AccountId: 011433970860
ContactId: d758766b-8f4e-4cbc-a977-a93b87554f4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1239800 ms
Total Talk Time (AGENT): 405633 ms
Total Talk Time (CUSTOMER): 473574 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/d758766b-8f4e-4cbc-a977-a93b87554f4e_20250423T19:08_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for provider Ruby to check on and claim status. Please be informed that this call is being recorded.
[AGENT][NEUTRAL] OK, I could check on a claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Please be informed that this call is being recorded and monitored for quality and training purposes. Yes, please go ahead.
[AGENT][NEUTRAL] OK, yes, um, can I get a good call back number from you first, [PII] just in case we're disconnected?
[CUSTOMER][NEUTRAL] Of course it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 8016, it's a direct line extension.
[AGENT][NEUTRAL] OK, thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Sure. So the policy number is going to be
[CUSTOMER][NEUTRAL] 02563342.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Of course, my first name is [PII]. Last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Sure. For this claim, the date of service is going to be 12-12-2024.
[CUSTOMER][NEUTRAL] Total bill amount is 450. Yes, yes, [PII].
[AGENT][NEUTRAL] That was 1212.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][POSITIVE] OK, yes, go ahead with that building out please.
[CUSTOMER][NEUTRAL] $453 even.
[AGENT][NEUTRAL] 453. OK, got it. Thank you. One moment please.
[AGENT][NEUTRAL] [PII], do you have the uh tax ID for this provider?
[CUSTOMER][NEUTRAL] Yes, of course. So the tax ID of the provider is going to be [PII].
[AGENT][POSITIVE] OK, thank you so much for that. One moment please.
[CUSTOMER][NEUTRAL] Of course
[AGENT][POSITIVE] OK, I appreciate your patience, [PII]. So we did receive this claim and we paid a benefit of $87 and excuse me, $84.70 and that did meet their maximum.
[CUSTOMER][NEUTRAL] So, um.
[CUSTOMER][POSITIVE] You have received this claim and you have paid the benefit.
[AGENT][NEUTRAL] We did receive the claim. We paid a benefit of $84.70 and that did meet their maximum for this date of service.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So, uh, just for the clarification, may I know you have, uh, paid this, uh, claim or not?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, we paid a benefit of $84.70 through a check. We had sent a check, and I've got that information for you whenever you're ready.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, just a second. I'm checking uh with a few of the details. Just a second.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I required a few details. I believe you can help me out with those details.
[AGENT][NEUTRAL] OK, yeah, so, um, I've got that claim number whenever you're ready.
[CUSTOMER][NEUTRAL] OK, before the claim number, can you please just help me out with the received date?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh yes, one moment.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, uh, so this claim was received [PII].
[CUSTOMER][NEUTRAL] To.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] process is on [PII] of
[CUSTOMER][NEUTRAL] May I know the pay date?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, so the check was in.
[CUSTOMER][NEUTRAL] Pay it.
[AGENT][NEUTRAL] Yes, this check was issued [PII] and I am showing it has not yet cleared, so I can get this voided and reissued to you um whenever you're ready I can verify the address that we have.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, till that, uh, can I just get the, I mean, may I just get the claim number?
[AGENT][NEUTRAL] Oh yes, uh, that's 354-861-4.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Uh, no need to reissue as uh the claim has been processed. Uh, we can wait for the payment. No worries for that.
[AGENT][NEUTRAL] OK, um, so typically it's, uh, within or if it's been longer than 30 days of the issue date and you haven't received it yet then we can get it voided and reissued so if it's, um, if you haven't received it in a little bit, just know that you can call back whenever you'd like uh and have this voided and reissued.
[CUSTOMER][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need any other information from me, [PII]?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes, just a moment it's.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So you said that it is not released, right? I mean, it is not uh
[AGENT][NEGATIVE] It, it has not been uh cleared.
