AccountId: 011433970860
ContactId: bd06d38e-7629-4dd0-95ea-429de6b25cf6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 660580 ms
Total Talk Time (AGENT): 220543 ms
Total Talk Time (CUSTOMER): 297238 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/bd06d38e-7629-4dd0-95ea-429de6b25cf6_20250221T14:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, this is [PII]. I'm calling for provider, uh, [PII]. Please note this call will be monitored recorded for quality training purposes. I'm calling to check on claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, [PII]. Um, [PII], I'm sorry. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, that is [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, that is 01835977.
[AGENT][NEUTRAL] Thank you. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] To claim.
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes. So the member first name is [PII] and the last name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yes, that is [PII] and the bill amount for this one.
[CUSTOMER][NEUTRAL] That is $1,764 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the name of the provider's office?
[CUSTOMER][NEUTRAL] Yes, provider office is Beta County Memorial Hospital.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 351-0714.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And on [PII], we paid out to the provider a total of $1,074.30.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 1000.
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] And also for this one, it was uh uh single or bulk payment.
[AGENT][NEUTRAL] It was a single check. Did you need the check information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Um, so it's check number 2004952.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] And it was mailed to PO Box.
[CUSTOMER][NEUTRAL] All right. And
[AGENT][NEUTRAL] It was mailed to [PII]. Is that correct?
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, I just
[CUSTOMER][NEUTRAL] And also, let me verify the patient account num sorry, patient account number that is [PII] [PII].
[AGENT][NEUTRAL] The patient account number for the claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] that we have used
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK do you have any other like.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, [PII], [PII].
[CUSTOMER][NEUTRAL] All right. And can you provide me the um payment clear or case date?
[AGENT][NEUTRAL] No, the payment is still outstanding. Um, that's why I went over the, the address with you. So that is the correct address?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm asking.
[CUSTOMER][POSITIVE] Yes, yes, that's the correct address.
[AGENT][NEUTRAL] OK, so I can go ahead and put in a request for a representative to check on the check. If it has in fact been um processed, we can provide a copy of the clear check. If not, we can reissue it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And how many days it will take?
[AGENT][NEUTRAL] Um, we give it the same turnaround as a claim, 7 to 10 business days.
[CUSTOMER][NEUTRAL] 72.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] All right. Thank you so much. And yes, uh, can we move on to the next claim?
[AGENT][NEUTRAL] Hold on one moment, is it the same member?
[CUSTOMER][NEUTRAL] Uh, different members.
[AGENT][NEUTRAL] OK, and what's the next member's policy number?
[CUSTOMER][NEUTRAL] Yes, that is 02369642. M as in Mike, L Lima, number 8.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] 23569642.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] No. No. 02369642 M. Mike L Lima, number 8.
[AGENT][NEUTRAL] Was that correct?
[AGENT][NEUTRAL] OK, here we go. Thank you. Sorry about that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes, that is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the um date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, that is [PII] and the bill amount, let me just check.
[CUSTOMER][NEUTRAL] Bill amount is $305 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any other way to submit?
[CUSTOMER][NEUTRAL] Today I did here.
[AGENT][NEUTRAL] And that was $305 even?
[CUSTOMER][NEUTRAL] But this is
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'm not showing a claim on file for $305. Um, there is one claim that we
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, one moment, let me just check the bill amount.
[AGENT][NEUTRAL] Because this is a different provider also, this wouldn't be your claim.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So we don't have a claim on file for the member.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I do have the claim number. Can you check with this claim number?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That is 3486745.
[AGENT][NEUTRAL] Is it the same provider as the previous provider?
[CUSTOMER][NEUTRAL] Provider is different.
[AGENT][NEUTRAL] OK, so then this is your claim, yes, that's the same claim number I'm looking at, but the total bill for this claim is $260.
[AGENT][NEUTRAL] Not 305. So it is 260.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this is the claim, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the claim was received on [PII]?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The claim number is 348.
[AGENT][NEUTRAL] 6745.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hey
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Office visit and cover.
[CUSTOMER][NEUTRAL] One moment here, let me just check.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] All right. And also for this one, which CPT is not covered as uh the patient policy?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] Um, there's only one code for this claim, that's 99214.
[CUSTOMER][NEUTRAL] 214.
[CUSTOMER][NEUTRAL] Alright thank you and also for this one, can you provide me the timely filing to submit correct the claim?
[AGENT][NEUTRAL] Um, there's no timely filing for a corrected claim for an appeal. You have 180 days from the denial date.
[CUSTOMER][NEUTRAL] So there's no
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 180 days.
[CUSTOMER][NEUTRAL] Alright, and also mailing addresses am I correct correctly?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK so
[CUSTOMER][NEUTRAL] All right. And also uh mailing address to submit a bill.
[AGENT][NEUTRAL] It's the same, but it'll be to APL um appeals.
[CUSTOMER][NEUTRAL] OK, and is there any specific appeal form that we can use?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, no, there's no appeal form.
[CUSTOMER][POSITIVE] All right, thank you so much and yes you can provide me the call reference number.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. And again, that's [PII] The first initial to my last name is [PII] and today's date.
[CUSTOMER][POSITIVE] All right. Thank you so much. You have a great day.
[AGENT][POSITIVE] You also, and thanks for calling APO. Bye-bye.