AccountId: 011433970860
ContactId: d5f9f0c9-dc19-48f5-9a96-996b194f42e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1908180 ms
Total Talk Time (AGENT): 407714 ms
Total Talk Time (CUSTOMER): 833677 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/d5f9f0c9-dc19-48f5-9a96-996b194f42e3_20250321T15:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provider to check on a claim status. Please be informed that this call is been recorded and monitored for quality and training purposes. May I know if I can help you with the patient information and the provider information?
[AGENT][NEUTRAL] Uh yes, Miss [PII], can you please give me your callback number just in case our call gets disconnected.
[CUSTOMER][NEUTRAL] Yeah, yeah, sure. My callback number is [PII] and there is to decline the extension.
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. His first name is [PII] Last name is [PII]
[AGENT][NEUTRAL] OK, thank you. And what's the pa, mhm, go ahead.
[CUSTOMER][NEUTRAL] The date of birth is
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] And what is the uh patient's policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. The member ID is 02194752 M as in Mike, L as in Lima, 8.
[AGENT][POSITIVE] Thank you, let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I have Camille up and what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][POSITIVE] Thank you, and the charge amount?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, the charge amount is $382 even.
[AGENT][NEUTRAL] OK, and what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's 9671 cents.
[AGENT][NEUTRAL] OK, and the name of the facility, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Facility name is uh Summit Medical Group PA.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Miss [PII], while I look up this claim for you and I will be right back.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh shoot.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So looking on data service of [PII], I do not find a claim on file for the amount that you have given me.
[CUSTOMER][NEUTRAL] OK um.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $382 even um.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Correct and I don't find a claim on file for that amount.
[CUSTOMER][NEUTRAL] OK, just, uh, let me recheck the amount. Just give me a moment.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] OK um I he was killing me.
[AGENT][NEUTRAL] Hello, [PII], are you there?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK. Uh, OK, [PII], uh, do you receive any split claim because we submitted two claims. One is for charge 369 and one is for charge, um.
[CUSTOMER][NEUTRAL] 1313 $13. So do you receive any split claim?
[AGENT][NEUTRAL] No, I do not see the claim for that data service for the amount that you've given me.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] You'll have to resubmit the claim.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] It's not, it's not showing up.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yeah I thought I.
[CUSTOMER][NEUTRAL] OK. Could you give me the information about, uh, is the patient active on data of service?
[AGENT][NEUTRAL] The effective date of the policy is [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And are you a primary or secondary?
[AGENT][NEUTRAL] We are secondary.
[CUSTOMER][NEUTRAL] OK, [PII], uh, there's a confusion in the rate of, uh, sorry, bill amount because we submit the claim in two claim forms. So can you check with the both of the, uh, amount? Can you
[AGENT][NEGATIVE] I have checked and I don't have that claim on that date of service for either amount that you've given me or the $13 that you've given me either.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And the effective date will be [PII] and the patient is still active.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh, could you give me the information about when was the last coordination of benefits updated?
[AGENT][NEUTRAL] We don't do coordination of benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And what is the preferred mode of submission?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is I'm sorry, can you repeat the question?
[CUSTOMER][NEUTRAL] What is the preferred mode of submission of claims?
[AGENT][NEUTRAL] you can, um, send it electronically. I can give you the payer ID number.
[CUSTOMER][NEUTRAL] OK. Mm.
[CUSTOMER][NEUTRAL] And what is the claim submission timely filing limit?
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And the claim submission mailing address.
[AGENT][NEUTRAL] Is [PII]. That's in [PII].
[CUSTOMER][NEUTRAL] I got that one.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK. The address is [PII]. And what is the payer ID?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][POSITIVE] It's 60801. Thank you so much. And could you please assist me with the one more claim because I have a total 3 claims.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Uh, yes, ma'am. What is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure, and call reference number will be same for the both of the claims.
[AGENT][NEUTRAL] Yes, for all of them. It'll be my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK. It's story and today's date is [PII].
[CUSTOMER][POSITIVE] Thank you so much. [PII]K, the next member ID is 02030165.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] [PII]. I can spell it for you. The first name is [PII] and the last name is [PII]
[AGENT][NEUTRAL] Thank you. And the patient's date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Date of service is.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and the charge amount before and after primary?
[CUSTOMER][NEUTRAL] OK. OK. It is primary bill amount is $130 even. It's 130 and after primary amount is $50 even, it's $50.
[AGENT][NEUTRAL] Thank you and is it for the same facility?
[CUSTOMER][NEUTRAL] Uh, let me check. No, there's different facility. It's Premier Medical Group of Mississippi LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much, Ms. [PII], for holding for me.
[AGENT][NEUTRAL] I have um the date of service you said was [PII] and looking on that date of service, I do not find a claim for that date of service for this insured.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Just let me check.
[CUSTOMER][NEUTRAL] I I I.
[CUSTOMER][NEUTRAL] And you go there you can get.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I really.
[CUSTOMER][NEUTRAL] OK, give me the information about is the patient active on data of service?
[AGENT][NEUTRAL] The patient's effective date is.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, it's [PII] and the patient is still active. Are you a primary or secondary?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] No, [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] OK. Are you a primary or secondary?
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] What is the information about when was the last you be updated?
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] The last EOB?
[AGENT][NEUTRAL] Was not for you, so I can't give that information.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, when was the last coordination of benefits updated?
[AGENT][NEUTRAL] We don't do coordination of benefits.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And the preferred mode of submission is electronically, right? And there is no timely filing limit and the claim submission mailing address is [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] What is the pay ID for this claim?
[AGENT][NEUTRAL] It's the same, 60801.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. And uh uh should we go on the next claim?
[CUSTOMER][NEUTRAL] I think.
[AGENT][NEUTRAL] Yes, ma'am. Let's get the patient's name, date of birth, and policy number.
[CUSTOMER][NEUTRAL] Yes, patient's name is [PII]. The first name is [PII]
[CUSTOMER][NEUTRAL] And the last name is [PII]. And
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[CUSTOMER][NEUTRAL] And the member ID is 20055.
[AGENT][NEUTRAL] And what's the rest of the member ID? 20055?
[AGENT][NEGATIVE] That's not a good policy number for us.
[CUSTOMER][NEUTRAL] Oh, I have.
[CUSTOMER][NEUTRAL] Uh, I have the member ID only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, that's not a good policy number for us or member ID number for us.
[AGENT][NEUTRAL] Let me see if I can find her by her birth by her name.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, I do not find that member in our system.
[CUSTOMER][NEUTRAL] OK, by the, uh, by the name, date of birth, or date of service? OK. Can you search with patient account number?
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] The one that you gave me is incorrect.
[CUSTOMER][NEUTRAL] And do you have patient account number?
[AGENT][NEUTRAL] No, I'll need that in order to search.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Ah, I have last digits of SSN number.
[AGENT][NEUTRAL] I will need the full social.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] OK, just give me a moment.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, [PII], can you check with the phone number, patient's phone number?
[AGENT][NEUTRAL] No, we don't have a way to search my phone number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Is there any way to get the care, ah, to find the patient?
[AGENT][NEUTRAL] Um, my social security number or first and last name, and I have searched.
[AGENT][NEUTRAL] And we cannot find this member unless we have a good policy number and 20055 is not a good policy number.
[AGENT][NEUTRAL] Oh, I found her.
[AGENT][NEUTRAL] That number that you gave me?
[AGENT][NEUTRAL] Was the group number.
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] Um, this story, I'm here just, just a moment.
[AGENT][NEUTRAL] I have found her.
[AGENT][NEUTRAL] Can you give me the date of service, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, you can. OK, you found them?
[AGENT][NEUTRAL] Yes, the number you gave me was the group number.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So I looked under the group.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I have only leading member ID here, so I think that's a group, group number.
[AGENT][NEUTRAL] I, I've got
[AGENT][NEUTRAL] Right, I've, I've got it pulled up. Can you give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yes, sure. The date of service is [PII]. [PII].
[CUSTOMER][NEUTRAL] And the bill amount is?
[AGENT][NEUTRAL] OK, and what is the charge amount?
[CUSTOMER][NEUTRAL] Uh, the charge amount is $6,483 even.
[AGENT][NEUTRAL] OK, and then the charges after primary?
[CUSTOMER][NEUTRAL] After primary, the charges are $4810.97.
[AGENT][NEUTRAL] OK, and what is the name of the facility?
[CUSTOMER][NEUTRAL] Facility name is Key West HMA Physician Management LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for us and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Huh.
[AGENT][POSITIVE] No, I'm good.
[CUSTOMER][NEUTRAL] You are on
[AGENT][NEUTRAL] OK, thank you for holding for me, [PII]. I've got this claim pulled up. It is claim number 3549589.
[AGENT][NEUTRAL] The claim was paid $3000 with check number 2022233. After that payment, it exhausted the benefits for the calendar year.
[AGENT][NEUTRAL] The check was cashed on [PII].
[CUSTOMER][NEUTRAL] OK, so you paid the amount $3000 right? And uh there is the remaining amount is $1810 with 97 cents. Can you elaborate the amount?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] After the $3000 was paid, it exhausted the patient's benefits for the calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK just a moment.
[CUSTOMER][NEUTRAL] So you pay the maximum amount on this claim, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] There will be no further payment.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, do you require the denied DOB?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, what did you, can you repeat that?
[CUSTOMER][NEUTRAL] OK, do you require the denied UB?
[AGENT][NEUTRAL] No, we have the EOB and we paid.
[CUSTOMER][NEUTRAL] OK. Uh, what is the denial date?
[AGENT][NEUTRAL] There is no denial that the claim was.
[CUSTOMER][NEUTRAL] What is the process date?
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] OK, and the pay date?
[AGENT][NEUTRAL] It was also the same day.
[CUSTOMER][NEUTRAL] Mm, sorry, the um process date is [PII], right? And the pay date is
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much for the information. And could you please give me the information about what is the allowed dollar amount for the services?
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] The allowed amount was $3000.
[AGENT][NEUTRAL] And that's just to verify benefits. It's not a guarantee of.
[CUSTOMER][NEUTRAL] And when was the last services billed?
[AGENT][NEUTRAL] I'm sorry, I don't understand the question.
[CUSTOMER][NEUTRAL] When was the last services are billed?
[AGENT][NEUTRAL] I can't get that information. That's private information. I gave you the information for your claim.
[AGENT][NEUTRAL] For your facility.
[CUSTOMER][NEUTRAL] OK. And what is the timely filing limit to submit the corrected claim?
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] The timely filing limit.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEGATIVE] Hello, there is not a timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the mailing address to submit the corrected claim? Is it [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] What is the timely filing you to submit an appeal?
[AGENT][NEUTRAL] Uh, you have 180 days from the date the claim was initially processed and you need to send a letter why you want to appeal.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so, um, the 180 days from the denial date?
[AGENT][NEUTRAL] From the date the claim was processed and the claim was processed on.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what is the um mailing address to submit an bill? Is that same with the corrected address?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] Is there any specific form for appeals?
[AGENT][NEUTRAL] No, you just need to send a letter why you're, you're wanting to appeal the payment.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] to do that.
[CUSTOMER][POSITIVE] OK. And OK, thank you so much for the information and do, do, you don't need to deny your right. And
[CUSTOMER][NEUTRAL] OK. And the call reference number will be the same for the both, all of the claims, right?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, thank you so much for the information, and I really appreciate your patience story. Thank you so much and um have a good day.
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] You too, [PII], you have a wonderful day too, and thank you for calling APL.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][POSITIVE] Bye-bye. You have a great day. Have a good weekend.
[CUSTOMER][NEUTRAL] Bye.