AccountId: 011433970860
ContactId: c403012a-c104-4bbb-a2ba-857359f98dd6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1078439 ms
Total Talk Time (AGENT): 379667 ms
Total Talk Time (CUSTOMER): 402523 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/c403012a-c104-4bbb-a2ba-857359f98dd6_20250224T14:53_UTC.wav
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[AGENT][POSITIVE] Good. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check up on our claim status.
[AGENT][POSITIVE] Well it would be my pleasure to assist you with that claim status, and I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII], thank you and a good call back number please.
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Thank you, [PII] and what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 01896422
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patients' names such as [PII], and the date of birth that is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And you were needing claim status for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I can help you with that. Do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] I have a data of service.
[CUSTOMER][NEUTRAL] Data service that is [PII].
[AGENT][NEUTRAL] And that is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the building amount, please, ma'am?
[CUSTOMER][NEUTRAL] $241.29.
[AGENT][NEUTRAL] And the patients, um, the
[AGENT][NEUTRAL] Facility name? I apologize.
[CUSTOMER][NEUTRAL] Scott and White Clinic.
[AGENT][NEUTRAL] All right, thank you. And I can help you with that claim status, [PII]. We received that claim on [PII].
[AGENT][NEUTRAL] Processed and paid on [PII] and paid $80 to Scott and White Clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the claim number?
[AGENT][NEUTRAL] Claim number is 355.
[AGENT][NEUTRAL] 5915.
[CUSTOMER][POSITIVE] Thank you and the kind of the payment in full.
[AGENT][NEUTRAL] Yes, it was a single paper check.
[AGENT][NEUTRAL] Check number 202.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] 4 580.
[AGENT][NEUTRAL] And it went to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2127. Is the check was and cast.
[AGENT][POSITIVE] I'm showing it's still outstanding.
[CUSTOMER][NEUTRAL] It is still in it is not at end cast, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and uh could you please fax us a copy of your before this one?
[AGENT][NEUTRAL] ELBs are obtainable from our provider portal at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For the same patient, I have one more day of service.
[AGENT][NEUTRAL] Same patient. It would be my pleasure to assist you with that other data service. Let me get back to him and that next date of service.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And that build out?
[CUSTOMER][NEUTRAL] For the bill amount of, yes, $745.73.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm checking on that. Bear with me.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you said 7, what was that bill amount?
[CUSTOMER][NEUTRAL] $745.73.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Did you?
[AGENT][NEUTRAL] Do you happen to have a CPT associated with that claim?
[CUSTOMER][NEUTRAL] Yes, it is 55,700.
[AGENT][POSITIVE] All right thank you I appreciate that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And that claim we received on [PII] and paid on [PII] $272.92 to [PII] and [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the paid amount?
[AGENT][NEUTRAL] $272.92.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the claim number?
[AGENT][NEUTRAL] Claim number 3555917.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] And the kind of the pay date.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can I have the check number?
[AGENT][NEUTRAL] Check number is 2024582.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Pay to add this.
[AGENT][NEUTRAL] [PII] in [PII].
[CUSTOMER][NEGATIVE] And uh it was uh in cashed or still in it is not getting cashed.
[AGENT][NEUTRAL] Still not cashed as of yet.
[CUSTOMER][NEUTRAL] OK, thank you. And uh can I have the next patient?
[AGENT][NEUTRAL] OK. And how many patients do you have?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I have 5 claims, but it is relative to only 2 patients.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm ready for that next patient.
[AGENT][NEUTRAL] Uh, policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it is 02458526.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name, it is [PII] and the date of birth, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] [PII] with the billed amount of $322 even.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hang on just a second, I'm not sure what.
[AGENT][NEUTRAL] Do you mind repeating that data service [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII] of 24.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] I apologize.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] It's OK. Take your time.
[AGENT][NEUTRAL] And what was that bill amount?
[CUSTOMER][NEUTRAL] $322 even.
[AGENT][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] OK, that claim we've received on.
[AGENT][NEUTRAL] [PII] then processed on [PII], that claim was denied as office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Uh, then it is the patient's responsibility or not?
[AGENT][NEUTRAL] We don't determine patient responsibility. We're not major medical.
[CUSTOMER][NEUTRAL] OK, that's not a patient's responsibility.
[AGENT][NEUTRAL] We don't determine that that's to be determined by the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you. Can I have the next date of service for the same patient?
[AGENT][NEUTRAL] Sure, what's that next data service?
[CUSTOMER][NEUTRAL] [PII] with the bill amount of $311 even.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] I received on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The 99213 was denied as non-covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the 20,550 was denied as max benefit met for the calendar year.
[CUSTOMER][NEUTRAL] One minute, I note it down.
[CUSTOMER][NEUTRAL] Received on [PII], processed on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the office visit is not covered.
[CUSTOMER][NEGATIVE] And for 20,550 it was denied for the maximum month that's exhausted, right?
[AGENT][POSITIVE] That's correct. Mhm.
