AccountId: 011433970860
ContactId: da7fc72f-dbe3-42d8-80bc-dc5045733f89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1130589 ms
Total Talk Time (AGENT): 455196 ms
Total Talk Time (CUSTOMER): 330842 ms
Interruptions: 7
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/da7fc72f-dbe3-42d8-80bc-dc5045733f89_20250512T17:42_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] Hi [PII], I'm calling from a provider's office calling to get claim status on 4 claims I have for a patient.
[AGENT][NEUTRAL] OK, so you have one patient with 4 claims that you're needing status on, is that correct?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Please.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] OK. My name is [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number [PII]?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It is 01834900.
[AGENT][NEUTRAL] OK, thank you. So give me a moment, [PII] to get the member's information pulled up and I will need to verify a few things with you and also any information that's provided on any of the claims would be a verification of benefits and not a guarantee of payment. And lastly, [PII], if we do have the claims on file and you need a copy of the explanation of benefits once you have the.
[AGENT][NEUTRAL] Claim numbers you should be able to print them from our portal by going to [PII].
[CUSTOMER][NEUTRAL] OK, you're gonna have to repeat that again because I'm writing it down. You said secure. What was it?
[AGENT][POSITIVE] OK, OK. I'm sorry. The website for our portal is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] All right. And what is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Sure, [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the first date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Sure. The first one is [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] For $450.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And you said the total bill amount is for $450 is that correct?
[CUSTOMER][NEUTRAL] Yes, let me double check here.
[AGENT][NEUTRAL] OK, because I don't have a claim on file for him for that data service and that total bill amount.
[CUSTOMER][NEUTRAL] OK, give me one second. I'm just gonna double check.
[AGENT][POSITIVE] Yes, ma'am. Oh, you're welcome. Sure.
[CUSTOMER][NEUTRAL] 392.
[CUSTOMER][NEUTRAL] 87.
[CUSTOMER][NEUTRAL] OK, is it $637? Because I'm not sure if he's got a split or not.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] No, I don't have a claim on file for that data service for either of those amounts, either of those amounts. Who's the provider?
[CUSTOMER][NEUTRAL] On your end.
[CUSTOMER][POSITIVE] It's responsive health.
[AGENT][NEUTRAL] What's the tax ID number?
[CUSTOMER][NEUTRAL] Tax ID is [PII].
[AGENT][NEUTRAL] OK, so I only have one claim for that tax ID number for that data service and it's for an office visit.
[AGENT][NEGATIVE] But the charge amount is not anywhere near that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's 187 if it's an office visit because I'm not, I, I feel like it got split.
[AGENT][NEUTRAL] That's correct. That is what we have. That's all, that's all we have a claim for.
[CUSTOMER][NEUTRAL] OK, so you only have the one for the office visit. OK, hold on.
[AGENT][NEGATIVE] And that one was denied because office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, bear with me I'm just gonna write this down. So, um, let's see, so office visits are not covered, you said under his policy, OK.
[AGENT][NEUTRAL] Yeah, no, you're fine.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That's correct, yes ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] What's the claim number on this one?
[AGENT][NEUTRAL] This one is gonna be 359-032-9.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me look
[CUSTOMER][NEUTRAL] So do you guys cover labs?
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] With his policy?
[AGENT][NEUTRAL] So there is another claim that's on file for his labs, and it looks like it, and it was received separately. What's the billed amount on the lab?
[CUSTOMER][NEUTRAL] Um, that one I have is 450.
[AGENT][NEUTRAL] OK, alright, so just a moment.
[AGENT][NEUTRAL] OK, so this claim was received separately for the lab.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 359-032-3.
[AGENT][NEUTRAL] And there has been a benefit paid in the amount of $131.23.
[AGENT][NEUTRAL] And that was paid on a single check and the check number is 2039627.
[CUSTOMER][NEUTRAL] OK, and that amount would came to the 450, is that correct?
[AGENT][NEUTRAL] That was for the 450 lap.
[CUSTOMER][NEUTRAL] OK, so for that did it pay both lines the 80307 and the G0481? It paid both, OK.
[AGENT][NEUTRAL] It is.
[AGENT][POSITIVE] It did. Correct.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] And the office visit was processed under the the first claim number and it was denied because office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that might be, maybe they split the rest of these too, OK, because I have um 3 more dates of service, please.
[AGENT][NEUTRAL] OK, what's the next data service and build them out?
[CUSTOMER][NEUTRAL] Sure. The next one is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I'm thinking it's probably gonna be the same thing with the one offices for 187 and then the other two labs for 450 if they got split.
[AGENT][NEUTRAL] And it appears that they did as well, the same thing. um, the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, but just a moment.
[AGENT][NEUTRAL] Well, that's, this visit is, for the visit, the claim is not for 187.
[CUSTOMER][NEUTRAL] For the offices at one?
[AGENT][NEUTRAL] What was filed. Mhm. It wasn't filed this.
[AGENT][NEUTRAL] 187.
[CUSTOMER][NEUTRAL] OK, that's how much office visits are. Why would it?
[CUSTOMER][NEUTRAL] Is a total $637?
[AGENT][NEUTRAL] It isn't.
[CUSTOMER][NEUTRAL] OK. Um, and I'm trying to figure it out because I'm, I'm not sure how it got split. That's why I'm not sure.
[AGENT][NEGATIVE] This is a one line for an office visit, but it is not for any of the amounts you've given me.
[AGENT][NEUTRAL] How much? Give me your two amounts again, [PII]. I'm not trying to be difficult, but for security, um,
[CUSTOMER][NEUTRAL] Sure, so,
[CUSTOMER][NEUTRAL] Yeah, well, typically our office visits are 187.
[AGENT][NEUTRAL] It's more than that.
[CUSTOMER][NEUTRAL] And then we have 2 labs, and those come to 450.
[AGENT][NEUTRAL] Um, and give me the tax ID number again.
[CUSTOMER][NEUTRAL] Sure, tax ID is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it's for the same it's for that tax ID, the same facility name, but these charges on here, this one show it's more than, again, it's more than the 187.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 265 is what this is for.
[CUSTOMER][NEUTRAL] 265.
[CUSTOMER][NEUTRAL] For 99214?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Yep, I'm seeing that one right here 912142 because that was, yeah, and that you said that one's gonna deny because it's the office is, right?
[AGENT][NEUTRAL] And it was denied. You do see it?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] So is that another one for that data service that you have for to check?
[CUSTOMER][NEUTRAL] OK, what's the claim number for this?
[CUSTOMER][NEUTRAL] Yeah, that would be the labs.
[AGENT][NEUTRAL] OK, but the office says it's under claim number 3,590,330.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then there should have been the other one, which would be for the two labs for the G0481 in the 80307.
[AGENT][NEUTRAL] And the amount on that one.
[CUSTOMER][NEUTRAL] 450.
[AGENT][NEUTRAL] OK. This one was also processed on the [PII].
[AGENT][NEUTRAL] Uh, the claim number is 359-032-7.
[AGENT][NEUTRAL] And the benefit paid 131.23.
[AGENT][NEUTRAL] And that was also on a single check, correct. And that's a single check as well, 2039633.
[CUSTOMER][NEUTRAL] And that was for the both lines like the other one?
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next day the service I have is [PII].
[AGENT][NEUTRAL] [PII]. OK. Oops, one second.
[CUSTOMER][NEUTRAL] Yep
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I believe that one if it was split would be the 187 and then the other one is 450.
[AGENT][NEUTRAL] So the 187 was on claim number 359-0326 that was denied as office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the 450.
[AGENT][NEUTRAL] That one is gonna be, um, that was also processed on the [PII]. That claim number is 359-0325.
[AGENT][NEUTRAL] And the benefit paid 131.23 on both line items.
[AGENT][NEUTRAL] That was also on a single check, 2039629.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does it happen to stay on your end if these were cashed already?
[AGENT][NEUTRAL] I didn't check that as I was going through the claims.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Are you needing to know that?
[CUSTOMER][NEUTRAL] Well, I was curious if it shows because I don't have a payment here. That's why I'm, I'm calling to check on it. So I don't know if you want to do the last one first and then double check or how it's up to you.
[AGENT][NEUTRAL] Oh, you still have more?
[CUSTOMER][NEUTRAL] I just have one more data service and that's it.
[AGENT][NEUTRAL] OK. All right, well, just one moment.
[AGENT][NEUTRAL] OK, what's the next date of service?
[CUSTOMER][NEUTRAL] The next one is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] And that would, if it's split, it would be 450 for the one, let me check.
[CUSTOMER][NEUTRAL] Mmm.
[CUSTOMER][NEUTRAL] And then 187.
[AGENT][NEUTRAL] OK, so we'll do the 187 1st.
[AGENT][NEUTRAL] That's claim number 359-857-6.
[AGENT][NEGATIVE] And that was denied his office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then one moment.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, that one was processed on 57.
[AGENT][NEUTRAL] And there, that's claim number 359-8572.
[AGENT][NEUTRAL] There was a benefit paid in the amount of 13123 that is both line items.
[AGENT][NEUTRAL] And that's on check 2043308.
[CUSTOMER][NEUTRAL] 308 OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Got it. Yeah, if it shows if it's been um cleared or not, that would be helpful because I, I'm not seeing this payment in our system.
[AGENT][POSITIVE] The first one is still showing as outstanding.
[AGENT][POSITIVE] Um, that we did 2039627. That one is still outstanding.
[AGENT][POSITIVE] Um, the one ending in 33 is also still outstanding.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][POSITIVE] They're all still outstanding as of now.
[CUSTOMER][NEUTRAL] OK, and they were paid on what this last one was on [PII].
[AGENT][NEUTRAL] Correct. So it probably hasn't had its on today's on the [PII].
[CUSTOMER][NEUTRAL] So that, and that was.
[CUSTOMER][NEUTRAL] Right. So you guys mail them?
[AGENT][NEUTRAL] They are mailed, but it would have not been mailed. Yes, a paper check along with the explanation of benefits and that would have gone out the next day. It would have, it was processed on the [PII], so it wouldn't have been mailed out until the [PII], and that would have been Friday.
[CUSTOMER][NEUTRAL] me a lot of
[CUSTOMER][NEUTRAL] OK, and so the other ones I believe you said like on the [PII] being like [PII]?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] What is the, do you want to verify the address?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, give me one second. I'm just writing this down. Sure, it should be [PII].
[AGENT][NEUTRAL] It was on the claim?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am, that is the address that it was sent to all of them.
[CUSTOMER][NEUTRAL] OK, OK, which that's so weird. So I'm gonna do some research on my end. So what happens if we just do not find this payment or what or we don't have it? What, what would I do then?
[AGENT][NEUTRAL] We cannot request for it to be um we will have to send it for financial approval to void and reissue, but we cannot do that until it's beyond 30 days.
[CUSTOMER][NEUTRAL] OK, so let me write this down. So it has to be 30 days after what, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I would call back and say that we need what again?
[AGENT][NEUTRAL] If you've not received them by after the [PII], again, it will have to be after 30 days, then we will have to, you know, just, that's what you would say that you have not received them and request us to verify that they are still outstanding and to avoid them and reissue them to you all.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so we'll have, we have a little more time.
[AGENT][NEUTRAL] Mhm. Because they did go to the correct address. Yeah, they, they did go to the correct address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect, [PII], I appreciate it. Um, is there a call reference number for today? Thank you.
[AGENT][POSITIVE] Oh, absolutely. You would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK, so how would you spell it because I don't know if you have a [PII] or no [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, see, there, oh, I've never seen that before. OK, so and then today's date which is the [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, very good. I appreciate it. Thanks so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. And again, if that is all I can help you with [PII], thank you for calling APL and I hope you have a great afternoon.
[CUSTOMER][POSITIVE] You too. Thanks so much. Bye-bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.