AccountId: 011433970860
ContactId: da4e5f6c-0a0e-4ed0-80ef-eb2b9e9569fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 635869 ms
Total Talk Time (AGENT): 230530 ms
Total Talk Time (CUSTOMER): 200484 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/da4e5f6c-0a0e-4ed0-80ef-eb2b9e9569fa_20250513T17:04_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] here. Initial of my last name, [PII], calling from provider office to check on the claim status. But before I proceed, can you note that this call is being recorded for quality and training purpose. Are you OK with that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes. And I'm sorry, what was your first name again?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your [PII]?
[CUSTOMER][NEUTRAL] Initial of my last time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, no, right.
[AGENT][NEUTRAL] OK, thank you. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII] with the extension of [PII].
[AGENT][NEUTRAL] OK, your voice cut out just a little bit, [PII]. You said 1800 and what was after that?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you. And how many you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Actually, yeah, 3 claims I have.
[AGENT][NEUTRAL] You have 3 claims, are they?
[CUSTOMER][NEUTRAL] Different, different date of service.
[AGENT][NEUTRAL] Is it for different patients or is it one patient with multiple dates of service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] uh, different patient, uh, and same provider.
[AGENT][NEUTRAL] OK, [PII], so you will use my name along with today's date as each of your call reference numbers. Also, any information that is provided on the claims today would be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And lastly, if we do have the claims on file and you need a copy of the explanation of benefits once I provide you the claim number, you can print those if you go to our portal at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so what is your first patient's policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It is 019.
[CUSTOMER][NEUTRAL] 8259 M Lima.
[CUSTOMER][NEUTRAL] Uh, sorry, I'm Mike Lima 8.
[AGENT][NEUTRAL] OK, so I need, OK, so the number, you need the first part of the number before the M. I need for you to repeat that again because I was either you're missing a number or I just didn't hear it.
[CUSTOMER][NEUTRAL] Yeah, yeah, sure.
[CUSTOMER][NEUTRAL] No, it is 019.
[CUSTOMER][NEUTRAL] 8259
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK, so you're missing a number, [PII].
[CUSTOMER][NEUTRAL] OK. So which one?
[CUSTOMER][NEUTRAL] Like I have only this member ID?
[AGENT][NEGATIVE] And that's not a valid ID.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] You can
[CUSTOMER][NEUTRAL] And then.
[AGENT][NEUTRAL] Do you have
[AGENT][NEUTRAL] Do you have the full social security number for the insured?
[CUSTOMER][NEUTRAL] Actually, uh,
[CUSTOMER][NEUTRAL] Only have this, um, and at, do you want uh patient name to put like the date of birth?
[AGENT][NEUTRAL] I can try by the I can't search by the date of birth so I can try by the name, but if I'm not able to locate it by the name you would just have to get the correct number and call us back, OK? So what is the last name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Last name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, what was after the [PII]?
[AGENT][NEUTRAL] Was that the last letter?
[CUSTOMER][NEUTRAL] After [PII]?
[AGENT][NEUTRAL] Yes, is that the last letter?
[CUSTOMER][NEUTRAL] No, that's it. The last letter is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the first name?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII], H Hotel.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yeah. Date of birth is like [PII].
[AGENT][NEUTRAL] OK, so the, OK, so one moment and I'll provide you the correct policy number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, so the correct policy number that you should so the number that you gave me.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] After the 9.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There should be a 2.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Also.
[AGENT][NEUTRAL] Before the M.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So 01982592.
[CUSTOMER][POSITIVE] Got it. Thank you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And what is the date of service and the total bill amount for her place, [PII]?
[CUSTOMER][NEUTRAL] It is [PII]. The amount is $482 even.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK. So this claim was received, [PII]. It was received on [PII] and denied on [PII].
[AGENT][NEUTRAL] The claim number is 353-19, denied on 320.
[CUSTOMER][NEUTRAL] Yes you've done?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 357-882-8.
[AGENT][NEUTRAL] And the reason for the denial states to please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, do you have the fax number?
[AGENT][NEUTRAL] [PII] attention claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Apartment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like for all the claims that the uh car will be the same, right?
[AGENT][POSITIVE] Correct, yes sir.
[CUSTOMER][NEUTRAL] OK. Just a moment, pulling up the next claim.
[AGENT][NEUTRAL] And then you
[AGENT][NEUTRAL] All right, so that's all of the information you need on this number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, yeah. That's it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] And I'm ready when you are for the next one.
[CUSTOMER][NEUTRAL] Yeah. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 128.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. The next member ID is 024.
[CUSTOMER][NEUTRAL] 62244
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] And the date of service and total build out for her.
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. The amount is $379 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was also received. The received date on this was 2-11-2025.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 356-4059.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And this claim was denied for the same reason we need the primary insurance company's EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, you'll be
[CUSTOMER][NEUTRAL] OK, got it. And
[CUSTOMER][NEUTRAL] Can you please spell out your name for me once?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sir. Thank you, guys, for your assistance and have a great day ahead.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, was that the last one? I thought you had 3 of them, [PII]. You only had 2?
[CUSTOMER][NEUTRAL] No, that's it. One is like done the same.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] OK, well if that's all I can help you with then thank you again for calling APO and I hope you have a nice day all set.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah bye.
[AGENT][NEUTRAL] Bye bye.