AccountId: 011433970860
ContactId: c24cc1ec-bbd1-410f-90dd-a793227f12f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1509380 ms
Total Talk Time (AGENT): 297896 ms
Total Talk Time (CUSTOMER): 585500 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/c24cc1ec-bbd1-410f-90dd-a793227f12f7_20250304T16:20_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so, this is [PII] calling from the provider office to get the claim status. How are you, sir?
[AGENT][POSITIVE] I'm good thank you how about you, Mr. [PII]?
[CUSTOMER][POSITIVE] I'm good. I'm doing good today.
[AGENT][NEUTRAL] Good. May I have a callback number just in case we get disconnected, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes, our callback number is [PII].
[AGENT][NEUTRAL] Thank you. And um may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, the patient's policy number is 1335660M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Waiting on the system, bear with me.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure. The member's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, the date of service for this claim is [PII] and the amount on the claim is $37,588 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] That was [PII], correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 2. Let me see if I can find this claim for you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And for the future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And yeah, let me pull this EB.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like we processed the claim on [PII] and the claim was denied. The denial reason for this claim is that inpatient benefits for the calendar year has been met.
[AGENT][NEUTRAL] Mr. [PII], did you get that?
[CUSTOMER][NEUTRAL] Yeah, I got it. You said the uh impatient for the, sorry, I'm so sorry, I forgot.
[CUSTOMER][NEUTRAL] Inpatient.
[AGENT][NEUTRAL] Inpatient um benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] For the calendar year has been made, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So it is made as per the visit or the dollar value.
[AGENT][NEUTRAL] OK, it's gonna be the dollar value.
[CUSTOMER][NEUTRAL] OK. May I know the dollar value?
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage and the inpatient maximum is 2000 per year.
[CUSTOMER][NEUTRAL] $2000.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] And she said.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] OK. Just give me a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh actually, so I do, I do have more claims. Could you please help me with that claims too?
[AGENT][NEUTRAL] Uh, sure. I just need to make a note on each one before I move forward.
[CUSTOMER][POSITIVE] Sure. Take your time. No problem.
[AGENT][NEUTRAL] OK. And um do you need any other information on this one?
[CUSTOMER][NEUTRAL] Yeah, would you please provide me the call reference number?
[AGENT][NEUTRAL] OK, we don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK, so, uh, could you please spell 11 time your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, sir. Thank you so much.
[AGENT][NEUTRAL] Welcome.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, I'll provide you the another um member I like another member ID whenever you are ready, OK?
[AGENT][NEUTRAL] OK. Bear with me just a second, OK?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] My ID is 952624969 and yeah.
[CUSTOMER][NEUTRAL] OK, so for this member, the member has any other insurance?
[AGENT][NEUTRAL] For which one? For Prieto?
[CUSTOMER][NEUTRAL] For yeah, yeah, for pre.
[AGENT][NEGATIVE] Um, none with us.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so remember that, uh, doesn't have any other insurance, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, OK, no problem.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] OK, just give me a second. I'll provide you that, OK? Give me a moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 20.
[CUSTOMER][NEUTRAL] 608,240.
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] OK, so the next, uh next member ID is gonna be.
[CUSTOMER][NEUTRAL] It's 02141739 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] One
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, so it's gonna be and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service for this claim is [PII] and the
[CUSTOMER][NEUTRAL] Total charge on this claim is $8,853 even.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Let me see if I can find that one.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, that's [PII], correct?
[CUSTOMER][NEUTRAL] No, yeah, correct. [PII].
[AGENT][NEUTRAL] [PII]. Mhm. OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The.
[AGENT][NEUTRAL] Looks like this one we need the uh primary EOB to continue the processing of the claim.
[CUSTOMER][NEUTRAL] For this claim, uh, you're requiring primary EOB.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] OK. But we have already sent you the primary EOB on previously.
[CUSTOMER][NEUTRAL] Did you receive that? We have faxed the primary UB. I'll provide you the fax number.
[AGENT][NEUTRAL] We have not received that as of today. The only thing we have for that date of service is the one that we're asking for the primary ALD.
[CUSTOMER][NEUTRAL] That's a second.
[CUSTOMER][NEUTRAL] OK, so you did not receive any EOB, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Could you please provide me a fax number so we can uh fax, uh, fax the primary EOP.
[AGENT][NEUTRAL] Sure. That is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Oh.
[CUSTOMER][NEUTRAL] OK. 1 2nd.
[CUSTOMER][NEUTRAL] You said [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, one second. I'll provide you another member ID, OK, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, bear with me just a second. I need to make a note. So we're done with this one.
[CUSTOMER][NEUTRAL] Yeah, I'm done with this claim. OK, I'll provide you the, we'll, we'll send the primary the EOB to your fax number.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, one moment, let me make a note.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you want.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You too
[AGENT][POSITIVE] OK, I'm ready for the next one.
[CUSTOMER][NEUTRAL] OK. One second, I'll provide you the next member ID.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Are in the.
[CUSTOMER][NEUTRAL] Uh, name invalid
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. So the next member ID is gonna be 02511179 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Give me one moment
[CUSTOMER][NEUTRAL] Call connect me with us.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure. The member's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge amount is $43,891.42.
[AGENT][NEUTRAL] No, it was [PII], correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] We don't have that claim on file.
[CUSTOMER][NEUTRAL] You don't have any claim on file for this claim?
[AGENT][POSITIVE] Correct. I don't have no claims for that date of service.
[CUSTOMER][NEUTRAL] Uh, OK. We have billed this claim through paper and on your mailing address. I'll provide you the mailing address is that correct? Just confirm that, that the mailing address is correct or not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, uh, the, the mailing address we have sent is attention to claims department, [PII].
[CUSTOMER][NEUTRAL] MS [PII]
[AGENT][NEGATIVE] That's an incorrect address. No.
[CUSTOMER][NEUTRAL] Is that the correct address?
[CUSTOMER][NEUTRAL] OK. So that's the incorrect address, right?
[AGENT][NEGATIVE] That is the incorrect address.
[CUSTOMER][NEUTRAL] OK, one second.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Could you please provide me the correct address?
[AGENT][NEUTRAL] It's the one in [PII].
[CUSTOMER][NEUTRAL] And the payer ID?
[AGENT][NEUTRAL] It's the same one that I provided you in the beginning, which is the [PII] address [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, in [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, do you have any payer ID?
[AGENT][NEUTRAL] Uh, for this one, we need to claim either to be fax or mail because it needs the primary EOB attached to it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. You need a primary UV to attach to it. OK. Uh, could you please tell me the fax number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, you need.
[CUSTOMER][NEUTRAL] Primary B, right? Attached with the claim form.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Uh, uh, but, uh, actually, I do want, do you have any payer ID? I want, uh, actually want a payer ID too.
[AGENT][NEUTRAL] OK, I can give it to you, but if you send it electronic, it may not get here with the EOB, OK. So the payer ID.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, yeah, we'll send it through, we, we'll send it through fax or by mail, but actually, I want to pay ID for the document purposes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, uh, that is 60801.
[CUSTOMER][NEUTRAL] 60801, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] OK, I got it. Thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, I have only one last claim, uh, then we are done for this call, OK? So just give me a second, I'll provide you one more ID.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Unlisted diagnostic diagnostic issues are presented for the reference. We need some information for 276498.
[CUSTOMER][NEUTRAL] complete.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] G.
[CUSTOMER][NEUTRAL] 7499
[CUSTOMER][NEUTRAL] OK, so shall I provide you the next member ID?
[AGENT][NEUTRAL] Yes, go ahead.
[CUSTOMER][NEUTRAL] OK. Are you OK?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, OK, OK. So the next member ID is
[CUSTOMER][NEUTRAL] It's 60801.
[AGENT][NEUTRAL] OK, that's the payer ID, um, do you have the copy of the card?
[CUSTOMER][NEUTRAL] Uh, I'll check one second.
[CUSTOMER][NEUTRAL] Man
[CUSTOMER][NEUTRAL] I want to
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, actually, I do not have any copy of the card. Uh, only have that.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Once again, I will check one more time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I don't have any other payer ID. Could you please check the member's name with name or with date of birth?
[AGENT][NEUTRAL] OK. What's the spelling of the last name?
[CUSTOMER][NEUTRAL] The member's last name is
[CUSTOMER][NEUTRAL] Its spelling is [PII].
[CUSTOMER][NEUTRAL] And the first name is [PII] and the first name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] the same.
[AGENT][NEUTRAL] What is her date of birth?
[CUSTOMER][NEUTRAL] Members's date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service for this claim is?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] And the total charge amount is $2,672 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if I can find this one.
[AGENT][NEUTRAL] Let me pull this.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Could you please tell me the member's ID
[AGENT][NEUTRAL] Yes, that's [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] OK, [PII], right? 02475822. And what was the effective date and um date for the policy?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, bear with me just a second.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, um, the effective date on this policy is um [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there's no claim on file for that. Mhm. Go ahead.
[CUSTOMER][NEUTRAL] And still like there.
[CUSTOMER][NEUTRAL] Yeah, OK. There is no claim on file for that, uh, date of service, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, OK. OK, no problem. We'll uh we'll fax it to you, uh, on your payer ID uh on your fax number, OK?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You require primary you'll be with that?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, OK. OK, we'll provide you that also, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, sir. Thank you so much for all the information that you're given to me. Have a nice day ahead. Bye-bye.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You as well, and thank you for calling APO. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I