AccountId: 011433970860
ContactId: c405a3b1-9111-47fd-817e-e9db2705d791
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1535869 ms
Total Talk Time (AGENT): 438008 ms
Total Talk Time (CUSTOMER): 462501 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/c405a3b1-9111-47fd-817e-e9db2705d791_20250220T15:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good evening. Uh, sorry, good morning, [PII]. My name is [PII]. My last [PII] is [PII]. And I, can I have your name spell the last initial for documentation purpose.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. So here I have 4 claims with me, so I would like to check the status of that claim. Would you be able to help me with that?
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with your claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Sure, [PII]. It is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, sure. It is 0813081836718.
[AGENT][NEUTRAL] OK, do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Yes, I think, uh, let me check that here.
[CUSTOMER][NEUTRAL] Oh I don't have it here.
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] Do you have the member's social or first and last name?
[CUSTOMER][NEUTRAL] Yes, I do have the member's first and last name and the social as well as here. So I could provide you with the member's first name spelled out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, may I have your social, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm. Sure. Is that the full social or the last four digits of the social?
[AGENT][NEUTRAL] The full social?
[CUSTOMER][NEUTRAL] Mhm. It is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name?
[CUSTOMER][NEUTRAL] Sure, ma'am. His first name is [PII], last name is [PII].
[AGENT][NEUTRAL] And can you verify her date of birth?
[CUSTOMER][NEUTRAL] Sure. It is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Sure. It was [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And may I have the total bills?
[CUSTOMER][NEUTRAL] It's $735 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, sure. It's Mercy Hospital, Springfield Communities.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3185781.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 8781, OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied as the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, outpatient.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And may I know when it was met and how many units have been allowed per year, per calendar year?
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the calendar year max is $5000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we don't provide providers with when the the benefit was exhausted, but by the time your claim was processed, it had been exhausted.
[CUSTOMER][NEUTRAL] OK. Uh, so it was $5000 I mean, $5000 per calendar year for the outpatient benefit and it has been met before the date of service, right?
[AGENT][NEUTRAL] Not the date of service before your claim was received for processing.
[CUSTOMER][NEUTRAL] OK, before the claim was received or processing.
[CUSTOMER][NEUTRAL] OK. Thank you so much for that information, [PII]. Uh, so, and I don't have the EOB here. Is there any possibilities that you could fax me the EOB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] with the attention of my name with my last initial.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] And will you need an explanation of benefits for the other 3 claims that we're going over as well?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yes, uh, give me a minute. My system is, I'm pulling up here.
[CUSTOMER][NEUTRAL] One moment, [PII]. My system is loading here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. So, uh, it is for the same patient, but with a different date of service and uh bill amount.
[AGENT][NEUTRAL] Are all the claims for the same patient?
[CUSTOMER][NEUTRAL] No, only this claim.
[AGENT][NEUTRAL] OK, what's the next date of service?
[CUSTOMER][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $2,0006 even.
[AGENT][NEUTRAL] All right, so for this claim, I'm showing.
[AGENT][NEUTRAL] 308. We received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3183308.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the outpatient benefit for the calendar year has been used.
[CUSTOMER][NEUTRAL] OK. And may I also know uh how many dollars or units are allowed for the calendar year?
[AGENT][NEUTRAL] Yes, this is the same member, so the benefits are the same. So it
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you needed the dollar amount again?
[CUSTOMER][NEUTRAL] It's the same 5000.
[AGENT][NEUTRAL] Yes, 5000.
[CUSTOMER][POSITIVE] No, no, I have it here. OK, great. Thank you so much for that. And I would like to have this member, I mean, these claims you'll be as well through the fax.
[AGENT][NEUTRAL] Yes, I'll be emailing all the claims we go over today.
[CUSTOMER][POSITIVE] Mm, OK. Thank you so much for that.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][POSITIVE] Mhm. Take your time.
[AGENT][NEUTRAL] OK. And the next member's policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Yes, sir. So the next member's policy number is 02340540.
[AGENT][NEUTRAL] 0234 0540.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure, ma'am. First name is [PII], last name is [PII]. And as far as the date of birth, it's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So for this member, their policy, their claims are actually processed through Web TPA. So I can give you the phone number um for Web CPA so that you can contact them for um claim status. I can transfer you at the end of the call as well if you'd like.
[CUSTOMER][POSITIVE] OK, thank you so much. And I'm ready for the contact number for of the web TPA.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Hold on one moment, let me note this one.
[CUSTOMER][POSITIVE] Mhm. Take your time, no issues.
[AGENT][NEUTRAL] OK. And the last member's policy number?
