AccountId: 011433970860 ContactId: baa4d1c8-4d9a-4fe3-b2b8-e8643bbdae50 Channel: VOICE LanguageCode: en-US Total Conversation Duration: 2634649 ms Total Talk Time (AGENT): 514219 ms Total Talk Time (CUSTOMER): 591090 ms Interruptions: 3 Overall Sentiment: AGENT=0.9, CUSTOMER=0.3 Redaction Types: PII Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/baa4d1c8-4d9a-4fe3-b2b8-e8643bbdae50_20250506T18:11_UTC.wav -------------------------------------------- [AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you? [CUSTOMER][NEUTRAL] Oh hi, my name is [PII] calling from Broader office and um I'm looking for a claim status. May I know your name again? I'm sorry. [AGENT][NEUTRAL] [PII] [CUSTOMER][NEUTRAL] Do I see, OK, got you. I think I spoke to you a few minutes before. [AGENT][NEUTRAL] You did, [PII]. I believe you did. What is your callback number? [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Oh, it is [PII]. [CUSTOMER][NEUTRAL] [PII]. It's a direct. [AGENT][POSITIVE] OK, thank you. All right. And then, how can I help you now? [CUSTOMER][NEUTRAL] Oh, now I'm looking for a claim status as well. [AGENT][NEUTRAL] OK, you said a claim status, so you only have one? [CUSTOMER][NEUTRAL] Oh no, this time, actually, I have a different patient. To, I have 34. [AGENT][NEUTRAL] Uh [CUSTOMER][NEUTRAL] 567 patients. [AGENT][NEUTRAL] And one data service for each of the 7? [CUSTOMER][NEUTRAL] Yes. [AGENT][NEUTRAL] OK, yes, I can help you, and the same information applies as before you will use my name and today's date is your call reference number. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] Excuse me, any information provided will be a verification of benefits and not a guarantee of payment. And lastly, if you need a copy of the explanation of benefits, you may print those by going to [PII]. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] OK, [PII], and the first member's policy number? [CUSTOMER][NEUTRAL] So the first number I have 024. [CUSTOMER][NEUTRAL] 734 [CUSTOMER][NEUTRAL] 97 M as in Mike, L as in Lima, number 8. [AGENT][NEUTRAL] Thank you. One moment. And your patient's name and date of birth? [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] So, patient first name gonna be [PII] and the last name gonna be [PII] and uh [CUSTOMER][NEUTRAL] The date of birth will be [PII]. [AGENT][POSITIVE] Thank you. [AGENT][NEUTRAL] And the date of service and total bills amount, please. [CUSTOMER][NEUTRAL] Mhm. So, the data service I have [PII]. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] And uh the total charge will be $1,273 even. [AGENT][POSITIVE] Thank you. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] You. [AGENT][NEUTRAL] OK, so this claim was also received. It was received on [PII]. [AGENT][NEUTRAL] Processed and denied on [PII]. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] The claim number is 353. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] 858 99. [CUSTOMER][NEUTRAL] What [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] And the reason for the denial on this claim states to please provide copies of your explanation of benefits from your primary insurance carrier. [CUSTOMER][NEUTRAL] OK. So we need a year be right for the primary? [AGENT][POSITIVE] That is correct. [CUSTOMER][NEUTRAL] OK and uh. [CUSTOMER][NEUTRAL] May I know the mailing order to submit the information? [AGENT][NEUTRAL] Yes sir it's the same as the claims mailing address. [CUSTOMER][NEUTRAL] OK. So it is uh [PII]. [CUSTOMER][NEUTRAL] [PII], [PII], and the ZIP code is [PII], right? [AGENT][NEUTRAL] [PII]. [CUSTOMER][POSITIVE] Uh oh, OK, so ending with [PII]. OK, awesome. [AGENT][NEUTRAL] Yes, sir. Mhm. [CUSTOMER][NEUTRAL] One. [CUSTOMER][POSITIVE] OK, then. Perfect. Thank you. And shall we want the next member? [AGENT][NEUTRAL] One moment. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] OK. And the next member's policy number, please? [CUSTOMER][NEUTRAL] Mhm. So, the next two are member ID I have, it is uh 023. [CUSTOMER][NEUTRAL] 889 [CUSTOMER][NEUTRAL] 73 M as in Mike, L as in Lima, number 8. [AGENT][POSITIVE] Thank you. [AGENT][NEUTRAL] And your patient's name, [PII], and date of birth? [CUSTOMER][NEUTRAL] Mhm. So, patient name is uh [PII], the first name and the last name will be [PII], and the date of birth, [PII]. [AGENT][POSITIVE] Thank you. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] OK [AGENT][NEUTRAL] Data service and total bills amount please. [CUSTOMER][NEUTRAL] Mhm. So, the data service is [PII], 2024. [CUSTOMER][NEUTRAL] And the bill amount is $1,064 even. [AGENT][NEUTRAL] 1064. Is that correct? [CUSTOMER][NEUTRAL] Yes. [AGENT][POSITIVE] OK, thank you. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] OK [CUSTOMER][NEUTRAL] Yeah. [AGENT][NEUTRAL] OK, so this claim was also received, the received date was [PII]. [AGENT][NEUTRAL] It was denied on [PII]. [AGENT][NEUTRAL] The claim number is 356. [AGENT][NEUTRAL] 384 2. [AGENT][NEUTRAL] And the reason for the denial on this claim, [PII], states. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] The maximum benefit payable for this state of service has been met. [AGENT][NEUTRAL] We processed the claim prior to yours being received for the same day service. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][POSITIVE] So, this one also maximum benefit we. [AGENT][NEUTRAL] Yes sir. [CUSTOMER][POSITIVE] OK. Perfect. Thank you so much. And uh tell him on the next member? [AGENT][NEUTRAL] One moment. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] And the next member's policy number? [CUSTOMER][NEUTRAL] Mhm, so the next 2 on it. [CUSTOMER][NEUTRAL] The member ID I have 019. [CUSTOMER][NEUTRAL] 882 [CUSTOMER][NEUTRAL] 59 M as in Mike, L as in Lima, number 8. [AGENT][POSITIVE] Thank you, one moment. [CUSTOMER][NEUTRAL] OK [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] And your patient's name and date of birth? [CUSTOMER][NEUTRAL] Patient name will be [PII], the first name and the last name will be [PII]. [CUSTOMER][NEUTRAL] And uh the date of birth [PII]. [AGENT][POSITIVE] Thank you. [AGENT][NEUTRAL] Data service and total bill amount. [CUSTOMER][NEUTRAL] Oh, the data service I have. It is June [PII], 2024. [CUSTOMER][NEUTRAL] And uh the bill amount is $1,064 even. [AGENT][POSITIVE] Thank you. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] OK, and again you said the bill amount is $1,064 for data service 6-17-2024, is that correct? [CUSTOMER][NEUTRAL] Yes. [AGENT][NEUTRAL] OK, so we do not have a claim on file for that data service and that bill amount. [CUSTOMER][NEUTRAL] $1,064. [AGENT][NEUTRAL] No claim on file. [CUSTOMER][POSITIVE] OK. Perfect then. [AGENT][MIXED] Correct, not on file. [AGENT][NEUTRAL] And we will have to have a copy of the primary insurance company's explanation of benefits along with the claim for review. [CUSTOMER][NEUTRAL] Mhm. Uh. [CUSTOMER][NEUTRAL] OK, then perfect. And uh what will be the patient affected it? [AGENT][NEUTRAL] The effective date on this plan is 10. I'm sorry. One moment. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] The effective date is [PII]. [CUSTOMER][NEUTRAL] Yeah. [AGENT][NEUTRAL] And the policy is still active. [CUSTOMER][NEUTRAL] OK, [PII] and [PII]. I still like to. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] And you are the 2nd year, right? [AGENT][POSITIVE] That is correct. [AGENT][NEUTRAL] And the primary insurance explanation of benefits is required for our review along with the claim. [CUSTOMER][NEUTRAL] OK, then, sir. [CUSTOMER][POSITIVE] OK, then. Perfect. I understand. [CUSTOMER][NEUTRAL] 01 moment, uh, this one I need to mention it the primary. Yeah. OK. Awesome. And the payer ID will be 60801, correct? [AGENT][NEUTRAL] Mhm. [AGENT][POSITIVE] Correct. [CUSTOMER][POSITIVE] OK, then. Perfect. Thank you. And uh shall we want the next member? [AGENT][NEUTRAL] One moment. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] OK, and the next member's policy number? [CUSTOMER][NEUTRAL] OK. So the next member ID. [CUSTOMER][NEGATIVE] It is it's loading come on. [CUSTOMER][NEUTRAL] OK, yeah. So, the member ID I have 106. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] 6911. [AGENT][NEUTRAL] 6911. Is that correct? [CUSTOMER][NEUTRAL] Yes. [CUSTOMER][NEUTRAL] Yes. [AGENT][POSITIVE] OK, thank you. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] And your patient's name and date of birth? [CUSTOMER][NEUTRAL] Uh, patient first name will be [PII] and the last name will be [PII]. [CUSTOMER][NEUTRAL] Uh, let me get dollar or dollar, yes, and uh the date of birth I have [PII]. [AGENT][NEUTRAL] Thank you. Data service and total bill amount please. [CUSTOMER][NEUTRAL] So, the data service I'm looking for [PII]. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] And uh the bill amount will be $710 even. [AGENT][NEUTRAL] 710. [CUSTOMER][NEUTRAL] Yes. [AGENT][POSITIVE] OK, thank you. [CUSTOMER][NEUTRAL] Yeah. [CUSTOMER][NEUTRAL] Yeah [CUSTOMER][NEUTRAL] How [AGENT][NEUTRAL] OK, so this claim was received on [PII]. [AGENT][NEUTRAL] It was processed on [PII]. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] The claim number is 351. [AGENT][NEUTRAL] 1172. [AGENT][NEUTRAL] There was a benefit paid in the amount of $344.94. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] This was on single check. [AGENT][NEUTRAL] 2004789. [AGENT][NEUTRAL] And this does still show us out is open. Please verify the address. [CUSTOMER][NEUTRAL] Mm, so this one is a whollyorous emergency physician. One moment. [CUSTOMER][NEUTRAL] do. [CUSTOMER][NEUTRAL] OK. Very good. Got you. So the address will be [PII], and the ZIP code is [PII]. [AGENT][NEUTRAL] OK, so that is where it was sent to. [CUSTOMER][NEUTRAL] OK. And it was on uh [PII]. [AGENT][POSITIVE] Yes sir, that is correct. [CUSTOMER][NEUTRAL] OK, so it will be the longest. Can you avoid the check and uh reissue the new check to the same address? [AGENT][NEUTRAL] OK, yes sir, I can, um, and I'll have to, you'll have to give me a few minutes to type up the request to have that verified and processed. Is that OK? [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][POSITIVE] OK. OK. Take your time. [AGENT][NEUTRAL] All right. All right, for just a moment, please. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Yeah [CUSTOMER][NEUTRAL] Yeah [CUSTOMER][NEUTRAL] Yeah. [AGENT][NEUTRAL] OK. And is there any, I've submitted that request for you, [PII]. Is there anything else on this policy that you need? [CUSTOMER][POSITIVE] Oh, everything that I'm really appreciate it. And uh so I want the next team member? [AGENT][NEUTRAL] One moment. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] OK, and the next policy number? [CUSTOMER][NEUTRAL] So, the next number I have is 022. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] 632 [CUSTOMER][NEUTRAL] 96 M as in Mike, L as in Lima, number 7. [AGENT][POSITIVE] OK, thank you. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] And the patient's name and date of birth, please? [CUSTOMER][NEUTRAL] Mhm. So, patient name is uh [PII], and the last name will be [PII], and then the date of birth is [PII]. [AGENT][NEUTRAL] Mhm. [AGENT][POSITIVE] Thank you. [AGENT][NEUTRAL] Data service and total bill amount. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] So, the data service. [CUSTOMER][NEUTRAL] Uh, I'm looking for. [CUSTOMER][NEUTRAL] Moment. This 1 [PII]. [AGENT][NEUTRAL] Mhm. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEGATIVE] And the total charge $992 even. [AGENT][POSITIVE] OK OK, thank you. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] OK, so this claim was received. It was received on [PII]. [AGENT][NEUTRAL] Processed on [PII]. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] The claim number is 351. [AGENT][NEUTRAL] 0984. [AGENT][NEUTRAL] There was a benefit paid in the amount of $497.19. [AGENT][NEUTRAL] That was paid on single check. [AGENT][NEUTRAL] 200. [AGENT][NEUTRAL] 4978. [AGENT][NEUTRAL] If you could verify the mailing address for that one also. [CUSTOMER][NEUTRAL] Oh, the address is [PII], and the ZIP code is [PII]. [AGENT][POSITIVE] OK, thank you. [AGENT][NEUTRAL] So that is where it was sent to and it does still show that it's open from what I can tell. [CUSTOMER][NEGATIVE] So, this one also not clear. [AGENT][POSITIVE] Correct. [CUSTOMER][NEUTRAL] Oh, can you reissue the new check? [AGENT][NEUTRAL] Yes sir I'll have to create another ticket for this one also so do you mind waiting while I do that? [CUSTOMER][NEUTRAL] OK. Take it. [AGENT][POSITIVE] Thank you. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] OK [CUSTOMER][NEUTRAL] Yeah [CUSTOMER][NEUTRAL] No. [AGENT][NEUTRAL] Do you need anything else on this policy, [PII]? [CUSTOMER][NEUTRAL] Mm, everything, gotcha. [AGENT][NEUTRAL] OK, and what is your next patient's policy number? [CUSTOMER][NEUTRAL] So, the next policy number I have it is 024. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] 44831. [AGENT][NEUTRAL] OK, was that 3 4s, [PII]? [CUSTOMER][NEUTRAL] Oh yes. 023174831. [AGENT][NEUTRAL] OK. [AGENT][POSITIVE] OK, thank you. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] And your patient's name and date of birth? [CUSTOMER][NEUTRAL] Patient name is uh [PII], the first name and the last name will be [PII] and the date of birth will be uh [PII]. [AGENT][POSITIVE] Thank you. [AGENT][NEUTRAL] And the date of service and total bill amount, please? [CUSTOMER][NEUTRAL] Mhm. So, the data service I'm looking for [PII]. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] And uh the bill amount is $1,485 even 1485. [AGENT][NEUTRAL] 1485 or 1483? [CUSTOMER][NEUTRAL] I just [CUSTOMER][NEUTRAL] 85. [AGENT][POSITIVE] But, OK, thank you. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] 4 [CUSTOMER][POSITIVE] Super. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] OK, so this claim was received on 9-25-2024. [AGENT][NEUTRAL] It was processed on [PII]. [CUSTOMER][NEUTRAL] Mhm [AGENT][NEUTRAL] There was a benefit paid in the amount of $421.65. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] That was paid also on single check 200. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] 4961. [AGENT][NEUTRAL] And if you could verify that address, please? [CUSTOMER][NEUTRAL] OK. And uh before, uh, may I know the claim number? [AGENT][NEUTRAL] I'm so sorry, 351-073-7. [AGENT][NEUTRAL] I forgot to give that to you, [PII]. I'm sorry. [CUSTOMER][NEUTRAL] 0 [CUSTOMER][NEUTRAL] Oh, that's OK. [CUSTOMER][NEUTRAL] And uh this one the address I have [PII]. And the ZIP code will be [PII]. [AGENT][POSITIVE] Yes, that is where it was mailed and this one does also still show there is outstanding from what I can tell. [CUSTOMER][NEUTRAL] OK. And this one also, can you reissue the check? [AGENT][NEUTRAL] Yes sir, and again I'll have to submit the same type of request that I've been submitting for the other one. So do you mind allowing me time to do that? [CUSTOMER][POSITIVE] Yes, sure, we can. [CUSTOMER][NEUTRAL] I [AGENT][NEUTRAL] One moment. Almost finished with this one, [PII]. [CUSTOMER][POSITIVE] Mhm. Take your time. [AGENT][NEUTRAL] OK, so that request has now been submitted for this one. [AGENT][NEUTRAL] Was there anything else that you needed on this claim, on this policy rather? [CUSTOMER][NEUTRAL] No [CUSTOMER][NEGATIVE] Oh, no. [CUSTOMER][NEUTRAL] You know, I tell him on the last two. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] I'm sorry. Say that again, [PII]. [CUSTOMER][NEUTRAL] Uh, you know, I, I'm done with this claim and I shall we on the last one. [AGENT][NEUTRAL] Yes. [AGENT][NEUTRAL] What is that policy number? [CUSTOMER][NEUTRAL] Mhm [CUSTOMER][NEUTRAL] So, the member ID I have this one is 016. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] 03406. [AGENT][POSITIVE] Thank you, one moment. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] So [AGENT][NEUTRAL] And your patient's name and date of birth? [CUSTOMER][NEUTRAL] Mhm. Patient name is uh [PII] and the last name will be [PII] and uh the date of birth will be [PII]. [AGENT][POSITIVE] Thank you. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Yeah. [AGENT][NEUTRAL] And the date of service and total bill amount for him please. [CUSTOMER][NEUTRAL] Mhm. So, this one, I'm looking for [PII]. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] And uh the bill amount will be $2,235 even. [AGENT][NEUTRAL] 2233. Is that correct? [CUSTOMER][NEUTRAL] No, 223 5. [AGENT][NEUTRAL] OK. [AGENT][POSITIVE] Thank you. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] OK, so this claim was received on [PII]. It was processed on [PII]. [AGENT][NEUTRAL] The claim number is 351. [AGENT][NEUTRAL] 1086. [AGENT][NEUTRAL] There was a benefit paid in the amount of $238.38. [CUSTOMER][NEUTRAL] Mhm [AGENT][NEUTRAL] And that was also uh paid on single check 200. [AGENT][NEUTRAL] 4983. [AGENT][NEUTRAL] And if you could verify the address on this one, please? [CUSTOMER][NEUTRAL] Mhm. So, this one, the address will be [CUSTOMER][NEUTRAL] [PII]. And the ZIP code is [PII]. [AGENT][POSITIVE] OK, yes, sir, that is where that one was mailed to. This one is still also showing as outstanding from what I can tell. [CUSTOMER][NEUTRAL] OK. And this also, can you do the same one, I mean, uh, avoid the check and the reissue can you check? [AGENT][NEUTRAL] Yes, sir, just one moment for me to submit that request. [CUSTOMER][NEUTRAL] Mhm. OK. [AGENT][NEUTRAL] Well, more than a moment, as you know, it's gonna take me a few minutes to do this, but just a second. [CUSTOMER][NEUTRAL] OK. Take it. So actually this is the last time, so everything is finished. [CUSTOMER][NEUTRAL] Yeah [AGENT][NEUTRAL] Oh [AGENT][NEUTRAL] Hm [AGENT][NEUTRAL] Just a moment. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Yeah [AGENT][NEUTRAL] OK, [PII], so I have already, um, I have also rather submitted the ticket for you for this. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] To be verified and are still outstanding to also be ordered and reissued. Do you want to check to see if you have any other claims for APL while you and I are still on the phone? [CUSTOMER][POSITIVE] Oh, I know, everything, uh, I'm really appreciate it. I just wanna wait for you have to complete that. So that's why. [AGENT][NEUTRAL] OK, so this, this request has been approved. I mean, not approved, has been completed, I have submitted it. [CUSTOMER][NEUTRAL] Oh [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] So is there anything else at the moment, [PII], t[PII] I could help you with? [CUSTOMER][POSITIVE] Everything that I'm really appreciate toy. Thank you so much. I hope you enjoy your day. [AGENT][POSITIVE] OK, well, you're certainly very welcome. Yes, sir. I hope you do too, and thank you again for calling APL. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][POSITIVE] Bye-bye. Take care. [AGENT][NEUTRAL] Uh-huh. Bye-bye, [PII].