AccountId: 011433970860
ContactId: de7cc792-d273-47aa-ab7d-12160660caca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1084819 ms
Total Talk Time (AGENT): 242376 ms
Total Talk Time (CUSTOMER): 292033 ms
Interruptions: 3
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/de7cc792-d273-47aa-ab7d-12160660caca_20250331T19:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on the status of the claim. Could you please help me with that?
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] Yes, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure, it's [PII].
[AGENT][NEUTRAL] The policy number of the patient?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah, the policy number is 01828796.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] OK. The patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You have the date of service.
[CUSTOMER][NEUTRAL] Yeah, just a moment. Uh, the data service is [PII] with the total charge of 174.
[AGENT][NEUTRAL] You should say 174, is that correct?
[CUSTOMER][NEUTRAL] Mhm yes.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, looks like we processed that and hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, the benefits were applied to the $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] Um, sorry, I didn't get that one.
[AGENT][NEUTRAL] The benefits were applied to the deductible.
[CUSTOMER][NEUTRAL] OK, uh, why it is applied to the amount that is 10,160 cents, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, why is this apply to the deductible?
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Look.
[AGENT][NEUTRAL] OK, are you there?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like.
[CUSTOMER][NEUTRAL] When you receive the claim.
[AGENT][NEUTRAL] I don't know why there's a OK hold on just a second, let me see what your EOB says.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] So 10,160 was the patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] Yes, it's 351.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] 6123.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so for outpatient services.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I, I'm looking at the claim hold on one moment.
[AGENT][NEUTRAL] Uh, I don't know why it was.
[CUSTOMER][NEUTRAL] 2024
[AGENT][NEGATIVE] I'm not sure why it was um I can send it back through for review because I don't see why.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEGATIVE] I'm not sure why it was not covered.
[CUSTOMER][NEUTRAL] Uh, just a moment.
[AGENT][POSITIVE] Oh, I'm sorry. I found it.
[CUSTOMER][NEUTRAL] No, like, uh, ma'am, can I get the receipt date and the process date?
[AGENT][NEUTRAL] Yes, receive date is, so there is a $1000 deductible for outpatient services.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So the primary allowed 10,160, and that's what we applied towards the $1000 outpatient deductible.
[CUSTOMER][NEUTRAL] Because
[AGENT][NEUTRAL] And the received date is [PII].
[AGENT][NEUTRAL] And this process date is [PII].
[CUSTOMER][NEUTRAL] OK. Uh, and what is the allowed amount?
[AGENT][NEUTRAL] The primary allowed 101,160, so that's what we applied towards the deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, that is 10,160 cents, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] So, uh, ma'am, I have a doubt why it is applied towards the deductible.
[AGENT][NEUTRAL] There is a $1000 deductible for this policy.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] For outpatient services.
[CUSTOMER][NEUTRAL] may be.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh just give me one minute.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Hello, ma'am, can you please uh tell me the claim number?
[AGENT][NEUTRAL] 351-613.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 61030613?
[AGENT][NEUTRAL] 351.
[AGENT][NEUTRAL] 6123.
[CUSTOMER][NEUTRAL] 3. OK. Um.
[CUSTOMER][NEUTRAL] Can you please send this uh Yi to the fax?
[AGENT][NEUTRAL] OK, what's your facts?
[CUSTOMER][NEUTRAL] It's 585440-9493.
[AGENT][NEUTRAL] OK, it's 585.
[CUSTOMER][NEUTRAL] Get
[AGENT][NEUTRAL] Will you repeat that?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII].
[CUSTOMER][NEUTRAL] May I know your name, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, can you please spell it for me?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. Do you have a last name or do you have the initial?
[AGENT][NEUTRAL] Uh, last initial is [PII], and then today's date is the reference number.
[CUSTOMER][POSITIVE] Yeah, thank you so much and I have another claim with me. So how many days it would take to uh get the yourP?
[AGENT][NEUTRAL] Oh, I, I will fax it after we get off the call.
[CUSTOMER][NEUTRAL] Mhm. Uh, attention to my name.
[AGENT][NEUTRAL] How do you spell your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] How many days it will take?
[CUSTOMER][NEUTRAL] How many days it will take?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, I will fax it after we end the call.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Today, I'll send it today.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] And did you say you had another claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I just have one.
[AGENT][NEUTRAL] Is it for the same patient or a different?
[CUSTOMER][NEUTRAL] OK. Uh
[CUSTOMER][NEUTRAL] Yeah, it was a different one.
[AGENT][NEUTRAL] OK, what's the policy number, please?
[CUSTOMER][NEUTRAL] So, 02467806.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] So the patient's name is [PII] or [PII].
[CUSTOMER][NEUTRAL] Uh ma'am. And the date of birth is [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The date of service?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII] with the total charge of 176.
[AGENT][NEUTRAL] OK, this uh claim was received on [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was received on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] That is the reason?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So office visit is not covered under?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Can I get the claim number?
[AGENT][NEUTRAL] 351-621-7.
[CUSTOMER][NEUTRAL] Sorry, 351.
[AGENT][NEUTRAL] 621 7.
[CUSTOMER][NEUTRAL] The Office visit is not covered under this claim.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So the denial date is [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Can you please send the copy of the UB through the fax which I have already provided you?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And attention to my name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Yeah, I have the, the two more claims with a different patient.
[AGENT][NEUTRAL] OK, do you have access to the internet?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] To look on, do you have access to our portal?
[CUSTOMER][NEGATIVE] Oh no.
[AGENT][NEUTRAL] To check full claim status and EOB.
[CUSTOMER][NEUTRAL] 17
[CUSTOMER][NEGATIVE] No, no, I don't have the access to the your portal.
[AGENT][NEUTRAL] OK, do you want to get that access or is that something you can do or no?
[AGENT][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] What is the policy number of the next one?
[CUSTOMER][NEUTRAL] 01982621
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Data service?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] State of service?
[CUSTOMER][NEUTRAL] Sorry. Date of service is [PII].
[AGENT][NEUTRAL] Fill them out.
[CUSTOMER][NEUTRAL] Uh, the total charge of 125.
[AGENT][NEUTRAL] That claim was received 10-7-2024.
[AGENT][NEUTRAL] Denied on 10-10-2024.
[CUSTOMER][NEUTRAL] Sorry, I, uh, what is the date?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Office for this are not covered under this policy.
[CUSTOMER][NEUTRAL] OK uh.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] What is this policy name?
[AGENT][NEUTRAL] Policy what?
[CUSTOMER][NEUTRAL] What is the name of the policy?
[AGENT][NEUTRAL] Uh, like the product name or?
[AGENT][NEUTRAL] Um, let me
[CUSTOMER][NEUTRAL] Yeah, I just need a claim number.
[AGENT][NEUTRAL] Claim number is 3515944.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, thank you so much for your patience. Uh, I just want to know the, uh, you have told me that office visit is not covered under this policy, right?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So may I know if this is um under the patient's plan or patient's responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Uh, you don't have the information?
[AGENT][NEUTRAL] Correct. We don't determine any patient responsibility. This is a supplemental policy.
[CUSTOMER][NEUTRAL] OK. Uh, can you please provide me the, uh, UB?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] at
[AGENT][NEUTRAL] And did you have another claim number or another policy?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Did you have another policy number that you wanted to check on?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Are you wanting another claim status or is that all?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Uh, no, thank you so much, ma'am. Uh, this much only.
[CUSTOMER][NEUTRAL] To
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][POSITIVE] Thank you so much, ma'am, for assisting me today.
[AGENT][NEUTRAL] OK, I will get those claims faxed over to [PII].
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][POSITIVE] OK thank you so much bye bye.
[AGENT][NEUTRAL] OK, thank you for calling APL.
[CUSTOMER][NEUTRAL] OK