[CUSTOMER][NEUTRAL] It is 01742617.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure, ma'am's first name is [PII], last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, sir. It was [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $84 saving.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3388216.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim $47.98.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need the checking information?
[CUSTOMER][POSITIVE] Yes, I do need it.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So it was a single check in the amount of 47.98?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The check number is 1823495.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was issued on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And voided on [PII] because it was still outstanding.
[CUSTOMER][NEUTRAL] OK. It was ordered on
[CUSTOMER][NEUTRAL] OK, what is the valid date again?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Uh, so, uh, I would like to, uh, mhm.
[AGENT][NEUTRAL] So I can
[AGENT][NEUTRAL] I can go ahead and put a request in for this to be reissued to you all. Is the correct address [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] No, uh, that is not the correct pay to address.
[AGENT][NEUTRAL] OK, so that may be what's going on. So you'll need to submit a corrected claim to us with the correct mailing address and that's where the payment will be reissued to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, is there any possibilities that we could just submit the name form because it's uh more than a 2 year old claim, right?
[AGENT][NEUTRAL] Well, that would be the only way to correct an address is to correct the claim, because the claim, the address that is sent to is the address on the claim. So if it's not correct, we'll need to correct the claim with the correct address so we can pay to the correct place.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I need to submit a corrected claim, right? And may I know what is the time the filing to submit the corrected claim?
[AGENT][NEUTRAL] For APL, there's no timely filing as long as the policy was active on the data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Thank you so much for that information. And may I know what was the address the claim should be submitted or is there any payer IDs that we could submit the claim electronically?
[AGENT][NEUTRAL] Yes, our pay ID is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Mhm. OK. Thank you so much for that. And can I also have the mailing address as well for the documentation purpose?
[AGENT][NEUTRAL] Sure, our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great. Thank you so much for that. And uh I do have two more clients with me. Uh, would you be able to assist me with that too, [PII]?
[AGENT][NEUTRAL] OK, how many clients do you have in total today? Sure.
[CUSTOMER][NEUTRAL] That is going to be the last two points for today's call.
[AGENT][NEUTRAL] OK, let me note this policy. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm. OK, sure. You are on hold.
[AGENT][NEUTRAL] I literally ask so I can get my mind right, so just be honest.
[AGENT][NEUTRAL] And we can just jail 318.
[AGENT][NEUTRAL] Am I trip
[AGENT][NEUTRAL] Oh I am driven.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII]?
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] Thank, thank you so much for holding and what is the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. And the next member's policy number is 01359352.
[AGENT][NEUTRAL] Thank you for that. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, ma'am, first name is uh [PII], last name is, [PII] for the date of birth, it's number [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yeah, sure. The date of service is number 27 of 2023 with the amount of $126 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so there's no claim on file for [PII] for [PII]. Let me see if she has any other policies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, there, [PII].
[AGENT][NEUTRAL] Yeah, there's no policies that were active on her date of service. The latest policy terms on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. So, the patient was not active for the date of service, right? Great.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. And for that patient, that's all the information I needed. So thank you so much for that.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Yes, uh, there's uh one more patient that's it, right? So I'm ready with the next patient when ready.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] Mm mhm. OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Sorry for that.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] It was 02145098.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. My first name is [PII], last name is [PII]. And as for the date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and the data service and total bills.
[CUSTOMER][NEUTRAL] The service is [PII] with the amount of $196 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 30993.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] 93
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was paid out on a total of $85.78.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you need the check information?
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So a single check in the amount of $85.78?
[AGENT][NEUTRAL] Um, check number 1693844.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was, sorry, the check was issued on [PII] and cleared on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, what is the clear date, [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, [PII]. OK, great. Thank you so much for that information. And uh
[CUSTOMER][NEUTRAL] Mm, may I also have the page to address for this claim?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now, uh, I'm asking for the pay to address which the check was sent.
[AGENT][NEUTRAL] 00, I'm sorry, hold on one moment.
[CUSTOMER][POSITIVE] No issues. No issues, no issues.
[AGENT][NEUTRAL] It was sent to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, great. Thank you so much for that. So you said the check was already cash, right? And uh so I don't have any EOB with me for this claim. Is there any possibilities that you would also attach me these claims that you will be at for for me?
[AGENT][POSITIVE] Yes, I've sent all the EOBs. This one has been sent to you as well, so you should be receiving them all shortly.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. And uh, yeah, for today's call, I have got enough information from you and uh can I have the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. First initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you so much, [PII], for the information. I have got enough information from you for this call. Thank you so much and have a great day. Bye-bye.
[AGENT][POSITIVE] You also thanks for calling APL. Bye bye.