AccountId: 011433970860
ContactId: bf109e20-e2ea-4b8f-a44d-5b6662cbcf3d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1375979 ms
Total Talk Time (AGENT): 363403 ms
Total Talk Time (CUSTOMER): 489381 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/bf109e20-e2ea-4b8f-a44d-5b6662cbcf3d_20250418T19:23_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Yes hi how are you today?
[AGENT][POSITIVE] Hi, I'm good, thank you. How about you?
[CUSTOMER][POSITIVE] I'm doing just fine, thank you for asking. I am calling to check on a patient.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, sure. I can assist you with eligibility and benefits. And may I have your name?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And may I have a callback number just in case we get disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, that is going to be.
[CUSTOMER][NEUTRAL] 01869092
[AGENT][NEUTRAL] All right. And what is the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] Last name is [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK perfect thank you.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of information are you needing, Ms. [PII]?
[CUSTOMER][NEUTRAL] Claim status.
[AGENT][NEUTRAL] All right. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, data services 927-2024.
[CUSTOMER][NEUTRAL] Total charges on the claim are $4,677.00.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. Thank you. Let me see if I can find this claim for you and that was September [PII], correct?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 0, 24. OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 435. OK.
[AGENT][NEUTRAL] Let's see, and for future you can check claim status online through our website at [PII] and that's just optional and bear with me just a minute, let me pull this EOB.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I'll get that website from you again because the one on here is different.
[AGENT][NEUTRAL] Oh OK, yes, that will.
[CUSTOMER][NEUTRAL] On an explanation of benefits.
[AGENT][NEUTRAL] OK. Well, we have to, you can either go to [PII] or you can go to [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm waiting for the ARB to pull up.
[CUSTOMER][NEUTRAL] I'll see if I can get registered under that one. I, I'm not sure if I am or not, but I've been out of work for 5 months, so I'm just barely getting my feet back in the water right now.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's OK, no problem. You can always call. That's just optional. That's, yeah, not everybody will do it. Um, so it looks like we processed the claim [PII] and the claim was denied. The reason for this denial is that the outpatient benefits for the calendar year has been met, has been exhausted.
[CUSTOMER][NEUTRAL] 6.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, OK. Is there any way that I can have that explanation of benefits?
[AGENT][NEUTRAL] Yeah, I can fax it to you. Do you have fax number?
[CUSTOMER][NEUTRAL] OK, great. Of course, that's gonna be 956-683.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1502.
[AGENT][NEUTRAL] Alright, [PII].
[CUSTOMER][NEUTRAL] 31502. Yes, that is correct. And um.
[AGENT][NEUTRAL] OK, to your attention.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK. Alright, um, let me go ahead and send this out right, oh yeah, go ahead.
[CUSTOMER][NEUTRAL] There there's a, there's one.
[CUSTOMER][NEGATIVE] Yes, I'll go ahead and wait. No, no, no. I'll wait for that one because there's another one I need that I didn't receive. I, I called on 3 on the same patient, but I only received 2.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And I didn't receive the last, so maybe I can uh get that from you as well, please.
[AGENT][POSITIVE] Got you. OK. All right, give me just a minute, I'm practicing it right now.
[AGENT][NEUTRAL] But while I wait on that system, let me have the other date of service. You said it's the same member, correct?
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] Yes, it's the same number. It's just uh uh the lady I spoke to earlier, I guess only 2 went through, not the last one. And the last one was, I think, uh, let me see, I think it's the [PII]. Let me just double check.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, it's OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Let me see, I'm sorry, thank you for your patience.
[AGENT][NEUTRAL] No, it's OK.
[CUSTOMER][NEUTRAL] Oh, I think it was [PII], it's uh [PII].
[AGENT][NEUTRAL] OK, and how much is this one for?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, the, uh, the bill amount was $4,609.90.
[AGENT][NEUTRAL] Yeah, OK.
[CUSTOMER][NEGATIVE] And I know this one denied for the same, yeah, it denied for the same thing because of the max benefits, yes, I just needed the explanation of benefits.
[AGENT][NEUTRAL] Sain reason. Yeah.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so let me send this one as well.
