AccountId: 011433970860
ContactId: ceda269f-27d8-4de0-989c-eed32adf8b7a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1503219 ms
Total Talk Time (AGENT): 382016 ms
Total Talk Time (CUSTOMER): 485451 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/ceda269f-27d8-4de0-989c-eed32adf8b7a_20250218T18:37_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, [PII]. My name is [PII]. My last initial is [PII]. And, I would like to know uh some claim status. Uh, would you be able to help me with that?
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with the claim status and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Today, I would have like around 10 clients.
[AGENT][NEUTRAL] OK, I can assist you with the 1st 5 and then the next 5, they can be assessed on our online service center. You can um conduct claim statuses with your provider, um, information on the portal.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Thank you so much for that. And uh, uh, but actually, we know, mhm, OK. Uh we don't have any access for that. uh, but I can call again, no issues. And uh can I have your name spelled with the last change for documentation purpose?
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Sure, my name is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] You're welcome. And uh may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, [PII]. It is 02114297.
[AGENT][NEUTRAL] And I'm sorry, can you repeat the phone number I was typing, but I just noticed that it didn't type. Can you repeat that for me, please?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Sure, no issues. It's [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No issues, and you can take your time.
[AGENT][NEUTRAL] And can you
[AGENT][NEUTRAL] Thank you. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Sure. The member's first name is [PII], last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And 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 like me to check on?
[CUSTOMER][NEUTRAL] Mm mhm.
[CUSTOMER][NEUTRAL] Yes, sure. The date of service is [PII].
[AGENT][NEUTRAL] Thank you for that. And the total bills?
[CUSTOMER][NEUTRAL] It's $171 even.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] 709.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 3324709.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] As office visits are not covered by
[CUSTOMER][NEUTRAL] I mean.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK. Uh, so, uh, this patient has Meli uh policy, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. So, office is not covered. And you said when was the uh claim got denied? Actually, I didn't get the date correctly.
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][POSITIVE] OK, no issues.
[AGENT][NEUTRAL] 709.
[AGENT][NEUTRAL] 3324. Hold on one moment, I have to search for it again. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no issues. You can take your time, [PII].
[AGENT][NEUTRAL] OK, so it was denied on [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, great. Thank you so much. And actually, I don't have any EOB in mind. Is there any possibilities that you could fax me the EOB through the fax number?
[AGENT][NEUTRAL] Yes, will you be needing an EOB for all the claims we go over today?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, what's the fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and the attention is my name with my last initial.
[AGENT][NEUTRAL] And the last initial, the first initial to your last name is?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And that's [PII]. Attention [PII]?
[CUSTOMER][NEUTRAL] Yes. Actually, my name is not [PII], it's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Sorry about that. OK, so I'll be sending explanation of benefits for each of the claims that we go through. What's the next um policy number?
[CUSTOMER][POSITIVE] Mm. No issues.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. So the next policy number is 02132116.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Sure, ma'am. The first name is [PII], last name is [PII], and as for the date of birth, it's [PII].
[AGENT][POSITIVE] Thank you for that and the date of service and total bill.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Data services number [PII] with a bill amount of $184 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Now sure.
[CUSTOMER][NEUTRAL] And uh can I have the call reference number? Are we going to use different call reference number or the single call reference number for the entire call?
[AGENT][NEUTRAL] So the call reference number for the entire call is going to be my name and today's date?
[CUSTOMER][POSITIVE] OK, great. Thank you so much.
[AGENT][NEUTRAL] You're welcome. And I'm showing that we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3229181.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Thank you. So again, it's because the patient has the Metlink policy, right?
[AGENT][NEUTRAL] Well, it's because the, no, it's the policy benefits, not policy type. Um, so this particular policy just doesn't cover offices as there are some Meli policies that do.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So as per the patient policy, there uh offices not be covered, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK. OK. Thank you so much for that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] uh.
[AGENT][POSITIVE] And I'm ready for the next member's policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Yes, I'm ready for that. Uh, so the member's policy number is 02304504.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] 023 04504
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, my first name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. Now, for this member, the um claims are processed through web CPA. I can give you their phone number um for the claim status.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] And let me know when you're ready.
[CUSTOMER][POSITIVE] OK, I'm ready for the con yeah, I'm ready for the contact number.
[AGENT][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII]. Great. Thank you so much. So for this member, it will be handled by web TPU, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, great. Thank you so much.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] I'm good
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I think that
[CUSTOMER][NEUTRAL] The address
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And the next member's policy number when you're ready.
[CUSTOMER][NEUTRAL] And I'm putting that
[CUSTOMER][NEUTRAL] Yes, I'm ready. So the next member's policy number is 02069892.
[CUSTOMER][NEUTRAL] Of
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, my first name is [PII], last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information again 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] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, sure. The day of service is [PII] uh with the amount of $157 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, so I'm showing this claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 340.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3813.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3813. Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So it was denied on [PII].
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you so much. I've documented that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We gotta get them
[AGENT][POSITIVE] OK, and I'm ready for the next member's policy number when you are.
[CUSTOMER][NEUTRAL] Yes, I'm ready. So the policy number 01907607.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, my first name is [PII], last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills for the insured?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] with the amount of $184 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Alright, so the policy, the claim was received on [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 341.
[AGENT][NEUTRAL] 8942.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, that's OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for the information, uh, and I, I really appreciate your patience and the information you have given me with the information right and looking for it. Thank you so much for that.
[AGENT][NEUTRAL] You're very welcome. Did you want to go through the other claims as well?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] If possible, it would be great.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] Yes. Uh-huh OK give me a moment.
[CUSTOMER][NEUTRAL] Calling system is loading.
[CUSTOMER][NEUTRAL] OK, got it. So, it is 01822342.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I'm sorry. Uh, uh, OK. Uh, the member's first name is [PII], last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yes, sure. The date of service is [PII] with the amount of $328 even.
[AGENT][NEUTRAL] That was [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, for $328?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, hold on one moment and again just for the call, the information provided is a verification of benefits, not a guarantee of payment. So let me see.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] On
[AGENT][NEUTRAL] And the total bill is $328. Is there any other amount that it could be for total bill?
[CUSTOMER][NEUTRAL] No, uh, the date of service was uh [PII] with the bill amount of $328. That's the uh information that shows here.
[AGENT][NEUTRAL] OK, well, if that's the case, then there's no claim on file. I just want to make sure because we received two claims, but it's a different total bill, so there's no claim on file for your for your claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] For the same date of service, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. Uh, can you check, uh, with the amount of $42.32? Because that is the responsibility to crossover from Blue Cross Blue Shield for the data service.
[AGENT][NEUTRAL] OK, um, so the claims that were here, um, it's a diff, that's not the total bill, so there's no claim on file, but you can pro you can um send the claim and let me see what the
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, date was on here. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, the policy.
[AGENT][NEUTRAL] Oh no, the policy wasn't active on your data service. It turned on [PII].
[CUSTOMER][NEUTRAL] OK. Policy was not active, right? And may I know the effective date as well?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Uh, can you check is there any other, uh, coverages active for the data of service?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was 3 12:26.
[AGENT][NEUTRAL] OK, so there is an active policy. The policy number is 246.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2881.
[CUSTOMER][NEUTRAL] 2881, OK.
[AGENT][NEUTRAL] The policy has been effective since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh hold on one moment, let me get the claim status for you.
[CUSTOMER][NEUTRAL] This one
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 22.
[AGENT][NEUTRAL] OK, so the policy, the claim was received on [PII]?
[CUSTOMER][NEUTRAL] [PII], OK?
[AGENT][NEUTRAL] Claim number is 344.
[AGENT][NEUTRAL] 671 9.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the denial reason is the policy provides no benefits for any loss resulting from or cause.
[AGENT][NEUTRAL] Um, by alcoholism or drug addiction, whether directly or indirectly.
[CUSTOMER][NEUTRAL] OK. Uh, so policy, as per the policy, the service was not covered because, uh, if the reason is regarding the drug addiction or alcoholism, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] May I also, uh, know, uh, what was the appeal timely filing for this claim?
[AGENT][NEUTRAL] Also, there's 180 days from the denial date that you can file an appeal.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Mhm gray.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][POSITIVE] Claim number receive date deni date, uh, OK, great. Uh thank you so much uh for the information. I think I have got enough information from you and uh have a great day.
[AGENT][POSITIVE] Alrighty, well, thank you so much for calling APL sir and I hope you have a great day.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Really