AccountId: 011433970860
ContactId: d57eb822-4512-4daa-aec1-8e80a79cfa9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1661219 ms
Total Talk Time (AGENT): 276409 ms
Total Talk Time (CUSTOMER): 528959 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/d57eb822-4512-4daa-aec1-8e80a79cfa9d_20250508T20:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. Uh, good afternoon. My name is [PII] and last term is [PII]. I'm calling from provider's office regarding the claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can you give me the name of the provider and then a good callback number?
[CUSTOMER][NEUTRAL] Sure. [PII]. It is a direct line.
[AGENT][NEUTRAL] And provider name?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's a Gastro Health LLC. It is a group name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you have the policy number of the patient?
[CUSTOMER][NEUTRAL] OK. 0200310.
[CUSTOMER][NEUTRAL] 3 M for Mary, L for Lima 7.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth, [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the date of service and bill charges.
[CUSTOMER][NEUTRAL] [PII] and the total charge $2,862 even.
[AGENT][NEUTRAL] OK, was that [PII]?
[CUSTOMER][NEUTRAL] [PII]. 0 yeah, it's [PII].
[AGENT][NEUTRAL] And what were the bill charges again?
[CUSTOMER][NEUTRAL] Uh, [PII]. Yeah, it's $2,862 even.
[CUSTOMER][NEUTRAL] So that's
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, looks like we received that claim on.
[AGENT][NEUTRAL] [PII] process 27 2025.
[AGENT][NEUTRAL] Duplicate, let me find the original.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, sorry, we received it 4 times.
[CUSTOMER][NEUTRAL] You got the claim?
[AGENT][NEUTRAL] Yeah, I'm trying to find it. We received it 4 times, so I'm trying to see which one's the correct one.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, we originally received it 1021, 24, process 1021, 24, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it looks like we were needing the explanation of benefits that shows what amounts were applied to the deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] So, what is the updated claim information like you received in [PII] and then on [PII], right?
[AGENT][NEUTRAL] That's a duplicate.
[AGENT][NEUTRAL] So it didn't have any new information with it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one second.
[CUSTOMER][NEUTRAL] Can you please provide the duplicate claim number?
[AGENT][NEUTRAL] Uh, duplicate claim number 356-0762.
[CUSTOMER][NEUTRAL] OK, and when I tell, uh, first to receive the claim information?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] May they initially received the claim information like initially claim original claim information I need original claim information.
[AGENT][NEUTRAL] So the very first time the claim was submitted was 10-7-2024.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Like you stated, like the original claim was for the requested, uh, UOB, right?
[AGENT][NEUTRAL] We received the EOB, but it doesn't give a breakdown of how the, how it was applied to deductible, co-insurance, or co-pays.
[AGENT][NEUTRAL] So we have to have a breakdown of that for the charges.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, sure. And also, can you please provide the general information on the claim like receive date, process date and claim number?
[AGENT][NEUTRAL] For the original claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Original claim was received 10-7-2024. Processed 10-11-2024.
[AGENT][NEUTRAL] And that claim number is 351-6398.
[CUSTOMER][NEUTRAL] One second, 351.
[AGENT][NEUTRAL] 6398.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] This one was denied as.
[CUSTOMER][NEGATIVE] Um, there is no proper, uh, coincidence cope information right on the TRB.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. And let's go to the another patient.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's loading. Just give me a moment.
[CUSTOMER][NEUTRAL] OK, um, the member ID is 021.
[CUSTOMER][NEUTRAL] 8 919 M for Mary, L for Lima 7.
[AGENT][NEUTRAL] What was the policy number again?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah. It's 02189.
[CUSTOMER][NEUTRAL] 19
[CUSTOMER][NEUTRAL] M for Mary, L for Lima, 7.
[AGENT][NEUTRAL] Um, I'm not pulling up that policy number. Looks like you're missing a number.
[AGENT][NEUTRAL] 02189.
[CUSTOMER][NEUTRAL] OK, can you please
[CUSTOMER][NEUTRAL] Yeah. 9 after 19, M for Mary, L for Lima, 7.
[AGENT][NEUTRAL] OK, so 021891-99.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Single 9.
[CUSTOMER][NEUTRAL] 021-8919 M for Mary, L for Lima 7.
[AGENT][NEUTRAL] Yeah, there, there should be 8 digits.
[AGENT][NEUTRAL] And you're, so we're missing a digit. Do you have the last name of the patient?
[CUSTOMER][NEUTRAL] OK, one second. I can check the patient ID card, OK? Just give me a moment.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK, I can spell the name, so we didn't find any ID card in my system, patient documents.
[AGENT][NEUTRAL] OK, what's the name?
[CUSTOMER][NEUTRAL] Secondary insurance, um, just, just give me a moment, it's loading.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Sorry for the inconvenience. So I'm trying to check the patient ID card, but it is not available in my documents. OK. Uh, the last name is [PII] [PII].
[CUSTOMER][NEUTRAL] And the first name is [PII].
[AGENT][NEUTRAL] OK. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, looks like we're missing the seven at the end. So [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] And do you have his date of birth?
[CUSTOMER][NEUTRAL] After [PII], right?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh no, it's so it's [PII].
[CUSTOMER][NEUTRAL] So there is no ML, right? [PII]ima.
[AGENT][NEUTRAL] Yeah, I mean you can file that, but we identify it just with those 1st 8 digits, so.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] And his birthday?
[CUSTOMER][NEUTRAL] The date of service is [PII]. Yeah. The date of service is [PII]. And the total charge $4,288 even.
[AGENT][NEUTRAL] Did you have his birthday?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The date of birth for [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. OK, and sorry, what was that date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the total charge $4,288 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] See see.
[CUSTOMER][NEUTRAL] So I need a general claim for this claim.
[AGENT][NEUTRAL] Uh, that one was received 12-11-2024.
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And same reason, we need an an explanation of benefits showing how deductible, co-insurance, or co-pays were applied by primary.
[CUSTOMER][NEUTRAL] OK, may I have the claim number?
[AGENT][NEUTRAL] 03540733
[CUSTOMER][NEUTRAL] Repeat again. 030354.
[AGENT][NEUTRAL] Yeah, 354-073-3.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] That's more than the patient.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And patient's ID number?
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[CUSTOMER][NEUTRAL] Oh this one.
[CUSTOMER][NEUTRAL] I that.
[CUSTOMER][NEGATIVE] Shit
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The member ID is 022.
[CUSTOMER][NEUTRAL] Yeah. 022.
[CUSTOMER][NEUTRAL] 01875 M for Mary, L for Lima 8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Day of service and bill charges.
[CUSTOMER][NEUTRAL] OK. It's [PII] and the total charge $471 even.
[AGENT][NEUTRAL] Uh, the claim was received 327-25.
[CUSTOMER][NEUTRAL] 12.
[AGENT][NEUTRAL] Process 3:31 25.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Offices are not cover under the patient plan?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And may I have the claim number?
[AGENT][NEUTRAL] 3582762
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK. 3582762, right?
[AGENT][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Thank you so much and it's more than the claim. Total 35 claims. So you already provided 3 and 2 more is there.
[AGENT][NEUTRAL] OK. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Well, I think it's done.
[AGENT][NEUTRAL] Policy number for the patient?
[CUSTOMER][NEUTRAL] You're asking the next patient information.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it's 01820389 M for Mary, L for Lima 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's I, I the um and the date about [PII].
[AGENT][NEUTRAL] of service bill charges?
[CUSTOMER][NEUTRAL] OK. The date of service is.
[CUSTOMER][NEUTRAL] [PII] and the total charge.
[CUSTOMER][NEUTRAL] $3,915 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And it looks like we received that claim on 2-17-25.
[AGENT][NEUTRAL] Process 2 1925.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Maximum payable for the date of service has been met.
[CUSTOMER][NEUTRAL] It's a deductible?
[AGENT][NEUTRAL] No, the max dollar amount has been met for the date of service.
[CUSTOMER][NEUTRAL] Like it's still for the maximum in 60, right, maximum number of uh.
[CUSTOMER][NEUTRAL] Units are built
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] OK, noted for maximum benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Do you need that claim number?
[CUSTOMER][NEUTRAL] OK. And may I have the claim number?
[AGENT][NEUTRAL] Yes, it's 353565604.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 356-560-4
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Let's move to the last claim.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Just.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] OK, the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a moment. It's loading.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] OK. Sorry for the long hold.
[CUSTOMER][NEUTRAL] We should
[CUSTOMER][NEUTRAL] The member ID is 2925921.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Uh, what was the number again?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, it's 204 sorry.
[CUSTOMER][NEUTRAL] You're asking the dollar amount, right?
[AGENT][NEUTRAL] No, the, the policy number for the patient, the member ID.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just, uh, one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It's loading.
[CUSTOMER][NEUTRAL] The member ID is 25921.
[CUSTOMER][NEUTRAL] And the patient name is [PII].
[CUSTOMER][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] OK, policy number 25921.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, what was the uh name of the patient?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] I'm not pulling that up. Um, you have the, what, how do you spell the last name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I provided the last name so that one.
[CUSTOMER][NEUTRAL] I, I can spell name, [PII].
[AGENT][NEUTRAL] OK. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm pulling up that name. Do you have a group number by chance?
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Just give me a moment. I'm checking the previous account history. Like if I found any other information, I will forward it, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Were you able to find anything?
[CUSTOMER][POSITIVE] OK, uh, sorry for the long.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, yeah, one second.
[CUSTOMER][NEGATIVE] It's loading, so that's why I take up too much of time.
[CUSTOMER][NEGATIVE] Uh, no thanks, that's it. And I have a doubt. Oh shit.
[CUSTOMER][NEUTRAL] I needed to UOB so I can provide the one claim number. So this one is you already provide the claim status, uh, but just only send the EOB through fax, OK? Only U is required. That's it. And you can pro don't provide any claim status to call.
[AGENT][NEUTRAL] Do you need EOB?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Or what?
[AGENT][NEUTRAL] You have the claim number?
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] Yeah, so the claim number is 356-5604.
[AGENT][NEUTRAL] OK, what was the other one?
[AGENT][NEUTRAL] Is that the only one?
[CUSTOMER][NEUTRAL] So you want the dollar amount? I guess.
[AGENT][NEUTRAL] No, you're, you're wanting an EOB for the claim we already went over, is that right?
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Yeah, yeah. So, um, actually I'm trying to check the uh UOB portal but unable to find the UOB, so that's why I need the UOB only that claim.
[AGENT][NEUTRAL] OK. Is that the only one you need?
[CUSTOMER][NEUTRAL] Only 11 2nd, and I'm checking one more. So if I phone?
[CUSTOMER][NEUTRAL] Only one time. If it is not found, you can provide it to you through call.
[CUSTOMER][NEUTRAL] Just give me a moment. It's loading.
[CUSTOMER][NEUTRAL] How are you doing today?
[CUSTOMER][NEUTRAL] But
[AGENT][POSITIVE] I'm doing OK. How about you?
[CUSTOMER][POSITIVE] Not bad. So I'm waiting for the weekend.
[AGENT][NEUTRAL] Yeah, me too.
[CUSTOMER][NEUTRAL] Like everyone, everyone is waiting for a weekend, right?
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] So what is your weekend plans?
[AGENT][NEUTRAL] Uh, going off-roading on dirt roads.
[AGENT][NEUTRAL] What about you?
[CUSTOMER][NEUTRAL] Off-roading with your with your family or boyfriend?
[AGENT][NEUTRAL] Uh, husband and dogs.
[CUSTOMER][NEUTRAL] Oh, you're already married. Oh, sorry.
[AGENT][NEUTRAL] Oh yes, I'm, I'm old.
[CUSTOMER][NEUTRAL] My plan is only sleeping, eat sleep routine. That's it.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Sounds, sounds perfect.
[CUSTOMER][NEUTRAL] OK, um, only one claim, that's it. So another claim I got that you will be in through hotel.
[AGENT][NEUTRAL] OK, that one.
[AGENT][NEUTRAL] OK, what's your facts?
[CUSTOMER][NEUTRAL] 615
[CUSTOMER][NEUTRAL] 777.
[CUSTOMER][NEUTRAL] 353 6
[AGENT][NEUTRAL] OK. OK, I'll get that faxed over. Just give me about 2 minutes, OK?
[CUSTOMER][POSITIVE] Yeah, sure, sure. And thank you so much and thank you for giving this information. And may I have the call reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That call reference number is my name is [PII], and today's date.
[CUSTOMER][POSITIVE] Yeah. Thank you, [PII]. Thank you for giving this information. Have a nice day and advance happy weekend.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] You too. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, bye-bye.