AccountId: 011433970860
ContactId: e0ed8522-59d6-4729-8c39-f6d37ff4053d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 873380 ms
Total Talk Time (AGENT): 257760 ms
Total Talk Time (CUSTOMER): 293990 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/e0ed8522-59d6-4729-8c39-f6d37ff4053d_20241230T14:49_UTC.wav
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[AGENT][POSITIVE] Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office. I'm here to check the status of the claim, so I need your help on it.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. You said your name is [PII]?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you, [PII]. And what is a good callback number?
[CUSTOMER][NEUTRAL] [PII] the direct line.
[AGENT][NEUTRAL] Thank you. And what is the, do you have a claim number or policy number?
[CUSTOMER][NEUTRAL] Um, no, I don't have a claim number here. Uh, I have the member ID.
[AGENT][NEUTRAL] All right, what's the policy number?
[CUSTOMER][NEUTRAL] It will be
[CUSTOMER][NEUTRAL] 019867.
[CUSTOMER][NEUTRAL] 25
[AGENT][NEUTRAL] And the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] Patient's name is [PII] and uh date of birth is on [PII].
[CUSTOMER][NEUTRAL] And [PII] spelled as [PII]
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you.
[AGENT][POSITIVE] I'm just getting everything pulled up bear with me just one moment.
[AGENT][NEUTRAL] And what is the date of service for the claim? It would be my pleasure to help you with that claim status.
[CUSTOMER][NEUTRAL] On the date of service of 6-24-2024 with the total charge of $184.
[AGENT][NEUTRAL] For 624-2024 for [PII], I do not have a claim on file.
[CUSTOMER][NEUTRAL] Mhm. All right. I do see the claim has been submitted um to the address of [PII], [PII]. ZIP code will be [PII]. Is this the right address to submit a claim?
[AGENT][NEUTRAL] It is the correct address for claim submission, and you can also fax the claim with the primary EOB directly to our claims department.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Kindly check who's the primary payer in your end as.
[AGENT][NEUTRAL] Sure, bear with me just one moment.
[AGENT][NEUTRAL] I'm showing Blue Cross Blue Shield to be primary.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] May I know when the card has been updated recently?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 21
[CUSTOMER][NEUTRAL] 21. From the date of [PII], I mean, from [PII], the BCBC is primary, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Fine. Um, I do see in my end, um, American Public Life is the primary payer in my end. I don't know, um.
[CUSTOMER][NEUTRAL] OK, fine.
[AGENT][NEUTRAL] We are secondary to the major medical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. Um, kindly check the members, uh, I mean the member plans active and the, I mean mem member plans eligibility.
[AGENT][NEUTRAL] It's a secondary gap policy.
[CUSTOMER][NEUTRAL] Mhm. Still active, right?
[AGENT][NEUTRAL] It turned on [PII].
[CUSTOMER][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] Let me check, let me check one thing for you. Bear with me just one second.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] You know what, there is another policy. Let me check this active policy number to see if we have the claim on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, let me give you the correct policy number.
[AGENT][NEUTRAL] For that data service, the correct policy number is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I do apologize. The correct policy number is 246.
[AGENT][NEUTRAL] 2791 and let me ask you what is the facility name because I do see a claim on file for that on that policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, let me grab it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, the facility name here is Mercy Clinic, Oklahoma Communities.
[AGENT][POSITIVE] All right, thank you, and I do apologize. I do see that we have.
[AGENT][NEUTRAL] A claim on file.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] And let me get that received date and process date for you.
[CUSTOMER][NEUTRAL] Mhm right go ahead.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was denied as office visits are not covered for the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I apologize for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] As for the plan.
[CUSTOMER][NEUTRAL] All right. Can I bill this to member?
[AGENT][NEUTRAL] That would be determined by the provider. We're not major medical.
[CUSTOMER][NEUTRAL] Mhm. All right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, kindly give me 2 more minutes, please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting. Can I get the claim number?
[AGENT][NEUTRAL] Claim number is 348.
[AGENT][NEUTRAL] 0425.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 0425. OK. Um, kindly tell me, um, what about the time limit to submit an appeal.
[AGENT][NEUTRAL] 180 days from denial.
[CUSTOMER][NEUTRAL] OK. And the last name, it will be um um [PII]. Am I right?
[AGENT][NEUTRAL] That's correct. It was processed on [PII].
[CUSTOMER][POSITIVE] Perfect. I'm done with this one claim. Can I get the call reference?
[AGENT][NEUTRAL] Call reference number is my name and today's date. I spell my name [PII]
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] CIA first initial of my last name is [PII], it was a pleasure to assist you with that claim status. Anything else I can help you wi[PII] today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] For this claim, I'm done with uh [PII]. I have a few more claims. Shall we move for the next one?
[AGENT][NEUTRAL] Yeah, give me just one second.
[AGENT][NEUTRAL] Also we do have a provider portal at secured.
[AGENT][NEUTRAL] [PII] where you have 24/7 access to claim status, claim submission and EOBs.
[CUSTOMER][NEUTRAL] Right, is it an open portal or we have to get access?
[AGENT][NEUTRAL] No, you just create a login and password. It's just simple using this tax ID number and the patient's account number listed in box 26 on the HIA.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, I'll try it.
[AGENT][NEUTRAL] So it's a simple self registration.
[CUSTOMER][NEUTRAL] OK. Uh fine. Shall we move for the next?
[AGENT][POSITIVE] I'm ready for that next policy number and thank you for your patience.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][POSITIVE] Thank you so much for waiting here and, and the next members ID here is 02122540.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And what is that patient's name and date of birth, please, [PII]?
[CUSTOMER][NEUTRAL] The name will be [PII] and uh the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what is that data service?
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] 62624. The claim total bill for $168.
[AGENT][NEUTRAL] And what is that facility name?
[CUSTOMER][NEUTRAL] Uh, Mercy Clinic East Community.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] That claim we received on 7-15-24.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed on.
[AGENT][NEUTRAL] 7 1824.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] This claim was denied as services were rendered after the policy turned.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know when the policy turned?
[AGENT][NEUTRAL] Mhm, the policy termed on 3-1-2023.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. Um, kindly check, is there any other plan is active on the data service?
[AGENT][NEUTRAL] And that was APL.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, I'm done with this one thing and I'm moving for the next.
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] OK, it's loading.
[AGENT][POSITIVE] And I'm ready when you are.
[CUSTOMER][NEUTRAL] Yeah, it's still spinning.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Here we go. Uh, the next, uh, member ID will be 02252370.
[AGENT][NEUTRAL] 0225, can you repeat that please? I apologize.
[CUSTOMER][NEUTRAL] Sure, it's OK. It will be 022523.
[CUSTOMER][NEUTRAL] 70.
[AGENT][POSITIVE] So thank you.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] And that patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The date of birth?
[CUSTOMER][NEUTRAL] On um
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that.
[AGENT][NEUTRAL] And date of service?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Checking data services on [PII] and the claim totally billed for $189.
[AGENT][NEUTRAL] That's 6:20, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And that facility name?
[CUSTOMER][NEUTRAL] There is the Mercy Clinic East Community.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII] we received that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Processed on [PII] and denied as office visits not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, got it, um.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] OK. I'm done with this one time and uh
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Yeah, I'm done. I don't have any other questions. So thank you for the assistance, [PII], and enjoy the rest of the day. Bye-bye. Take care. Wish you a [PII] ahead. Bye-bye.
[AGENT][POSITIVE] [PII] to you as well, [PII] and thank you for calling APL. Hope you have a wonderful day as well. Take care.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you. Bye-bye.
[AGENT][NEUTRAL] Bye bye.