE] And this one was denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Now if I send this you will be for the primary coverage do I need to send an additional copy of the claim with it, or do you got?
[AGENT][NEUTRAL] No. No. You just need to send the what we're needing. Mhm. And you can reference that claim number that I gave you 3556075. Did I give you that, [PII]? I'm sorry. I thought I did. OK. I thought I did, but then I questioned it.
[CUSTOMER][POSITIVE] Yes, you did, you did, mhm, yep, you're fine.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, well I will get.
[AGENT][NEUTRAL] OK, let's see. Give me, give me one second, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and your next date of service and build them out.
[CUSTOMER][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] And that amounts 296.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] And the claim number is 3556084.
[AGENT][NEGATIVE] This one was also denied needing primary insurance EOB.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And when you're ready to go move on to the next one, just let me know when I'm ready.
[CUSTOMER][NEUTRAL] OK, next data service 917 of 24.
[AGENT][NEUTRAL] Mhm, build a male.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] 304.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] 9-172024, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, there's no claim on file for that data service.
[AGENT][NEUTRAL] And on all of these, any of these will have to have, so when you submit this claim, you will also need to include the primary explanation of benefits, primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, that'll be.
[CUSTOMER][NEUTRAL] That'll be all of them for.
[AGENT][NEUTRAL] OK, so I want to um
[AGENT][NEUTRAL] Let me, I want to go back to the very first data service that we did 8-15-2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me look it.
[AGENT][NEUTRAL] Because you gave me a billed amount of 392.
[CUSTOMER][POSITIVE] For total build, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you are, let me pull, let me pull the information up.
[AGENT][NEUTRAL] And what provider are you with again for this particular claim?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the tax ID number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, now we have a claim on file for [PII] for this provider and under this tax ID number for the 815, but it's the bill amount on it is 384.
[AGENT][NEGATIVE] And we've received that twice.
[CUSTOMER][NEUTRAL] Let me see if I just looked at the wrong claim.
[CUSTOMER][NEUTRAL] And it looks like I may have done that. I do have 384, but you have it 2 times?
[AGENT][NEUTRAL] OK, right, so the first time, OK, so you do have the 3, so it is for 384?
[CUSTOMER][NEUTRAL] It is 34 yes ma'am.
[AGENT][NEUTRAL] OK, so let me just
[AGENT][NEUTRAL] Let me do make a change here.
[AGENT][NEGATIVE] OK, so on this claim, the first time we received it, it was denied needing the primary EOB. The second time that it was received, it was.
[AGENT][NEUTRAL] Denied, stating benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's on claim 3559359.
[CUSTOMER][NEUTRAL] OK, so I need to send EOB for that one as well.
[AGENT][NEUTRAL] Uh yes, if they have come back and paid for it according, you know, if they did end up paying on it, then yes, ma'am. That is when we would need the explanation of benefits for showing up.
[CUSTOMER][NEUTRAL] OK, so other, OK, so if primary didn't pay, doesn't pay anything that you guys are not paying anything.
[AGENT][NEGATIVE] We will not pay.
[AGENT][NEUTRAL] That is correct. Because this policy only helps with co-pays, deductibles and co-insurance amounts. So if they're not covering it, there's nothing applied to those, so there would be no benefits on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, I'll just make a note of that for when stuff comes back, um, but in that case that's, I think that's all of them that I have right now. There are a few others out there, but the primary hasn't done anything yet, so I'm not obviously I'm not worried about those.
[AGENT][NEUTRAL] Yeah, because if we don't, yeah, if there's, if you submitted the claims to APO without the.
[AGENT][NEUTRAL] Primary EOB with them?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then they will be reviewed, you know, but if that's the missing piece of information, it would be the same scenario as this we will have to have that. That's a required piece of documentation for these types of claims.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It, it should have came with it so I'm just, I'm not sure like that I've had a really difficult time just getting you guys anything, um.
[AGENT][NEUTRAL] Really?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, I have unfortunately, um, because right now if I print out this claim because it is going to secondary coverage it automatically print is gonna print an EOB for me from primary so I don't know I'm not sure what's happened there but um I will try to get them all to you guys again um I think last time I called maybe you guys have a fax number?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] We do. 877.
[CUSTOMER][NEUTRAL] Can you verify, yeah.
[AGENT][NEUTRAL] Uh, [PII] attention claims.
[CUSTOMER][POSITIVE] OK, I will get these.
[CUSTOMER][NEUTRAL] Sent again.
[AGENT][NEUTRAL] OK, well, is there anything else there, and now that you have our portal website, you know, you can also, if we have a claim on file, you should be able to check status there as well and again be able to print out these EVs that we've gone over.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty well thank you.
[AGENT][POSITIVE] Well, you are certainly very welcome. So if that's all I can help you with at the moment, thank you again for calling APL and I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][NEUTRAL] Um bye bye.
[AGENT][NEUTRAL] Papa.