[CUSTOMER][NEUTRAL] OK, one moment. And it is the patient's responsibility for office visit or not?
[AGENT][NEUTRAL] And again, this is a secondary policy, not major medical. The provider would determine patient responsibility.
[CUSTOMER][NEUTRAL] It depends upon the provider.
[AGENT][NEUTRAL] That's correct. We can't determine if it's patient responsibility. We're not major medical.
[CUSTOMER][NEUTRAL] OK, maximum balance it's exhausted as for the visit so dollar amount for this one.
[AGENT][NEUTRAL] Dollar amount per calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Another dollar amount?
[AGENT][NEUTRAL] Yes, ma'am, it is $3000 per calendar year.
[CUSTOMER][NEUTRAL] OK, one was $3000 was exhausted.
[AGENT][NEUTRAL] We paid that on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], but we have not built the claim with the date of service of [PII].
[AGENT][NEUTRAL] It was
[AGENT][NEUTRAL] It was to a different provider and I'm unable to disclose any more information regarding that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Then it is also pay uh depends upon the provided develop patient for this one also for maxim and with exhausted.
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK, thank you. Then can I have the next page so next date of service for the same vision.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, the next date of service it is [PII] with the billed amount of $484.39.
[CUSTOMER][NEUTRAL] You can
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What was the building amount again? I apologize.
[CUSTOMER][NEUTRAL] $484.39.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim we received.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm getting that for you, bear with me. That claim we received on.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] and processed on January.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry, [PII] it was received and processed on [PII].
[AGENT][NEUTRAL] And paid $114.91 to [PII] and [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK then for the procedure code 99213.
[AGENT][NEGATIVE] Was denied his office says it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can I have the paid date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can I take your number?
[AGENT][NEUTRAL] Claim number 3555941.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. And uh can I have the check number?
[AGENT][NEUTRAL] Check number 2024581.
[CUSTOMER][NEUTRAL] And the pay to address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is the check wasn't cashed?
[AGENT][POSITIVE] Still outstanding.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you. And uh
[CUSTOMER][NEUTRAL] And I have the next patient?
[AGENT][POSITIVE] Yes ma'am, I'm ready.
[CUSTOMER][NEUTRAL] Yeah. One month.
[CUSTOMER][NEUTRAL] OK, next member ID is uh 253-7762.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name, it is uh [PII] and the date of birth it is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, thank you. I actually don't have any claims on file for [PII].
[CUSTOMER][NEUTRAL] But uh I have received the new for this one.
[AGENT][NEUTRAL] What's that EOB what's the claim number?
[CUSTOMER][NEUTRAL] It is uh
[CUSTOMER][NEUTRAL] 351-487-78
[AGENT][NEUTRAL] And that's not for [PII].
[AGENT][NEUTRAL] Is the patient's name [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it's a reo.
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] And there is a no claim.
[AGENT][NEUTRAL] For [PII], no claims.
[CUSTOMER][NEUTRAL] [PII] of the house.
[AGENT][NEUTRAL] Yeah, [PII], now that claim I do have for [PII] is the patient's name [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It's a [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, that claim I do have on file for [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I thought you were asking about [PII].
[AGENT][NEUTRAL] And that claim we received on 10-4-24 and processed on 10-8-24.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Everything was denied for?
[AGENT][NEGATIVE] Denied, mhm, it's not a covered loss under the plan, so it's not covered.
[CUSTOMER][NEUTRAL] Or a covered loss.
[AGENT][NEUTRAL] Under the patient's plan.
[CUSTOMER][NEUTRAL] Can I, can I have the claim number?
[AGENT][NEUTRAL] It's the one you gave me 351-487-8.
[CUSTOMER][NEUTRAL] OK. Thank you. And can I have the last date of service for this patient?
[AGENT][NEUTRAL] Mhm. Let me get so we pulled back up.
[AGENT][NEUTRAL] And what is the last date of service?
[CUSTOMER][NEUTRAL] It is uh [PII] with a billed amount of $209 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That claim was received on [PII].
[AGENT][NEGATIVE] Processed on [PII] and denied for the same reason.
[CUSTOMER][NEUTRAL] Like the night for the not a covered loss under the patient plan?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] No, could you please give it one second the 9?
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Um, and it's for the patient's plan. It is not a covered loss for the patient's plan.
[CUSTOMER][POSITIVE] OK, thank you Can dream number.
[AGENT][NEUTRAL] Claim number 3556265.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. And could you please spell out your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And uh this one is the patient's responsibility for this one.
[AGENT][NEUTRAL] It's a secondary policy also we don't determine patient responsibility to be determined by the provider.
[CUSTOMER][NEUTRAL] Thank you. And then, can I have the call reference number?
[AGENT][NEUTRAL] Is my name in today's date.
[CUSTOMER][POSITIVE] Thank you. Have a nice day.
[AGENT][POSITIVE] [PII], thank you for calling APL. Hope you have a wonderful day as well. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye.