AccountId: 011433970860
ContactId: cc328209-c76a-4335-8174-4edf5351461c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 714549 ms
Total Talk Time (AGENT): 230005 ms
Total Talk Time (CUSTOMER): 175286 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/cc328209-c76a-4335-8174-4edf5351461c_20250424T19:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office and looking on a claim status. Can you help me?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] 3 claims.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the members, the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah. It's 01.
[CUSTOMER][NEUTRAL] 48
[CUSTOMER][NEUTRAL] 0528.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] It's [PII] for $150 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's integrated dermatology of South Miami.
[AGENT][NEUTRAL] Alright, so I'm trying to received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3592282.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I know the patient's pla plan name?
[AGENT][NEUTRAL] This is their Metlink supplemental gap insurance.
[CUSTOMER][NEUTRAL] OK. And so it's a patient responsibility?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we're not a major medical insurance company. Um, it'll just be whatever your procedures are an outstanding or remaining balances.
[CUSTOMER][NEUTRAL] OK. Can you fax me the EUB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And should I put attention [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And are the other two claims for the same member or they're different members?
[CUSTOMER][NEUTRAL] It's for different member.
[AGENT][NEUTRAL] OK, hold on one moment, let me save these notes then. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And will you need explanation of benefit copies for the other two claims that we go over as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'll, I'll wait for that. Alright, and what is the next member's policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The call reference will be same for the entire call or for each patient is will.
[AGENT][NEUTRAL] The entire call.
[CUSTOMER][NEUTRAL] OK. And the next member ID is 23297003.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For $225 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, so I'm not showing any claims on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] [PII] for $225. OK.
[CUSTOMER][NEUTRAL] And may I know the effective date of the policy?
[AGENT][NEUTRAL] The policy was effective as of [PII].
[CUSTOMER][NEUTRAL] A second. OK. And what are the payer ID?
[AGENT][NEUTRAL] I pay ID is 60801.
[CUSTOMER][NEUTRAL] And the mailing address?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] And the timely filing limit for claims.
[AGENT][NEUTRAL] Um, there's no timely filing as long as the policy was active on the day of service, you can file at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, and
[CUSTOMER][NEUTRAL] And shall I provide you the next member ID?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Um, hold on one moment, let me note this one and then I can move on to the next one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the, the next member's policy number?
[CUSTOMER][NEUTRAL] It's 02465750 ML8 ML 7.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [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 and the total bills?
[CUSTOMER][NEUTRAL] It's [PII] for $225 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I'm actually showing that there's no claims on file. We actually haven't processed the claim for um [PII].
[AGENT][NEUTRAL] On this policy.
[CUSTOMER][NEUTRAL] There is no claims for this patient.
[AGENT][NEUTRAL] I'll double check. Hold on, let me see if there's another policy. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, policy number 2140843.
[AGENT][NEUTRAL] Active since [PII]. Let me see if there's a claim on there. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, but I still, even on the um active policy, there's still no claim on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] OK. And may I know the policy number once again, if you don't mind?
[AGENT][NEUTRAL] Sure, it's 214.
[AGENT][NEUTRAL] 0843.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2140843 and it's active from [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the policy number which I provided is not active.
[AGENT][NEUTRAL] So the policy number that you provided was only active for a day, [PII].
[AGENT][NEUTRAL] So it could, it could have been an error, right?
[CUSTOMER][NEUTRAL] Only one day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh it's the same information for the payer ID and mailing address and timely filing, am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And for the fax, for the uh very first claim, when we will receive the fax?
[AGENT][POSITIVE] I'm going to send it um once I've finished these notes and um in the call. So if you do not receive it by end of day today, you can definitely um give us a call and we'll be more than happy to resend it, but I'm, I'm getting ready to send it to you now. We usually say about an hour for a fax.
[CUSTOMER][NEUTRAL] OK. And can you spell your name for me?
[AGENT][NEUTRAL] Sure, my name is [PII] First initial to my last name is [PII].
[CUSTOMER][NEUTRAL] And the call reference number for the entire call?
[AGENT][NEUTRAL] Is my name and today's date.
[CUSTOMER][NEUTRAL] The name on the list.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for the information.
[AGENT][NEUTRAL] All right, [PII], was there anything else? You're welcome. Was there anything
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][POSITIVE] No, that's all. Thank you, bye.
[AGENT][POSITIVE] Alright, thanks for calling APO bye bye.
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][POSITIVE] Yeah, you too. Thank you. Bye.