AccountId: 011433970860
ContactId: c2f4550d-c921-4bcf-8ed5-495ec55ca4bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 843289 ms
Total Talk Time (AGENT): 332820 ms
Total Talk Time (CUSTOMER): 405618 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/c2f4550d-c921-4bcf-8ed5-495ec55ca4bf_20250228T15:48_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII] and I'm calling from provider's office looking for a claim status.
[AGENT][NEUTRAL] Sure, I can check on the account for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII]. That's gonna be [PII]. That's a direct line?
[AGENT][NEUTRAL] Thank you. And then, uh, did you have that policy number?
[CUSTOMER][NEUTRAL] Oh, yes, and that's gonna be it's 01699961, M as in Mike, L as in Lima, 7.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh, the name that's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Uh, dinner service start uh [PII] and for the total charge of $618 even 618.
[AGENT][NEUTRAL] I'm sorry, that was, uh, you said $618?
[CUSTOMER][NEUTRAL] Yes, that's right. 618.
[AGENT][POSITIVE] OK, got it, thank you one moment.
[AGENT][NEUTRAL] OK, I am not showing that we have received a claim for that date of service for this number.
[CUSTOMER][NEUTRAL] Uh, you haven't received any claim for that number?
[AGENT][NEUTRAL] Not that I can see, but give me just a moment. I'm gonna see if
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] They have a different policy. Give me just a moment.
[CUSTOMER][POSITIVE] Sure. No worries. Yes, [PII].
[AGENT][NEGATIVE] OK, no, so we still have not received it. Um, they did have a different policy number that was active during that date of service, uh, the policy number you gave me terminated, um, [PII], um, but I did check this other policy and we've still not received it.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Oh, OK. And can I have the policy number? I think the one I gave you, it's uh 1MLN, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, that one terminated, uh, [PII], but I have one that was active during that date of service. I can give you that policy number when you're ready.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] So, I'm, I'm ready for that.
[AGENT][NEUTRAL] OK, it's 02473136.
[CUSTOMER][NEUTRAL] 02473136.
[AGENT][NEUTRAL] Correct, um, this one's effective date was [PII] and it terminated [PII].
[CUSTOMER][NEUTRAL] [PII] and terminated on [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Maybe, maybe is that a reason like you haven't received the claim? Because uh for the same number, I do have another data service where it's got paid here. So uh you said that ended on, give me a moment, [PII], right? Because I have a data service for uh [PII] where the, we have received the payment. Can you check on that? It's uh 49-2024 data service and for the total charge of $306 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 006. OK, yeah, um, I'll look at this uh policy where it was currently active. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, uh-huh.
[AGENT][NEUTRAL] And I'm sorry [PII], what was um the name of this provider's office?
[CUSTOMER][NEUTRAL] Holy Cross Hospital.
[AGENT][NEUTRAL] It's Holy Cross, OK, um, for this date of service was that remaining balance was that $20?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Yes, that's right, because uh I, I do see uh BCBS they have made a payment and special responsibility was transferred to you for 49-2024.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So we did receive this one, yes, I do see this one, and it's on this other policy number that I just gave you.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Sorry, ma'am. I, I didn't get you. Could you please repeat that?
[AGENT][NEUTRAL] Oh, that's OK. No, yes, um, so I am showing this claim and we did pay that $20 it went to that policy number that I gave you that was active during that date of service, so the one for [PII], um, I just need to be resubmitted.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, with a different claim number? The one you provided, right?
[AGENT][NEUTRAL] Um, the claim number for this for the date of service for uh [PII], that's 352-915-2.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] 152.
[CUSTOMER][NEUTRAL] No, uh, that's the claim number you are talking about, right?
[AGENT][NEUTRAL] Right, right, that's, that's for this one for the uh [PII].
[CUSTOMER][NEUTRAL] OK. No, you said the uh because we submitted under the same policy number which you told it got terminated on 41, uh, since it got terminated 41, uh, so I'm just wondering how it got paid for 49 because uh for that data service, uh, it, the policy was inactive, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It did go to this newer policy number usually they're pretty good about determining which policy like if they did have service uh they would automatically put it to that policy where it was active at that time.
[CUSTOMER][NEUTRAL] OK, and, uh, well, is it possible to turn this claim for this data service since it's been, uh, uh, so, OK, you mean like you haven't received the claim, that's what you're saying, right?
[AGENT][NEGATIVE] Correct, yes, the one for [PII], we have not received that one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, oh, OK, OK. Now, now I got it. No worries. Thank you so much. And just give me one moment here cause I, I do need to check for the other data service for the same member here. And uh how about uh for 10-8-2024, have you received any claim on that, ma'am, for data service, uh sorry, data service 482024. Sorry for that. OK.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] 0, 48. OK. Uh, 48 2024. What was that billed amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, $312 even.
[AGENT][NEUTRAL] 312. OK. Yes, give me just a moment.
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So, uh-huh.
[AGENT][NEUTRAL] OK, yes, it does look like we've received that one. Give me just a moment.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, so for this one we were unable to pay a benefit. Uh, it does state, uh, excuse me, state that, uh, kinesiology, speech, or occupational therapy are not covered benefits under this policy.
[CUSTOMER][NEUTRAL] Uh, uh, just give me a moment. So you got denied the special responsibility for that that's, uh, that, that's the special responsibility, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't, we don't say what is patient, we don't say what is patient responsibility that would be up to the provider but we were unable to pay a benefit.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. Uh, give me, give me one moment here. Let me just pull that U be here.
[CUSTOMER][NEUTRAL] C03, uh, so, so what, what benefit is that?
[AGENT][NEUTRAL] Uh, kinesiology, uh, speech or occupational therapy are not covered benefits under this policy.
[AGENT][NEUTRAL] If you'd like, I can send you a copy of this EOB, [PII].
[CUSTOMER][NEUTRAL] Uh yes, ma'am. Uh, I, I, uh appreciate that. You said that the speech therapy language is not covered, you mean, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK. So, in that case, uh, will that be a special responsibility on that or?
[AGENT][NEUTRAL] We do not say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Oh, OK, no, I mean it's not covered as per the member's plan, right? So, uh.
[AGENT][NEUTRAL] Correct. We were unable to pay a benefit.
[CUSTOMER][NEUTRAL] OK, I mean, like if it's not being covered under the member's plan, so just uh trying to understand if it's a member's responsibility. And uh can I have the claim number on that? OK.
[AGENT][NEUTRAL] Yeah, we don't say whether it is or not. Yes, this one is uh 352-896-0.
[CUSTOMER][NEUTRAL] 960. OK. Uh, one moment here, before I give you that, uh, 44 which you're not able to find. That one again, I see, OK, because that one again, it's a speech therapy language. OK, and that will be covered anyways, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, one moment please. 49.
[CUSTOMER][NEUTRAL] Physical, OK. Uh, just, just give me one moment. I'm just looking because we received partial payment. I'm just checking if we have received, uh, for the same denial here. And that's a physical therapy, OK, that got paid. OK. And just last one here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, and how about for the uh data service that's uh 425, 2024 for the same person, uh, total charge of $768.
[AGENT][NEUTRAL] 768. OK, one moment.
[CUSTOMER][NEUTRAL] Have you received that claim?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 425 2024.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes, we did receive this claim. Uh, it's the same denial as the other one, kinesiology, speech or occupational therapy are not covered benefits under this policy.
[CUSTOMER][NEUTRAL] Oh, OK. And can I have the claim number for that one?
[AGENT][NEUTRAL] Mhm. Yes, that's 354-857-1.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 571. OK, got it. And this last one, how about uh for the details $422 for the same number 422 2024 for the total charge of $312 even and I have next charge. Yeah.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, this one is the same denel as the others. James, uh, kinesiology, speech or occupational therapy are not covered benefits under this policy.
[CUSTOMER][NEUTRAL] OK, uh, can I have a clear, uh, well, ma'am, I can give you the data service because I still have a couple of data service. Maybe I, I didn't have the EOP. Can you please uh send me the copy of the letter which got denied. Since, uh, earlier you mentioned for 44, uh, give me a moment here. You said for 41, have you received the claim?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, I didn't check 1441.
[CUSTOMER][NEUTRAL] Oh, OK. Can you please check that, ma'am? Because previously you said you, you didn't receive for the 44, right?
[AGENT][NEUTRAL] Right, I didn't receive that one, the first one that you gave me for 44 for 618, um, you said there was one for [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How about for what?
[CUSTOMER][NEUTRAL] Yes, ma'am. [PII] for the total amount of $312 312 dollars.
[AGENT][NEUTRAL] 312, OK.
[AGENT][NEUTRAL] OK, yes, we did receive that one, and the denial is the same as the others, uh, kinesiology, speech or occupational therapy are not covered benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, ma'am. Uh, that's for [PII] and [PII] you haven't received that. And how about 48-2024, you said you received that and you'll be sending me the EOB 48 you received that and OK. And the next one, the next date of [PII], which you said you received.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And uh 425, which got denied. So I think there's a full claim. Uh, can I just request those EOB to be faxed to us? I can give the fax number.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Uh, that's gonna be [PII]. I repeat that, so [PII].
[AGENT][NEUTRAL] Got it. OK, and would I just put this to your attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, you can use my name, [PII].
[AGENT][NEUTRAL] OK, alrighty, I will get those sent to you. Um, should get them here in about 10-15 minutes depending on how busy your machine is. Um, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Uh-huh, OK.
[CUSTOMER][NEUTRAL] Oh, well, nothing else for a moment. Let me just verify the mailing address because one you, you haven't received, let me go ahead and resubmit that. So that's gonna be a [PII], right?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] No, there's a it's a different mailing address. Let me know when you're ready and I'll get that to you.
[CUSTOMER][POSITIVE] Uh, yeah, yes, I'm ready for that.
[AGENT][NEUTRAL] OK, it is [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], well, could you please repeat the ZIP code, ma'am? That's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. So that's gonna be uh the [PII], right?
[AGENT][NEUTRAL] That's correct, yes. um, and I've also got a fax number and a pair ID if you'd like, [PII].
[CUSTOMER][NEUTRAL] Uh, sure. Can I have the fax number?
[AGENT][NEUTRAL] Yes, fax number is 877.
[AGENT][NEUTRAL] 3659423
[CUSTOMER][NEUTRAL] 942-3. Got that. And uh what will be the timely time limit for uh submission of claim?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] OK. And uh can I have the payer ID please?
[AGENT][NEUTRAL] Her ID is 60801.
[CUSTOMER][NEUTRAL] 60801. OK, got that, uh, [PII], and that's it. And can I have a call reference number, ma'am?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Last [PII] is [PII] And was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] Uh, uh, no, nothing else for the moment. Uh, good for now, ma'am. Thank you so much, uh, [PII]. I really appreciate your time. Have a wonderful day. Happy weekend.
[AGENT][NEUTRAL] OK, of course.
[AGENT][POSITIVE] Yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.