AccountId: 011433970860
ContactId: be871fdb-f6d8-4efb-8e55-f99b0db0dd9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1028068 ms
Total Talk Time (AGENT): 414315 ms
Total Talk Time (CUSTOMER): 165664 ms
Interruptions: 0
Overall Sentiment: AGENT=2.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/be871fdb-f6d8-4efb-8e55-f99b0db0dd9d_20250127T20:11_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office checking on claims. Could you please help me with that?
[AGENT][POSITIVE] Yeah, I'd love to help you with claim status today, Ms. [PII] and
[AGENT][NEUTRAL] Do you mind if I get a quick call back number for you?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] it's a direct line.
[AGENT][POSITIVE] All right, wonderful. And what is the member ID number we're looking at today?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] That is 017.
[CUSTOMER][NEUTRAL] 92084.
[AGENT][POSITIVE] Wonderful and give me a moment to get that pulled up for you, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, I appreciate your patience. And may I have uh the insured's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] And the date of birth [PII].
[AGENT][POSITIVE] Wonderful thank you so much and what is the date of service for [PII] we wanna look at or do you have a particular claim number you'd like to look at?
[CUSTOMER][NEUTRAL] Uh, June [PII].
[AGENT][POSITIVE] Wonderful that filled them out.
[CUSTOMER][NEUTRAL] $403 is it?
[AGENT][POSITIVE] Thank you, let me take a look for that.
[AGENT][NEUTRAL] And what is the name of the facility on file?
[CUSTOMER][NEUTRAL] By clinic.
[AGENT][POSITIVE] Perfect. Alright, I do show that claim right here. I have your claim number listed as 3476859.
[AGENT][NEUTRAL] I show that we received your claim on.
[AGENT][NEUTRAL] [PII] and it looks like we processed the claim on [PII].
[AGENT][NEUTRAL] Um, and I do show that claim had benefits payable. It looks like the claim paid benefits of $118.74 and they were paid on a single check. That check number is 186-09997. It looks like that check was issued to Mercy Clinic on [PII], and it was cashed on [PII].
[AGENT][NEUTRAL] I do show that that claim also had a denial code um stating that office visits are not covered by the above number policy and it looks like that code was on um or that denial was on.
[AGENT][NEUTRAL] Let me go back. I'm so sorry. I just lost it.
[AGENT][NEUTRAL] Um, on code number 99214.
[CUSTOMER][NEUTRAL] OK, may I know which type of plan does the member have?
[AGENT][NEUTRAL] This plan with us is a secondary.
[CUSTOMER][NEUTRAL] OK, thank you. Could you please spell out your name?
[AGENT][NEUTRAL] Yes, it's [PII], first initial last name, [PII].
[CUSTOMER][POSITIVE] Thank you. I have 4 more claims. Could you please help me with that?
[AGENT][POSITIVE] Yeah, let me finish typing in this note for this one and I can help you with that next one, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just one more second.
[AGENT][NEUTRAL] OK there
[AGENT][NEUTRAL] Alright, [PII], what is the next policy number we want to look at or is it for the same member?
[CUSTOMER][NEUTRAL] Uh, it's different, uh, than the member ID 024.
[CUSTOMER][NEUTRAL] 62881.
[AGENT][POSITIVE] Perfect, let me pull them up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Wonderful, thank you for your patience and if you could verify for me that member's first and last name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth, [PII].
[AGENT][POSITIVE] Wonderful. I do see [PII] right here and for [PII], is it a data service we wanna search for or do you have the claim number?
[CUSTOMER][NEUTRAL] Uh, the date of service [PII].
[AGENT][POSITIVE] June 424 wonderful and that builds them out.
[CUSTOMER][NEUTRAL] $184 even.
[AGENT][POSITIVE] Thank you. Let me take a look.
[AGENT][NEUTRAL] All right, and it's the same facility, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Wonderful. All right, so I do see your claim right here. It looks like your claim number is 3532516. I show that we received your claim on [PII], and we processed this claim on [PII] I'm sorry, [PII], and I do show we processed it [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Sorry, could you please, uh, repeat the received date and process date?
[AGENT][NEUTRAL] We received it on [PII], and we processed it [PII].
[AGENT][NEUTRAL] I do show that the claim denied stating that office visits are not covered by the above to number policy.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] And is there anything else you're needing for this particular?
[CUSTOMER][NEUTRAL] Shall we not?
[CUSTOMER][NEUTRAL] No, She want the next one.
[AGENT][POSITIVE] Yeah, let me just put this note in real fast and I'll be ready for you.
[AGENT][POSITIVE] Wonderful, thank you for your patience. I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] 01792125.
[AGENT][NEUTRAL] Alright, and give me a moment to get this one up.
[AGENT][NEUTRAL] I appreciate that and if you could verify that member's first and last name and date of birth for me.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] uh the last name, [PII]
[CUSTOMER][NEUTRAL] And the date of [PII].
[AGENT][POSITIVE] Perfect. I do see Ms. [PII] right here and what is the date of service we're looking at today for her?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And the $129.07.
[AGENT][POSITIVE] 129 perfect thank you.
[AGENT][POSITIVE] Wonderful, and I did find that claim for you. I'm looking at claim number 353-265-9.
[AGENT][NEUTRAL] I am showing that that claim was received with us on [PII]. That claim was processed on [PII], and I'm showing that this claim denied for that same reason that office visits are not covered by the above number policy.
[CUSTOMER][NEUTRAL] OK, thank you. Is there any time filing limit?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][POSITIVE] OK, thank you. Shall you with the next one.
[AGENT][POSITIVE] Absolutely, let me see this note real fast.
[AGENT][POSITIVE] And I am ready for the next policy number when you are.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Yeah, thank you. Uh, the member ID is 02268420.
[AGENT][NEUTRAL] And you said 222-684-20 did I catch that correct?
[CUSTOMER][NEUTRAL] 02268420
[AGENT][POSITIVE] Thank you so much. I put an extra 2 in there. I appreciate you clarifying.
[AGENT][NEUTRAL] And let me get that pulled up.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] Alrighty and if you could verify this one for me pretty please.
[AGENT][NEUTRAL] Um, her first and last name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and the date of birth [PII].
[AGENT][POSITIVE] Wonderful. I really appreciate that the data service for Miss [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And that build them out?
[CUSTOMER][NEUTRAL] $184 is it?
[AGENT][POSITIVE] Alright, I appreciate that thank you.
[AGENT][NEUTRAL] Alright, I see your claim right here. I have claim number 346.
[AGENT][NEUTRAL] 8235.
[AGENT][NEUTRAL] I show we received the claim on [PII], and we processed the claim on [PII], and I do show that this claim also is denied that office visits are not covered by the above number policy.
[CUSTOMER][POSITIVE] OK, thank you. [PII] with the last one.
[AGENT][POSITIVE] Absolutely, let me hit save on this note and I will be ready to move on.
[AGENT][NEUTRAL] All righty, and that last policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] 02258986
[AGENT][NEUTRAL] 36, you betcha.
[AGENT][NEUTRAL] Let me get it pulled up.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] This insured's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] Name, and the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and I do see Miss [PII] right here.
[AGENT][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] And what is the data service for [PII] we wanna look at today?
[CUSTOMER][NEUTRAL] [PII] and the bill amount $205 even.
[AGENT][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][POSITIVE] And I'm so sorry, can you give me the date one more time?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, I am not showing any.
[AGENT][NEUTRAL] Any claims on file for [PII] for this insured?
[CUSTOMER][NEUTRAL] I have a claim number.
[AGENT][NEUTRAL] OK, what is the claim number?
[CUSTOMER][NEUTRAL] 352-071-5
[AGENT][NEUTRAL] OK, let me see.
[AGENT][POSITIVE] I am really sorry about that. I pulled up the
[AGENT][NEUTRAL] I, I just had her listed twice in here and I pulled her up under the wrong one so I do see that claim.
[AGENT][NEUTRAL] Um, let me pull up this information really fast, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I show your claim here. It does match that claim number I see we received it on [PII]. We processed it [PII], and it denied for that same reason that office visits are not covered by the above number policy.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Oh my pleasure.
[CUSTOMER][NEUTRAL] May I know the call reference?
[AGENT][NEUTRAL] Yeah, call reference is my name, [PII], first initial last name, [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you. Thank you for providing this information. That's all for today. Have a good day.
[AGENT][POSITIVE] Oh, it's my pleasure. Thank you, [PII]. You take care and have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye.