AccountId: 011433970860
ContactId: d90fe946-e29a-43b4-8a04-d779e1aa210e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401820 ms
Total Talk Time (AGENT): 202399 ms
Total Talk Time (CUSTOMER): 114715 ms
Interruptions: 3
Overall Sentiment: AGENT=1.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/d90fe946-e29a-43b4-8a04-d779e1aa210e_20250625T13:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from the provider's office and um I'm calling in regards to a claim that was submitted for a patient. I just wanna get a little bit more than um the reason of the denial.
[AGENT][NEUTRAL] OK, [PII], so you're calling to get a little more information you said on a on a claim that was denied, is that correct?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][POSITIVE] OK. Uh yes, ma'am. Well, I can certainly help you with that. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Oh, this is [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII]. OK, thank you. And what is the member's policy number that you're calling about today?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I have 01780684 M like Mary, L like Larry, number 8.
[AGENT][NEUTRAL] OK, thank you, so give me a couple moments please to get the member's information pulled up.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And then the information Tera that I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient name is [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount, please?
[CUSTOMER][NEUTRAL] Data services $4725 bills amount $2,196.
[AGENT][NEUTRAL] OK, 47 2025 for 2196. Is that correct?
[CUSTOMER][NEUTRAL] For 2 OK 4725 for 20196 yes mhm.
[AGENT][NEUTRAL] Yeah, 2196. OK, thank you. One moment.
[AGENT][NEUTRAL] OK, and do you already have the claim number for this?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, let's see if I have a claim number here on file, um.
[CUSTOMER][NEUTRAL] It shows that that we did receive a correspondence from you guys, um.
[AGENT][NEUTRAL] You, yes, can you.
[CUSTOMER][NEUTRAL] But I don't see.
[CUSTOMER][NEUTRAL] Received.
[AGENT][POSITIVE] OK. I'll be happy to give it to you.
[CUSTOMER][NEUTRAL] To do that I don't see a claim number.
[AGENT][NEUTRAL] OK, so on the we should have, I mean, you should have received an explanation of benefits and the claim number on this claim is going to be 360.
[AGENT][NEUTRAL] 134 6.
[CUSTOMER][NEUTRAL] 46. 0 yes, I saw it. I'm sorry.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh, that's, uh, that's OK. You do have it. OK. And so the denial remark on here states benefits are payable.
[AGENT][NEUTRAL] Only if your major medical insurance provider provides benefits.
[AGENT][NEUTRAL] If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] OK, so I do show here that the, the major medical did process the claim, but I think they applied it towards the patient responsibility.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So we actually need to just send you guys a copy of that um remit right? that you'll be.
[AGENT][POSITIVE] Yes, all you would need to send, yes, ma'am, is the explanation of benefits. That is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is there a fax number we could fax this to?
[AGENT][NEUTRAL] There certainly is. So our claims fax number is [PII] attention claims department.
[AGENT][NEUTRAL] And then in the future if you ever need a copy of an explanation of benefits on a claim that we have processed, we do have a portal that you should be able to get that from.
[AGENT][NEUTRAL] And the website for that is located at secured.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Because the claim remarks are always on page 2 of our explanation of benefits.
[AGENT][NEUTRAL] And I know a lot of times providers.
[AGENT][NEUTRAL] When it gets imaged in, once it's been received.
[AGENT][NEUTRAL] Get the front page but not always the second according to my callers anyway I mean you know I don't know.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Like if it's on the back when it's received by the, you know, so anyway, but that portal, especially if you have, and if you have trouble accessing it without the claim number, you can call us and once you have the claim number, it's generally very easy.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so again that website is secure. A like apple, M like Mary public.
[AGENT][POSITIVE] You have [PII]. That's correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII]. Alright, perfect. Alright, [PII], do you have a reference number just that we spoke today?
[AGENT][POSITIVE] Uh yes, ma'am, you will actually use my name along with today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, that's all I needed. Thank you so much for your help.
[AGENT][POSITIVE] OK, alright, well, you are very welcome and if that is all I can help you with, thank you again, [PII] for calling APL and I hope that you have a wonderful day.
[CUSTOMER][NEUTRAL] Same to you bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm.