AccountId: 011433970860
ContactId: e6a7ad25-b733-4093-ad20-2e3a770e84ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1729819 ms
Total Talk Time (AGENT): 399280 ms
Total Talk Time (CUSTOMER): 421284 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/e6a7ad25-b733-4093-ad20-2e3a770e84ed_20250319T15:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, uh, good morning. My name is [PII]. I'm calling from provider office. I want to check the claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status. Can you repeat your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], one moment.
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected Mr. [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, Mister [PII]?
[CUSTOMER][NEUTRAL] OK, sure, uh.
[CUSTOMER][NEUTRAL] 1449541
[CUSTOMER][NEUTRAL] M as in Mike, Lima, and the number 4.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the date of service and the amount of the claim.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and the charges is $1,066.47.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you and that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, we received the claim on [PII], and we processed on [PII] and the claim was denied. The reason for this denial is that the service was rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK, it's on the patient plan, right?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Each, uh, like you said the coverage is, uh, terminated after the service has taken after the coverage terminated. So I'm asking, is it on patient plan or ma'am uh provider?
[AGENT][NEGATIVE] No, the policy is terminated. It's lapsed. It's no longer active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So it's uh it's under uh member policy, right?
[AGENT][NEUTRAL] Correct, the policy is terminated. Mhm.
[CUSTOMER][NEUTRAL] OK, uh, could you please tell me the claim number?
[AGENT][NEUTRAL] Alright, the claim number is 3561401.
[CUSTOMER][NEUTRAL] 3561401, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] And could you please tell me the term date like effective and termination date.
[AGENT][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] Mhm, one moment, let me get that for you.
[AGENT][NEUTRAL] The policy was effective [PII] and it terminated [PII].
[CUSTOMER][POSITIVE] Thank you so much. And uh could you please repeat your name once again?
[AGENT][NEUTRAL] Sure. My name is [PII], that's initial [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, uh, how many status can I take at a time? Uh, I have 6 claims, so.
[AGENT][NEUTRAL] How many you got?
[CUSTOMER][NEUTRAL] 6.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I can do all 6. I just need to make a note on each one of them before I move forward to the next one.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, could you please give me the reference number for this?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment, let me finalize the note.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] 01845832 M as in Mike Lima and the number 8.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] $596.84.
[AGENT][NEUTRAL] 362.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] All right. We have received the claim [PII], processed [PII]. The claim was denied. The denial reason is that office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] So it is under a patient, right?
[AGENT][NEUTRAL] Office, yeah, under the member's plan, under the patient's plan, office visits are not covered.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] OK, thank you. And what is the claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 356-418-1.
[CUSTOMER][NEUTRAL] 356-418-1, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. And OK, we'll go for the next one.
[AGENT][NEUTRAL] Bear with me, let me make the note.
[CUSTOMER][NEUTRAL] When you are ready, please let me know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] OK, go ahead with the next one.
[CUSTOMER][NEUTRAL] 01449279 M as in Mike Lima, and the number 5.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. [PII].
[AGENT][NEUTRAL] OK, and what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] $245.28.
[AGENT][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] All right, um.
[AGENT][NEUTRAL] This one was received [PII], processed [PII], and the claim was denied, stating that the service was rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, what is the claim number?
[AGENT][NEUTRAL] That is claim number 3561439.
[CUSTOMER][NEUTRAL] OK. Could you please tell me the term date, uh, if you given time date?
[AGENT][NEUTRAL] Mhm. Sure, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] One minute.
[CUSTOMER][NEUTRAL] right
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, the effective date on this one is.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII] and it terminated [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much. OK, when you are ready, please let me know for the next member ID.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] To
[AGENT][NEUTRAL] OK, so with the next policy.
[CUSTOMER][NEUTRAL] 01933929.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] $2,299.
[CUSTOMER][NEUTRAL] Even
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will if I.
[CUSTOMER][NEUTRAL] There's a
[AGENT][NEUTRAL] Do you know what's the procedure cost for this one?
[CUSTOMER][NEUTRAL] 00840.
[CUSTOMER][NEUTRAL] So what was that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull this OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's the.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] On my phone.
[AGENT][NEUTRAL] Still waiting on there you'll be, bear with me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so this one was processed on [PII] and we send a benefit amount of $840.38 to the provider.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] So, uh, yeah, uh, I'm, I'm very sorry to ask again. Could you please repeat it once again?
[AGENT][NEUTRAL] Oh, yes, we process [PII] and we send a benefit amount of $840.38 to the provider.
[CUSTOMER][NEUTRAL] 800.
[AGENT][NEUTRAL] $840.38.
[CUSTOMER][NEUTRAL] To the provider, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Could you, uh, do we have, do you have the claim number?
[AGENT][NEUTRAL] Yes. The claim number is
[CUSTOMER][NEUTRAL] Uh, could you please.
[AGENT][NEUTRAL] Yes, 3561266.
[CUSTOMER][NEUTRAL] So for this claim I'm a little bit confused. Is it this is not denials claim, right? This is not denied by the payer, right?
[AGENT][NEUTRAL] No, this one was paid by us. We send a benefit of $840.38.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK. That is a bad amount, right?
[AGENT][NEUTRAL] Yes, that is the paid amount.
[CUSTOMER][NEUTRAL] OK, and what is, is it the allowed amount and the paid amount is the same?
[AGENT][NEUTRAL] I'll have to pull the EOB from the major medical. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Um, comfortable.
[AGENT][NEUTRAL] Yeah, that is the full amount they apply towards the member responsibility.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] So, uh.
[CUSTOMER][NEUTRAL] APO has paid $840.38. And there's no PR there's no patient uh responsibility, right?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] None that I can see. Um, again, we are the secondary, we're just the secondary. What we do is we follow primary based on the primary Aetna, the information we receive with this claim, they applied $840.38 towards the member's responsibility.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah, uh, so, uh, let me just check once again. So [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I has paid $1.12 right?
[AGENT][NEUTRAL] I'm not sure how much they have paid. I think that's, yeah, that looks like that's it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, let me just confirm uh the, how much primary has paid and how much applied to our patient like co-pay deductible. Let me just look up here once again and let me just make sure that we don't make a mistake, huh?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm not sure how much [PII] has paid.
[CUSTOMER][NEGATIVE] But, uh, upon checking my system, I found it's only $1.12 and
[CUSTOMER][NEUTRAL] How much you applied for patient responsibility. So, you said $84,040.38 is applied to what PR right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] Patient responsibility and, and that, that amount has paid by the American public life, right?
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][POSITIVE] OK. OK. OK. Thank you.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, here I have the uh next claim.
[AGENT][NEUTRAL] OK, let me make a note on this one. You don't need any more information on this one?
[CUSTOMER][NEUTRAL] Yeah, I have the claim number so I can pull up in the like portal and then I can yeah go for for the next step.
[AGENT][NEUTRAL] If you need the claim number, or you have the claim number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You have, you have told me the claim number that is 3561266, right?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment, let me make a note.
[CUSTOMER][NEUTRAL] And that's
[CUSTOMER][NEUTRAL] So.
[AGENT][POSITIVE] OK, I'm ready for the next one.
[CUSTOMER][NEUTRAL] OK. It's uh 02141821, M as in Mike Lima, and the number 8.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] May I have the name and date of birth?
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] $98.49.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, um.
[AGENT][NEUTRAL] We received the claim on [PII] to process the claim on [PII], and the claim was denied. The reason for this denial is that the service was rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK. Could you please tell me the claim number?
[AGENT][NEUTRAL] OK, the claim number is 356-4123.
[CUSTOMER][NEUTRAL] And could you please tell me the term effective term date?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hang on, you want to.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] OK, um, do you mind holding for me, my system is frozen.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding. OK, um, Mr. [PII], on the effective date is [PII] and it terminated [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. And um
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I have this last claim and it is under the same patient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I think it will be same denials, but I just need a claim number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, the date of service is [PII] and the charges is $111.78.
[AGENT][NEUTRAL] OK, you said it's the same patient, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It was received on the [PII], processed on the [PII], and the claim number is 356-4128.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 356-412-8, right?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think it is something else, sir?
[AGENT][NEUTRAL] Yes, it's the same now.
[CUSTOMER][POSITIVE] OK. So, I, yeah, that's all for now. Thank you so much.
[CUSTOMER][POSITIVE] Have a nice day.
[AGENT][POSITIVE] You're welcome. You as well thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Mm