AccountId: 011433970860
ContactId: e1f7f5de-b001-4293-b438-622526323f29
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1130050 ms
Total Talk Time (AGENT): 252124 ms
Total Talk Time (CUSTOMER): 328550 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/e1f7f5de-b001-4293-b438-622526323f29_20250417T15:55_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello. My name is [PII]. I'm calling you from Provada's office for the claims. How are you doing, ma'am?
[AGENT][POSITIVE] I'm doing good. How are you doing?
[CUSTOMER][POSITIVE] Thanks for asking me, dear. I'm also very well calling in regards for claims from the pro's office.
[AGENT][NEUTRAL] OK, and you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes, last, last initial [PII].
[AGENT][NEUTRAL] OK, [PII], do you have that policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, 014529.
[CUSTOMER][NEUTRAL] 43.
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] And then what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then do you have a data service and charge amount?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With the total bill, $900 even.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and I do see this claim on file. Would you like the claim number?
[CUSTOMER][NEUTRAL] Uh, just a second. Uh, what's your name you said first of all, I'm sorry.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Uh, can you spell it, please?
[AGENT][NEUTRAL] Yes, [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I said, I'm so sorry to interrupt you, but is it paid or denied?
[AGENT][NEGATIVE] It looks like this claim is denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See
[CUSTOMER][NEUTRAL] For what reason?
[AGENT][NEGATIVE] So this claim was denied. The service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEGATIVE] Services were not covered.
[AGENT][NEUTRAL] When
[AGENT][NEUTRAL] Performed
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] N A
[AGENT][NEUTRAL] Doctor's office.
[AGENT][NEUTRAL] Or clinic.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So, uh, this claim was denied as services were not covered when performed in a doctor's office. For what reason, ma'am?
[AGENT][NEUTRAL] It's just for that exact reason.
[CUSTOMER][NEUTRAL] As for the patient's plan or the provider's contract.
[AGENT][NEUTRAL] So the per the patient's policy.
[CUSTOMER][NEUTRAL] As for the patient's policy. All right, just a second. Services were not covered when performed in the doctor's office as per patient's plan, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] What type of plan does this member has?
[AGENT][NEUTRAL] They have a Medlink policy.
[CUSTOMER][NEUTRAL] Which policy? M E D L I N G?
[AGENT][NEUTRAL] K M E D L I N K.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK. Meddlike.
[CUSTOMER][NEUTRAL] What else meddling afterwards?
[AGENT][NEUTRAL] So they have a meddling policy and it looks like it's hospital indemnity.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So doctor's offices and clinics are not covered.
[AGENT][NEUTRAL] Under the policy because it's a hospital indemnity plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Would you like the claim number?
[CUSTOMER][NEUTRAL] Yeah, I just need to check this one.
[CUSTOMER][NEUTRAL] Doctor's office as for patient's plan.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Member.
[CUSTOMER][NEUTRAL] And ma'am, uh, may I know what type of services you are?
[AGENT][NEUTRAL] It's the Medli plan is what this patient has.
[CUSTOMER][NEUTRAL] OK. So the meddling plan does not cover the services which patient was trying to get, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what's the claim number, please?
[AGENT][NEUTRAL] It is 357.
[AGENT][NEUTRAL] 03.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 04.
[CUSTOMER][NEUTRAL] 357-0304. Is that it?
[AGENT][NEUTRAL] Yes, that is it.
[CUSTOMER][NEUTRAL] For reference, please?
[AGENT][NEUTRAL] Yes, it would be my first name, which is [PII].
[AGENT][NEUTRAL] And then [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then today's date.
[CUSTOMER][NEUTRAL] In today's date, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And [PII], uh,
[CUSTOMER][NEGATIVE] One more thing over here. So this is not covered over here.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] I have to check something over here that we billed this claim on [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] All right. So, uh, let's move on for the next member, OK?
[AGENT][NEUTRAL] OK, is this the new policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, I'm ready.
[CUSTOMER][NEUTRAL] You're ready for the member ID? OK. So the uh member ID is 02506.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 453.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. Patient's first name, last name, and date of birth, please?
[CUSTOMER][NEUTRAL] OK. His name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the date of service and charge amount?
[CUSTOMER][NEUTRAL] [PII] with the total bill.
[CUSTOMER][NEUTRAL] $300 even.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for that data service as of right now.
[CUSTOMER][NEUTRAL] Beg your pardon, ma'am.
[CUSTOMER][NEUTRAL] I'm sorry, ma'am. What did you said?
[AGENT][NEUTRAL] So we do not have a claim on file for that data service as of right now.
[CUSTOMER][NEUTRAL] There's no claim, ma'am. Uh, actually, we have billed this claim on [PII] as a paper claim.
[CUSTOMER][NEUTRAL] Can you please double check, ma'am?
[AGENT][NEUTRAL] Yes, um, so I have [PII]. Would you like me to look up [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] means this was the date of service and we billed this claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On [PII] as a paper claim.