[AGENT][NEGATIVE] It was sent, um, it was sent in the mail [PII] and has not yet cleared.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I documented the same thing. Thank you so much for that information. No worries, we can wait for the payment. Just a moment. I see. May I know the mode of payment?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It was a paper check, a single check in the mail.
[CUSTOMER][NEUTRAL] Can I get the check number?
[AGENT][NEUTRAL] Yes, that is 2021952.
[CUSTOMER][NEUTRAL] And the single amount of $84.70?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Paid amount is this, may I know the allowed amount?
[AGENT][NEUTRAL] Uh, you mean the total benefit amount that they have?
[CUSTOMER][NEUTRAL] The allowed amount
[AGENT][NEUTRAL] Uh, for this benefit, the total amount was, uh, well, let me get that for you. Give me just a moment.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] Bear with me just a moment. I appreciate your [PII]ence.
[CUSTOMER][POSITIVE] Of course, no worries.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, uh, so there of course there were two, procedure codes under this uh policy or excuse me, under this claim, so the procedure code, the 99213, the maximum benefit was $75 per visit, and that's how much that we did pay. The other procedure uh code the 69,210 is the surgery.
[AGENT][NEUTRAL] And for that one, we were only able to pay $9.70 as that benefit um had been exhausted previously.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. For, um,
[CUSTOMER][NEUTRAL] Procedure code 9, 69,210, the allowed amount was $9.70 dollars.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] $9.70 was how much we paid that benefit on that benefit as that was the remaining amount.
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] And the allowed amount was also the same, $9.70.
[AGENT][POSITIVE] Uh, for this one correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about 99213? What was the allowed amount?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] A lot amount was $75 and that is how much we paid.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And food the same.
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] Can we please verify with the payment mailing address and the patient account number? I'll verify, can you please check it from your side?
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Is it payment mailing address uh [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, that is
[AGENT][POSITIVE] Yes ma'am, that is exactly what we've got it and where we sent that.
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] And the um
[CUSTOMER][NEUTRAL] Patient account number [PII].
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] OK, both are correct.
[CUSTOMER][NEUTRAL] So you don't have the cash clear date, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The cash clear that you don't have, right?
[AGENT][NEGATIVE] It has not uh cleared yet, no.
[CUSTOMER][NEUTRAL] OK. Can I, uh, may I get the, uh, duplicate copy of UB?
[AGENT][NEUTRAL] Yes, of course, um, let's see, what was that uh do you have a fax number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm going to read that back to you to make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] Yes, and the attention for this one will be the patient account number which we verified.
[AGENT][POSITIVE] Got it, yes, OK, alright, I will go ahead and send that to you now. I should get it within about 10 minutes or so. Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] Yes, I do have one more claim with me. I believe you can help me out with that as well.
[AGENT][NEUTRAL] Is this for the same member or was this for a different member?
[CUSTOMER][NEUTRAL] Different ones.
[AGENT][NEUTRAL] OK, um, yes, if you don't mind, um, give me just a moment. I'm gonna send this fax and then I'll let you know when I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] OK, for sending us the fax of the duplicate copy of UB, uh, just wanted to uh verify with you one thing. The claim which we submitted on [PII]. May I know, did you receive that claim or not in the month of?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I believe so um as that one was registered as a duplicate.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Do you have the received date and the date of the duplicate one?
[AGENT][NEUTRAL] Uh, let me get that for you. Give me just a moment.
[CUSTOMER][NEUTRAL] Yes, just for my document purpose I require it.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, yes, uh, so that one was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, excuse me, [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEGATIVE] And denied on March.
[AGENT][NEUTRAL] [PII], [PII], yes.
[CUSTOMER][NEUTRAL] 4.
[CUSTOMER][NEUTRAL] What will be the claim number?
[AGENT][NEUTRAL] That is 3571055.
[CUSTOMER][POSITIVE] OK, no worries. You can fax me the copy of you. Thank you so much for this information.
[AGENT][NEUTRAL] Sure, um, so I'm sending you the, OK, uh, so I am sending you I just sent the um original claim that has the payment information. Did you need this other EOB as well that was the duplicate?
[CUSTOMER][NEUTRAL] I'll wait for the call reference number.
[CUSTOMER][NEGATIVE] No, no. No, no.
[AGENT][NEUTRAL] OK, just the original got it. OK, um, so, OK, so reference number would be the same um for uh both claims um it's going to be my first name, last initial, and today's date. Uh so my name is spelled [PII]
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And today's date?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII].
[AGENT][POSITIVE] OK, bear with me just a moment. Yes, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh.
[AGENT][POSITIVE] OK, I appreciate your patience, [PII]. You can go ahead and uh give me that next policy number.
[CUSTOMER][POSITIVE] That's so sweet of you. Thank you so much for that. I really appreciate it. So, the next policy number is A as in Alpha 6,423,002,700.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, so that's not gonna be one of our policy numbers, [PII] that's a bit too long, uh, to be one of our policy numbers. Um, do you maybe have this number's social and I could search for them that way?
[CUSTOMER][NEUTRAL] Just a moment, I'll check.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Or if you have a claim number I can search for them that way as well.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So um.
[CUSTOMER][NEUTRAL] Claim number is per checking over here, it's 202.
[CUSTOMER][NEUTRAL] 412,230
[CUSTOMER][NEUTRAL] 743.
[AGENT][NEUTRAL] OK, um, that's not gonna be one of our claim numbers either [PII] that's uh gonna be way too long to be one of our claim numbers.
[CUSTOMER][NEUTRAL] So, can I help you out with the member's first name and the last name?
[AGENT][NEUTRAL] Sure, if you wouldn't mind spelling those out for me.
[CUSTOMER][NEUTRAL] Of course, I will spell it out. It's [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Last name is spelled as [PII]
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Is that fine or should I spell it once again?
[AGENT][NEUTRAL] If you wouldn't mind spelling out the first name again, please?
[CUSTOMER][NEUTRAL] Of course. It's [PII].
[AGENT][NEUTRAL] OK, and the last name that was [PII]?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Yes, perfect.
[AGENT][NEUTRAL] Got it OK alright one moment let me see if I can find them.
[AGENT][NEUTRAL] OK, um, I don't have anyone with that name in our system, [PII].
[CUSTOMER][NEUTRAL] OK, you're stating that you are not able to find the member?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] $30
[CUSTOMER][NEUTRAL] OK, just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Should I help you out with any other information?
[AGENT][NEGATIVE] Unfortunately those are the only pieces I could search with unless you have their social security number.
[CUSTOMER][NEUTRAL] Should I help you out with the last four digits?
[AGENT][NEUTRAL] Uh, it would have to be the full social.
[CUSTOMER][NEUTRAL] Of course, just a second. I'll help you out with that as well. Just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] If I
[CUSTOMER][POSITIVE] It's getting loaded, so sorry.
[AGENT][NEUTRAL] Sure. No, you're fine.
[CUSTOMER][NEUTRAL] But no but not.
[CUSTOMER][NEUTRAL] OK. It's going to be whenever you're ready.
[AGENT][POSITIVE] I'm ready when you are.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I remember.
[AGENT][NEUTRAL] OK, no, I did not get a result with that social, [PII]. Let me read that back to make sure I heard it correctly. Um, that was [PII].
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] Yes, [PII]. It's correct.
[AGENT][NEUTRAL] Right, OK, so yeah, it does not look like this member is in our system.
[CUSTOMER][NEUTRAL] Um, that's OK. Um.
[CUSTOMER][POSITIVE] So, yeah, [PII], thank you so much for your assistance. Thank you for your patience as well. I really appreciate it. Have a rest of the day, blessed and take care. Bye-bye. Be safe.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you. You too, [PII]. You too. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Yes, bye-bye.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.