AccountId: 011433970860
ContactId: bf9f6b45-e025-40fe-b0e2-ae728f547fda
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 612739 ms
Total Talk Time (AGENT): 241635 ms
Total Talk Time (CUSTOMER): 191596 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/bf9f6b45-e025-40fe-b0e2-ae728f547fda_20250114T17:51_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] Hello. Good afternoon. My name is [PII] and I'm calling from the provider's office. I'm calling for claim status, please.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with claim status today. Do you mind if I get a good call back number from you?
[CUSTOMER][NEUTRAL] Yeah, um, absolutely. It is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Yes, um, I got, one second, 02465388.
[CUSTOMER][NEUTRAL] Not sure M L and then number 8.
[AGENT][POSITIVE] Wonderful. Give me a moment to get that loaded for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, one sec.
[AGENT][NEUTRAL] Thanks for your patience. Would you mind verifying for me, pretty please your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, um, it's [PII], [PII].
[AGENT][NEUTRAL] Perfect thank you I do see that right here and do you have the claim number and you're needing more information or you want me to search it for you with the date of service?
[CUSTOMER][NEUTRAL] Yes, um, I, I need the general status. I have only the date of service and the bill amount.
[AGENT][NEUTRAL] OK, yeah, what does that data service?
[CUSTOMER][NEUTRAL] And that's um
[CUSTOMER][NEUTRAL] Yeah, it's [PII], 2024.
[CUSTOMER][NEUTRAL] And $1,055.
[AGENT][POSITIVE] Perfect. And let me take a look.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, it doesn't look like I'm showing any claims on file for Ms. [PII].
[CUSTOMER][NEUTRAL] OK, and the client file. Let me see if we have the right, um, submission information. Um, we did try to submit it electronic. Is your payer ID 60801?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK. Um, and one thing that this policy picks, picks up, um, co-insurance from, uh, primary.
[AGENT][NEUTRAL] Yeah, we're their gap insurance.
[CUSTOMER][POSITIVE] OK, perfect. Thanks so much. Um, I'll just go ahead and resubmit the claim for the member. Um, let's see.
[CUSTOMER][NEUTRAL] Um, I do have another date of service for the same member.
[AGENT][NEUTRAL] OK, so I genuinely have zero claims on file for this number, so I don't have that one either. I'm so sorry. I, I'm so sorry. Um, is it, um, older than 2024? I can see if she had previous coverage with us.
[CUSTOMER][POSITIVE] OK. Oh, OK. OK. No problem.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, well, he has older claims, but those are 2024 ones and all has been paid except the two, no claim on file, so I'll have to submit those two.
[AGENT][POSITIVE] OK, yeah, I'm so sorry, but yeah, please resubmit that we don't have a time limit we'd be so happy to look at those for you.
[CUSTOMER][POSITIVE] Awesome, thank you. And I do have one more patient if you can look at it. I have 2 claims for other patients.
[AGENT][POSITIVE] Yes absolutely let me type in this note real quick and get it saved and then I can move on to another patient for you no worries.
[CUSTOMER][POSITIVE] Sounds good thank you. OK.
[AGENT][POSITIVE] Yeah, it's my pleasure and let's see what is.
[AGENT][NEUTRAL] What's the next policy number we want to look at?
[CUSTOMER][NEUTRAL] OK, let me open it up, a second.
[CUSTOMER][NEUTRAL] All righty. So I have 02286174 ML 8.
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Your patient's first and last name, please?
[CUSTOMER][NEUTRAL] Yup. [PII], um, [PII].
[AGENT][NEUTRAL] Perfect. I see him here. And what was the date of service on this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got [PII] for $468.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect. And then did you say you had 2 for him as well?
[CUSTOMER][NEUTRAL] Yes, um, let me see the other one is [PII] for $380.
[AGENT][POSITIVE] Perfect. Alright, I'll start looking into those.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I do believe I found both of them. Give me one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So I have to like search for them on one screen and then like pull them up on another one so it just takes a little bit to move between them.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] And can you verify the name of the facility on that again for me?
[CUSTOMER][NEUTRAL] Yeah, uh, the Neurology Institute.
[AGENT][NEUTRAL] Perfect. So the first claim I have for you um the one from the [PII], I show here that we received the claim [PII]. We processed it the following day, um, [PII], and it looks like the claim number is 35382.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] 47
[AGENT][NEGATIVE] And on this claim, I do show it was denied. The reason stating is office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Covered under the policy.
[CUSTOMER][NEUTRAL] Is it denied as contractual obligation or patient responsibility?
[AGENT][NEUTRAL] Because we're a supplemental poli like plan we can't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Um, and then the next one I have for you, um, it looks like we received your claim. This was the [PII] we received it [PII], and of this year we processed it the [PII] of this year. Your claim number is 355-0709 and it denied for the same reason.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, the [PII].
[CUSTOMER][NEUTRAL] Uh covered.
[CUSTOMER][POSITIVE] All righty. Um,
[CUSTOMER][NEUTRAL] Is it possible that you can fax the copy of the EOB?
[AGENT][POSITIVE] Yeah, let me pull those EOBs for you.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And while those are loading, do you mind if I snag a good call back or not a good call back? I can't talk. I'm so sorry. A good fax number to you.
[CUSTOMER][NEUTRAL] OK, yeah, it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2305.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Perfect and do you want me to make that attention to yourself when I send it or attention to some, uh, to the patient account number?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It's just uh my name please so I can look it up more easily. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I don't think it likes that I'm trying to play with two of them at once. Hold on, I'm so sorry.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm gonna read this fax number back to you one more time before I hit send. I have [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You got it, right?
[AGENT][POSITIVE] Perfect, so I'm sending that first one and then I am.
[AGENT][NEUTRAL] Um, gonna start working on that second one for you real quick. One second.
[CUSTOMER][POSITIVE] OK. OK. Thank you.
[AGENT][POSITIVE] Oh, it's my pleasure.
[AGENT][NEUTRAL] Alright, and I just hit send on that second one. It shouldn't be too long before you get it. It typically takes about.
[AGENT][NEUTRAL] 5 to 10 minutes.
[AGENT][NEUTRAL] Um, is there anything else I can do for you, my friend?
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] That will be all. Thank you. Do you have a call reference number?
[AGENT][NEUTRAL] Oh yes, it's my name, [PII], first initial, last name, [PII], and then today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you, Allie. You have a good day.
[AGENT][POSITIVE] Hey, my pleasure you too, thank you for calling APL and you have such a wonderful afternoon.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye