AccountId: 011433970860
ContactId: bf8b0f71-c76c-4274-b18f-0d2343fed400
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 840780 ms
Total Talk Time (AGENT): 307767 ms
Total Talk Time (CUSTOMER): 229000 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/bf8b0f71-c76c-4274-b18f-0d2343fed400_20250204T15:06_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, uh, my name is [PII], and I'm calling to check claim status for a member.
[AGENT][NEUTRAL] OK [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh, well, I actually have, um, 3.
[AGENT][NEUTRAL] You said.
[AGENT][NEUTRAL] For the same patient or different patients?
[CUSTOMER][NEUTRAL] Um, it's two of them same patient, the other one is a different patient.
[AGENT][NEUTRAL] OK, [PII], yes, I can help you with this. What is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. So a couple of things in advance, [PII], you will use my name that I gave you along with today's date as your call reference number for each. Also, any information that I provide for you will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of the explanation of benefits, you may go to our portal to print those.
[AGENT][POSITIVE] And our portal website is secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so what is your first patient's policy number with the multiple dates of service?
[CUSTOMER][NEUTRAL] OK. It's 021-75436.
[CUSTOMER][NEUTRAL] M. for Mary, L for Lima, number 8.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what is your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] OK, patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Data service and total bill amount please for the first day of service.
[CUSTOMER][NEUTRAL] Mhm, it's 926 2024 $200 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome
[AGENT][NEUTRAL] 926 of 2024. Is that correct?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] OK, we do not have a claim on file for Sandor for that data service.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm, OK, I think that I think we send this through mail on um [PII].
[AGENT][NEUTRAL] And what
[AGENT][NEUTRAL] And what address did you submit it to?
[CUSTOMER][NEUTRAL] OK, let me check here.
[CUSTOMER][NEUTRAL] OK, just allow me one second, let me double check.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, mm, come on.
[CUSTOMER][NEUTRAL] Mhm my system.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I understand. It's OK, no worries.
[CUSTOMER][NEUTRAL] Thank you. OK, it's [PII].
[AGENT][NEUTRAL] No, ma'am, that's not our address for APL. I don't know what that address is for.
[CUSTOMER][NEUTRAL] OK, let me see here.
[CUSTOMER][NEUTRAL] OK, could be
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Um, MSN [PII].
[AGENT][NEUTRAL] OK, so that is an old address. You need to update that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] In your system?
[CUSTOMER][NEUTRAL] OK, can you please provide me the address please?
[AGENT][NEUTRAL] Yes, the address is [PII].
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] Now it looks like who is the provider for the claim you were in question of?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Uh, Doctor [PII].
[AGENT][NEUTRAL] OK, so this claim has been just received and it's in line for reviews, so there's not a claim number assigned to it yet.
[AGENT][NEGATIVE] But it has been received.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was received on yesterday as a matter of fact.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK, mm got it.
[CUSTOMER][NEUTRAL] Um, and could you please, uh, double check for the date of service or if you receive another one for, mhm.
[AGENT][NEUTRAL] Alright, alright, give me, yeah, give me just one second.
[CUSTOMER][NEUTRAL] Yeah, yeah, sure.
[AGENT][NEUTRAL] OK, and what is the night for the service and total bill amount?
[CUSTOMER][NEUTRAL] Sure, it's 99-2024.
[CUSTOMER][NEUTRAL] $225 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said it's for 2:25, is that correct?
[CUSTOMER][NEUTRAL] Yeah, let me.
[AGENT][NEUTRAL] Can you, yes, can you check that build out?
[CUSTOMER][NEUTRAL] Double check. Yeah, let me double check.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK, mm
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, just
[CUSTOMER][NEUTRAL] OK, yeah, sorry.
[CUSTOMER][NEUTRAL] Oh yeah, it's 20225.
[CUSTOMER][NEUTRAL] Uh maybe it's just separately like for just the code 99213 is just for $200.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we did receive a claim for that, for the 200.
[AGENT][NEUTRAL] That claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] And one moment, I'll give you the claim number.
[AGENT][NEUTRAL] The claim number is 3552518.
[AGENT][NEGATIVE] This claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] Office visits are not covered by the supplemental policy, [PII].
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm mm mm.
[CUSTOMER][NEUTRAL] Could you please uh send me this explanation of uh payments or benefits through fax, please?
[AGENT][NEUTRAL] OK, I gave you the website for our portal so that you could print them yourself.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Can you access the internet? Mhm, yes ma'am, with the claim number, yes ma'am, you should be able to access that via our portal so you can print them.
[CUSTOMER][NEUTRAL] Oh sure, sure.
[CUSTOMER][NEUTRAL] Yeah, yeah, sure, mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK perfect thank you mhm.
[AGENT][NEUTRAL] Mhm. You're welcome. So is there any other information that you need for this number?
[CUSTOMER][POSITIVE] Uh, no, that will be all, thank you.
[AGENT][NEUTRAL] OK, so one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what is the next member's policy number, please?
[CUSTOMER][NEUTRAL] Sure, it's 0202.
[CUSTOMER][NEUTRAL] 4680.
[CUSTOMER][NEUTRAL] M for Mary, L for Lima, number 8.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And your patient's name and date of birth for this policy?
[CUSTOMER][NEUTRAL] Sure, uh, patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, now, um,
[AGENT][NEUTRAL] This policy, what is your data service in total bill amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] In total bill amount?
[CUSTOMER][NEUTRAL] OK, it's $450 even.
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] I said this policy, there is no claim on file under this policy. This policy terminated for [PII].
[AGENT][NEUTRAL] Let me see if he has another policy that is active, and he does. The correct policy number that you should have for this member?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is 02175427.
[CUSTOMER][NEUTRAL] OK, mm mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Just to confirm, it's 021-75427.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, perfect. I will check on that and we will resubmit this this claim. Thank you.
[AGENT][NEUTRAL] 75, OK.
[AGENT][NEUTRAL] Uh, no, let me, no, let me check to see if we pro we received it and processed it under the correct claim number even though it was submitted with an old number. Just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we did receive this claim and it was uh it was received on [PII], processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 2556.
[AGENT][NEUTRAL] And one moment on the canal.
[AGENT][NEUTRAL] This states the denial as this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, mm, got it, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, I think that will be all. Thank you so much for your help, um.
[AGENT][POSITIVE] Well, absolutely, [PII]. You're welcome and thank you again for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You too thank you. Just to confirm, uh, what was your name? I'm sorry?
[AGENT][NEUTRAL] Yes, ma'am
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, mhm, got it, thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling APL.
[CUSTOMER][POSITIVE] Mm thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.