[CUSTOMER][NEGATIVE] She was gonna send uh 3. I did receive 2, but one didn't, I believe one didn't come through, which was that one.
[AGENT][NEUTRAL] OK. OK. All right.
[CUSTOMER][NEUTRAL] And then I'll have to look for the other one that you're sending me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And I'm working on sending this, this other one, OK.
[CUSTOMER][POSITIVE] Oh, no, no, not a problem, not a problem.
[AGENT][POSITIVE] Mm, thank you.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so I did send that 2nd 1 and you have another one?
[CUSTOMER][NEUTRAL] Yes, I have another, it's another patient, but on this particular patient there's several dates of service, and they're all 2024 days of service. And this, it's got 123.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so bear with me.
[AGENT][NEUTRAL] OK. Bear with me just a minute. Let me go ahead and finalize this call and then I mean this number and then we can move forward to the next 11 moment. OK, um, so let me make a note.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] When the data service.
[AGENT][NEUTRAL] 2424.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] already
[AGENT][NEUTRAL] OK, so um we're done with this one and let's have the next policy number.
[CUSTOMER][NEUTRAL] Oh yes, OK, this on this patient, let me see which one is it.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 01868854
[AGENT][NEUTRAL] OK. What's the name and date of birth?
[CUSTOMER][NEUTRAL] You said you sent the other two.
[CUSTOMER][NEUTRAL] You sent the other two already, right? so I can have one look at the fact. OK, great, thank you, um.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And what's her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, perfect. OK, what's the first date of service?
[CUSTOMER][NEUTRAL] The first day of service is [PII].
[CUSTOMER][NEUTRAL] And the billed amount is $228.20 and after primary insurance, patient responsibility is $40.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, OK.
[AGENT][NEUTRAL] 845.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so this one was denied, office visits are not covered by the policy, and it was processed on [PII].
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] And do you need me to send a copy of that one?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] Oh, I wanna say all of these. Well, 1234.
[CUSTOMER][NEUTRAL] At least 4 of them. Let me see the other one.
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] See, while I'm waiting on that system, let me have the next date of service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's the amount on this one?
[CUSTOMER][NEUTRAL] Build them out.
[CUSTOMER][NEUTRAL] Billed amount is 31143 after primary insurance it's $40 patient responsibility.
[AGENT][NEUTRAL] OK, so this one was also denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Uh and.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, while I wait on that one to send and let me have the next date of service.
[CUSTOMER][NEUTRAL] For [PII], billed amount is $239.85 after primary insurance, uh, patient responsibility was $40.
[AGENT][NEUTRAL] OK, so this one was also denied as office visits are not covered. Um.
[AGENT][NEUTRAL] And it's gonna take me a minute. I'm waiting on this other one.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Sure not a problem.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And this one is taking a little bit longer because the other ones are trying to sell.
[CUSTOMER][NEUTRAL] Oh that's
[CUSTOMER][NEUTRAL] Oh, I understand, I understand.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Sweet.
[AGENT][NEUTRAL] Alright, so the first two already went out.
[AGENT][NEUTRAL] Um, and I'm waiting on the other 3.
[AGENT][NEUTRAL] Do you have another one for this one?
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the next one?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 828 2024.
[CUSTOMER][NEUTRAL] Build my
[CUSTOMER][NEUTRAL] It's $339.30.
[AGENT][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] pulling up to make sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] But it's also an office visit, but.
[CUSTOMER][NEUTRAL] I just wanna make sure you have it on file.
[AGENT][NEUTRAL] Yeah, this one we don't have it on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But it's gonna deny fur.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Office, uh, because office visits are not covered. OK, so let me see if I print it. Let me see if that one's printed. OK, that one's OK, so the next one, it's the same patient.
[CUSTOMER][NEUTRAL] The next one is 94 2024. Billed amount is $113.35. After primary insurance, it's a $40 responsibility.
[AGENT][NEUTRAL] No, that's [PII], correct?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] Yeah, that one is not on file.
[CUSTOMER][NEUTRAL] Let me check something here.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] OK, let me go ahead and put that one.
[CUSTOMER][NEUTRAL] Uh, batch for printing, OK.
[CUSTOMER][NEUTRAL] And I think on that one.
[CUSTOMER][NEUTRAL] OK, I'm waiting on this one.
[CUSTOMER][NEUTRAL] Well, there's one other data service which is 12-18-2024. bill amount was $80.
[CUSTOMER][NEUTRAL] After
[CUSTOMER][NEUTRAL] Uh, after primary insurance?
[CUSTOMER][NEUTRAL] Uh, responsibility is $23.28.
[AGENT][NEUTRAL] I don't have a claim for December 18024.
[CUSTOMER][NEUTRAL] OK, you said 8.
[CUSTOMER][NEUTRAL] OK, that would print it, OK.
[CUSTOMER][NEUTRAL] And that one was uh which one again? 1218, correct?
[AGENT][NEUTRAL] 18 of 24. Mhm.
[CUSTOMER][NEUTRAL] Let me set that one to to print uh bat. OK, I'm gonna send you in those 3. Let me just refresh here.
[CUSTOMER][NEUTRAL] I'll send you in those 3. I have to print 2 of them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and I just have uh let me see I think that was it but let me just double check.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] OK and then I think that was.
[CUSTOMER][NEUTRAL] Another 01 other patient.
[CUSTOMER][NEUTRAL] And that and that'll be all.
[AGENT][NEUTRAL] Let me make a note on this.
[CUSTOMER][NEUTRAL] Mhm, let me just, I need to grab something real quick. I'm gonna place you on. I'm not gonna put you on hold. I'm just gonna put my headset down.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I already printed out the 3, the 3 claims that I have to send on the previous patient, and then this patient is 2, and then the other is I'm just waiting on the denials to receive them so I can take them all off my aging report.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There's gonna be a lot of stuff coming off the report.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, and I think I'm almost done with this one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's the next policy?
[CUSTOMER][NEUTRAL] 0 186-876.
[CUSTOMER][NEUTRAL] 7.
[CUSTOMER][NEGATIVE] I'm gonna repeat that. That didn't even sound right to me.
[AGENT][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] 18687667 and it's [PII].
[AGENT][NEUTRAL] OK, let me have that one more time.
[CUSTOMER][NEUTRAL] 22319.
[AGENT][NEUTRAL] 18
[CUSTOMER][NEUTRAL] 186.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 6, OK, it's, it's 186.
[CUSTOMER][NEUTRAL] 876 7.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what's her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. OK, what's the date of service?
[CUSTOMER][NEUTRAL] OK, the first date of service is [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $428.40. After primary insurance, it's a $40 responsibility.
[CUSTOMER][NEUTRAL] Sorry, I have to write something over. I didn't understand my writing.
[AGENT][NEUTRAL] OK, and you said [PII], correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. We don't have that claim on file.
[CUSTOMER][NEUTRAL] OK, so I'll get that billed out and then the other one is I'll give you the data service either way it's 2-14-2025.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, billed amount is 450.78 after primary insurance, it's a $40 responsibility.
[AGENT][NEUTRAL] OK, that one is not on file.
[CUSTOMER][NEUTRAL] And I want to say.
[CUSTOMER][NEUTRAL] OK, and this policy also doesn't cover office visits, right?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Only because they're both offices that they're gonna get delayed.
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] Yeah, this one doesn't have office visit benefit either.
[CUSTOMER][NEUTRAL] OK, so I know those two will get denied. I mean, I have to leave them under regardless.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and well I will be expecting those faxes and did they all go through on your end already?
[AGENT][NEUTRAL] They all go through. Mhm all 6.
[CUSTOMER][POSITIVE] You, I know you said you did? OK, great. Wonderful. Let me go ahead and get those. There's 6 of them?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] 12345. OK, great. Thank you so much.
[AGENT][NEUTRAL] 3455. I'm sorry, it's 5.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I was like, I probably forget to write something, but OK, I had 5. OK, great. Thank you so much. You have a great day and happy [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Hm.
[AGENT][POSITIVE] You as so and thank you for calling APO. Have a good afternoon. Happy weekend. Bye-bye, Ms. [PII]. You're welcome.
[CUSTOMER][POSITIVE] Thank you.