AccountId: 011433970860
ContactId: c5371632-6af9-4820-9004-17100248329b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413619 ms
Total Talk Time (AGENT): 189508 ms
Total Talk Time (CUSTOMER): 116289 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/c5371632-6af9-4820-9004-17100248329b_20250213T19:40_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] I never do.
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from property's office checking for status.
[AGENT][NEUTRAL] OK. Did you say your name is [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], and you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] Yes, I can help you, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] Callback number [PII], my extension direct line.
[AGENT][NEUTRAL] Thank you. And how many claims do you have [PII], to check status on?
[CUSTOMER][NEUTRAL] Just so what?
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] It is 01813065 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] That is [PII] and total amount is.
[CUSTOMER][NEUTRAL] $1700 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim has been received multiple times. The last two times were denied as a duplicate. Are you needing the original claims information?
[CUSTOMER][NEUTRAL] Yeah, actually.
[CUSTOMER][NEUTRAL] Uh, this claim is not paid yet because, uh.
[CUSTOMER][NEUTRAL] It's 2nd row, right?
[AGENT][NEUTRAL] Yes, it is. Give me just one moment. Mhm.
[CUSTOMER][NEUTRAL] Yeah, the
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] I need to locate the original claim. OK, just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the original claim?
[AGENT][NEUTRAL] Number was received, well, the original claim was received on [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And what is the name of the provider group on this claim first?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Ama Medical Solutions.
[AGENT][NEUTRAL] OK and claim number is 3539561.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] There was a benefit paid on this in the amount of $556.47.
[AGENT][NEUTRAL] That was paid on single check 2017762.
[CUSTOMER][NEUTRAL] Yeah, actually, that I have a question on this.
[AGENT][POSITIVE] And that check has cleared.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, yeah, I got it. Actually I'm looking for the code [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that card was denied. Mhm. Benefits are payable only. Yes, sir. Um, do you have the denial reason?
[CUSTOMER][NEUTRAL] And a lot.
[CUSTOMER][NEUTRAL] Yeah, yeah, what happened is,
[AGENT][NEGATIVE] For that code, the code was denied.
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] Yeah, what happened is, uh, the primary code is denied for authorization number first, uh, initially denied initial claim denied for that reason, and is, uh, they send the remaining, uh, details to secondary. That's why [PII] denied as.
[CUSTOMER][NEUTRAL] Uh, non-covered service then uh
[AGENT][NEUTRAL] If it is not
[AGENT][NEUTRAL] No sir, APL.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] If the primary insurance does not pay for an expense, does not cover it, this policy would not either.
[AGENT][NEUTRAL] And according to the information we received, benefits are payable only if the major medical provider provides benefits.
[AGENT][NEUTRAL] If this claim is later paid by the major medical insurance, please send the explanation of benefits showing benefits were paid.
[AGENT][NEGATIVE] But if the primary does not cover it, we do not cover it.
[CUSTOMER][NEUTRAL] OK, yeah. Later.
[CUSTOMER][POSITIVE] Yeah, I like her, the primary insurance is paid.
[CUSTOMER][NEUTRAL] It's processed actually and they applied to.
[AGENT][NEUTRAL] OK. Then you need to send.
[AGENT][NEUTRAL] OK. So you need to send us a copy of the explanation of benefits from the primary insurance company showing that benefits were paid on this particular code.
[AGENT][NEGATIVE] It was denied for that reason.
[CUSTOMER][NEUTRAL] OK. How do you
[CUSTOMER][NEUTRAL] Yeah, how do you accept that?
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, you may print the EO OK.
[AGENT][NEUTRAL] You will have to
[AGENT][NEUTRAL] OK. Are you asking how to access our EOB or the primary insurance company's EOB?
[CUSTOMER][NEUTRAL] No, how do you accept the your email it's through fax or mail?
[AGENT][NEUTRAL] You can fax it or mail it. Yes, you can fax it or mail it.
[CUSTOMER][NEUTRAL] We have the.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Our secured fax line is [PII] and we only need the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of our explanation of benefits with this remark that I just read to you, [PII], you can print that by going to our portal, which is located at [PII].
[CUSTOMER][POSITIVE] Yeah, yeah, thank you and the reference number for today's call.
[AGENT][NEUTRAL] OK, yes, it would be my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you. Thank you very much. Have a great day. Bye-bye.
[AGENT][POSITIVE] Yeah absolutely you're welcome and thank you for calling APL have a nice afternoon.
[CUSTOMER][NEUTRAL] Yeah