AccountId: 011433970860
ContactId: d36fda1c-b10f-4deb-9c65-cbe877129eb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 658690 ms
Total Talk Time (AGENT): 279967 ms
Total Talk Time (CUSTOMER): 236757 ms
Interruptions: 8
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/d36fda1c-b10f-4deb-9c65-cbe877129eb9_20250522T13:48_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII], my name is [PII] calling from broader's office.
[AGENT][NEUTRAL] I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] To check on claims. My name is [PII] spelled as [PII].
[AGENT][NEUTRAL] OK, [PII], and you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][POSITIVE] Yeah thank you so much for that. My good call back number [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] For on.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] No, I will repeat it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 37.
[AGENT][NEUTRAL] Thank you and how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Yeah, currently I'm having one client.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] 024.
[CUSTOMER][NEUTRAL] 33
[CUSTOMER][NEUTRAL] 267.
[AGENT][POSITIVE] Thank you, one moment please.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payments. What is your patient's name and date of birth?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] And what is the date of service and total bill amount uh for her place?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah, and the date of [PII].
[CUSTOMER][NEUTRAL] $364.87.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you said that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received or the received date on it is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEGATIVE] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The claim number is 359-7636.
[CUSTOMER][NEUTRAL] Re
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And one moment and I'll provide you the information.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, so one of the denial reasons is that office visits are not covered by the above number policy. The member's plan does not cover office visits, Joy.
[CUSTOMER][NEUTRAL] Because.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] And the other codes, there's several that were denied as benefits are payable only if your major medical insurance provider provides benefits.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If this claim is later paid by your major medical insurance, please send me explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I should have major insurance process deductible for CBT [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And those two, it shows on here that insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So we need to submit the primary copy of you, right?
[AGENT][NEUTRAL] For the codes that were not showing that if the major medical has paid on the codes that it did not reflect that, then yes.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How can I submit a primary be through fax or?
[AGENT][NEUTRAL] Yes, the fax number is [PII] attention claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits with the remarks that I read to you, [PII], you can print that now that you have the claim number by going to our portal which is located at [PII].
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] which is one.
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] May I know the time filling limit for resubmitting a claim with the primary UB?
[AGENT][NEGATIVE] There is no timely filing?
[AGENT][NEUTRAL] But we do, yes, there's no timeline filing limit.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] For the fresh claim rebilling.
[AGENT][NEUTRAL] There's no timely filing on an initial claim. If you're filing an appeal, it must be filed within 180 days from the date of the decision.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. May I know.
[AGENT][NEUTRAL] And sent to attention appeals department.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] May I know the mailing address?
[AGENT][NEUTRAL] The same as the claims mailing address?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Do you have the mailing address for claims?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you so much. May I know the call reference number please, uh.
[AGENT][POSITIVE] You're very welcome.
[AGENT][POSITIVE] Yes, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Yeah, sure, and I forgot one thing you said the offices is for not covered under the member's plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] May I know what type of patient plan have?
[AGENT][NEUTRAL] This is a supplemental policy and it is called Medlik. We are not a major medical insurance.
[CUSTOMER][NEUTRAL] Uh, you cover the secondary, I mean primary deductible.
[AGENT][NEUTRAL] Of covered services and office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, for remaining procedures process towards deductable you will cover.
[AGENT][NEUTRAL] As I stated initially, I can only provide you the benefit information, I cannot guarantee payment.
[AGENT][NEUTRAL] We will review the claim for benefits of covered services.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, I'll resubmit the primary UB if it is called trajector means I'll follow up next time.
[CUSTOMER][POSITIVE] Thank you so much for that information, [PII]. Have a nice day.
[AGENT][NEUTRAL] Yes, sir, and once the, once the uh explanation of benefits has been submitted, you would need to allow 5 to 7 business days for processing and our offices will be closed on Monday for the holiday.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] So the business day.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][POSITIVE] Yeah, once again, actually.
[CUSTOMER][NEUTRAL] I forgot to tell you one thing.
[AGENT][NEUTRAL] I didn't understand you. I'm sorry, [PII].
[CUSTOMER][NEUTRAL] I, sorry for that. No only I noticed that actually we already submit the primary U be through fax.
[AGENT][NEUTRAL] Yes, sir, and according to the primary insurance company, there were no benefits paid on several of the codes, which is why it states benefits are payable only if your major medical insurance provider provides benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If the claim is later paid by your major medical insurance, please send me an explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, we sent to you already through fax.
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, and per this explanation of benefits received, there were several codes on here that the primary insurance company did not provide, there was not anything applied to their deductible co-pay or co-insurance for, according to these remarks.
[CUSTOMER][NEUTRAL] Already.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Anything applied to deductible coinsurance means you will not cover, right, for deductible.
[AGENT][NEUTRAL] No, sir, we have to review. This policy is a supplemental policy that provides benefits or covered services.
[CUSTOMER][NEUTRAL] The yeah.
[CUSTOMER][MIXED] I miss you.
[CUSTOMER][NEUTRAL] So you already issued the UB after uh retrieving the UB they made the decision, right?
[AGENT][NEUTRAL] I've explained to you, [PII], what we need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, understand.
[CUSTOMER][NEUTRAL] May I know when was the you will be received?
[AGENT][NEUTRAL] I gave you the received date and the reprocessed date.
[CUSTOMER][NEUTRAL] I get.
[CUSTOMER][NEUTRAL] [PII] on [PII], right?
[CUSTOMER][NEUTRAL] I thought it's claim.
[AGENT][NEUTRAL] The claim was received by APL 152.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright thank you so much. Have a nice day.
[AGENT][POSITIVE] You're welcome. And is there, yes, sir. And is there anything else I could help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that's all for now.
[AGENT][POSITIVE] OK, [PII]. Well, thank you again. I have, I hope you have a nice day as well, and thank you again for calling APL.
[CUSTOMER][POSITIVE] How wonderful day too.
[CUSTOMER][POSITIVE] Yeah you too bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.