[CUSTOMER][NEUTRAL] For the date of service, [PII].
[CUSTOMER][NEUTRAL] Please double-check, ma'am.
[AGENT][POSITIVE] OK, yes, of course.
[CUSTOMER][NEUTRAL] Yeah. OK.
[AGENT][NEUTRAL] OK and then how was the claim submitted because I'm not seeing the state of service.
[CUSTOMER][NEUTRAL] As a paper claim, ma'am. This claim was submitted as a paper, not electronically.
[AGENT][NEUTRAL] OK. And then let's verify the address that you have on file.
[CUSTOMER][NEUTRAL] So the claim mailing address that I can see over here on file is [PII], [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so the zip code is going to be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what we have, ma'am. [PII]. Yes, that's right.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh, I'm sorry, I thought you said [PII].
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh no, [PII].
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, that claim is not on file at this time. Would you like me to fax you over?
[AGENT][NEUTRAL] Oh, sorry, would you, can, can you please fax?
[CUSTOMER][NEUTRAL] I beg your pardon, ma'am.
[AGENT][NEUTRAL] Um, that EOB over to us.
[CUSTOMER][NEUTRAL] Just a second. fact the EUB, like, why you need EUB, ma'am?
[AGENT][NEUTRAL] If you fax the claim and EOB to APL, then we can process that.
[CUSTOMER][NEGATIVE] No, we, no, no.
[CUSTOMER][NEUTRAL] Uh, we did not, uh, fax this claim, but we billed this claim as a paper claim on a claim mailing address.
[AGENT][NEUTRAL] OK, I understand, but there is no claim on file for this state of service.
[CUSTOMER][NEUTRAL] All right. So you want us to rebuild, resubmit this claim?
[AGENT][NEUTRAL] Yes, will you please fax the claim and EOB to that claim address or sorry, to our fax address.
[AGENT][POSITIVE] The fax number I can give it to you as well.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK. Are you ready for, sorry. OK.
[CUSTOMER][NEUTRAL] Just give me one moment, please.
[CUSTOMER][NEUTRAL] Yes, sir. I'll, I'll let you know whenever I'm ready. Just give me one minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I appreciate your patience, ma'am. Just a moment, please.
[AGENT][POSITIVE] Yes, of course. Take your time.
[CUSTOMER][NEUTRAL] And your name, you said?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII], yes.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Stated that
[CUSTOMER][NEUTRAL] Same
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] As pay claim.
[CUSTOMER][NEUTRAL] So there was.
[CUSTOMER][NEUTRAL] Fine.
[CUSTOMER][NEUTRAL] And wrap that.
[CUSTOMER][NEUTRAL] You can.
[CUSTOMER][NEUTRAL] Fax us the claim. So you suggested me to fax you the claim, right?
[CUSTOMER][NEUTRAL] On
[AGENT][NEUTRAL] Yes, please. Mhm.
[CUSTOMER][NEUTRAL] What's the fax number, please?
[AGENT][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then please type um attention to claims, attention claims.
[AGENT][NEUTRAL] So that it goes to the correct department?
[CUSTOMER][NEUTRAL] Attention to
[AGENT][NEUTRAL] Yes, please. Claims. Yes, sir.
[CUSTOMER][NEUTRAL] Claims.
[CUSTOMER][NEUTRAL] Attention to claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so you just need the claim on fax, right? As you did not receive this claim as a paper claim, right? Got it?
[CUSTOMER][NEUTRAL] What is the, OK, call reference will be the same here.
[AGENT][NEUTRAL] So in
[AGENT][NEUTRAL] Sorry, we need the primary EOB.
[CUSTOMER][NEUTRAL] Oh, you need the primary UOB as well. Let me just, uh, you can find.
[AGENT][NEUTRAL] Yes, sir. Mhm.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So the claim and the primary EOB.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The primary you'll be attached. OK?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] On fax number already, got it, OK. And card reference will be the same, your name and today's date, OK?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I got it. And this one, right. So let's move on to the next member, [PII]. All right?
[AGENT][POSITIVE] OK, sounds good.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] So we do have an online portal you can sign up for it's our OSC website.
[AGENT][NEUTRAL] And you can check claim status there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ma'am, uh, I've already tried to check over there, so I couldn't find anything. That's why I had to reach you, ma'am.
[CUSTOMER][NEGATIVE] Otherwise, I really don't want it to uh waste your time, ma'am.
[AGENT][NEUTRAL] Would you like help setting it up?
[AGENT][NEUTRAL] I don't mind.
[CUSTOMER][NEUTRAL] Uh, I would, ma'am, but uh let me see if I have a few more members for the same insurance. Let me just check, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Mm, as upon checking over here, I guess that's all for today, ma'am. Thank you very much for helping me and you have a blessed day. Thank you.
[AGENT][POSITIVE] Yes. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] That's all for today, uh, dear [PII]. Thank you. Bye-bye.
[AGENT][POSITIVE] OK, thank you. Have a good day. Thanks for calling APL.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye.