AccountId: 011433970860
ContactId: d49113cd-6907-47fd-a879-17c83a85eba6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 667799 ms
Total Talk Time (AGENT): 203343 ms
Total Talk Time (CUSTOMER): 312147 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/d49113cd-6907-47fd-a879-17c83a85eba6_20250320T18:33_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]. I'm calling for the additional information on a claim. Please be informed that this call is been recorded and monitored for quality and training purposes. May I know if I can help with the patient information and the provider information?
[AGENT][NEUTRAL] Yes, first, [PII], can I get a callback number please?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, sure. My callback number is [PII] and there is direct line extension.
[AGENT][NEUTRAL] And [PII], do you happen to have the claim number?
[CUSTOMER][NEUTRAL] Yes, um, uh, OK, [PII], uh, by our previous call.
[AGENT][NEUTRAL] What's that number?
[CUSTOMER][NEUTRAL] I get the information about the claim is not on file and in that claim, the one of the question is what is the preferred mode of submission and the preferred mode of submission in yours is fax or mail, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And what is the fax number?
[AGENT][NEUTRAL] Fax number for claims is [PII], and that comes straight to our claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what is the attention to this uh fax number?
[AGENT][NEUTRAL] Claims
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Thank you so much, [PII], for the information. And what is the call reference number for this call?
[AGENT][NEUTRAL] It would be my name in today's date, and I spell my name [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] And and it was a pleasure to assist you with that claim submission information. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes. Um, could you please help me with the another claim issue?
[AGENT][POSITIVE] Sure, it would be my pleasure. Do you have that claim number or policy number?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Um, just let me check.
[CUSTOMER][NEUTRAL] No, I don't have a claim number, um, no.
[AGENT][NEUTRAL] What is patient's policy number?
[CUSTOMER][NEUTRAL] OK. The member ID is 02323553.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Patient's name is?
[CUSTOMER][NEUTRAL] [PII]. The first name is [PII]. Last name is [PII]
[AGENT][NEUTRAL] And her date of birth, please?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. And I can help.
[CUSTOMER][NEUTRAL] It's [PII], yes.
[AGENT][NEUTRAL] OK, and I can help you with that claim status. What is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] Have
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And what is the bill amount, please?
[CUSTOMER][NEUTRAL] The bill amount is $295 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What is the facility name?
[CUSTOMER][NEUTRAL] Facility name is?
[CUSTOMER][NEUTRAL] It's Musk and USK Community sicians.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, bear with me just one second.
[CUSTOMER][NEUTRAL] Yes sure.
[AGENT][NEUTRAL] And you said the total charge amount was 295, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, [PII], I'm showing that we did receive the claim on 10-9-24.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And process on [PII]?
[AGENT][NEUTRAL] The claim was denied because benefits are only payable if the major medical provides benefits. According to the EOB we received.
[AGENT][NEGATIVE] There was nothing applied to the deductible, co-pay or co-insurance of the major medical. Therefore, no benefits payable.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I'm so sorry, but could you please elaborate the reason for the denial?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] According to the primary EOB that we received.
[AGENT][NEUTRAL] With the claim?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The primary insurance did not provide benefits. This secondary policy only pays to deductible co-payer coinsurance, and there was nothing listed for the deductible co-payer coinsurance on that primary EOB. Therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so do you require a primary UB?
[AGENT][NEUTRAL] We do require the primary EOB showing what was applied to the deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK. So do you require the primary UB with the corrected claim or with the fresh claim?
[AGENT][NEUTRAL] A fresh claim.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] OK. Just give me a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, [PII]. So, for this claim, you required the primary UB right.
[AGENT][NEUTRAL] If it, uh we need the EOB showing what was applied to the deductible, co-pay or co-insurance for this service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So uh.
[CUSTOMER][NEUTRAL] What is the mailing address to sub uh submit the corrected your uh primary OP.
[AGENT][NEUTRAL] 2 it's [PII].
[CUSTOMER][NEUTRAL] Yeah, of course.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. OK. And what is the timely filing limit to submit the corrected claim?
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] And is there any time defending you to submit an appeal?
[AGENT][NEUTRAL] Appeal is 180 days from the date of denial. The date of denial on this claim is [PII].
[CUSTOMER][NEUTRAL] OK, so the, uh, so the claim is received on [PII], right?
[AGENT][NEUTRAL] That's correct and processed on [PII].
[CUSTOMER][NEUTRAL] And the claim denial date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you so much and um.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And uh how can we send the uh primary EOB? Is there any mode of submission to send the primary OB?
[AGENT][NEUTRAL] That can be faxed directly to our claims. You certainly can to our claims department.
[CUSTOMER][NEUTRAL] Can we fax?
[CUSTOMER][NEUTRAL] OK, and the fax number which I which you gave me [PII] attention to the claim, right? OK.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is there any specific form for a bill?
[AGENT][NEUTRAL] We will need a formal letter.
[AGENT][NEUTRAL] Giving details regarding the reason for the appeal decision.
[CUSTOMER][NEUTRAL] $515.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much. And could you please give me the call reference number for this claim?
[AGENT][NEUTRAL] Call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][POSITIVE] Thank you so much, [PII]. What is the claim number?
[CUSTOMER][NEUTRAL] right.
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 7481.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much for the information. I really appreciate your patience and have a good day bye bye.
[AGENT][POSITIVE] And it's been a pleasure to assist you with that claim status. Thank you for calling APL. If there's nothing else I can help you with, I hope you have a great day as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah