AccountId: 011433970860
ContactId: e6c18c9e-0836-4a68-86b6-c1f73215690c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 870330 ms
Total Talk Time (AGENT): 298124 ms
Total Talk Time (CUSTOMER): 406621 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/e6c18c9e-0836-4a68-86b6-c1f73215690c_20250116T21:02_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling for Cabins and Keeler and GPA. Please be informed this call is being recorded and monitored for the quality and training purposes. Today I'd like to get this cases uh regarding this claim.
[AGENT][POSITIVE] OK. Well, I'll be more than happy to help you with the claim, um, status. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so we have a direct line, so the direct line number is.
[CUSTOMER][NEUTRAL] [PII]. I'm sorry, [PII].
[CUSTOMER][NEUTRAL] I repeat the number again. It's [PII].
[AGENT][NEUTRAL] OK, so it's
[CUSTOMER][NEUTRAL] [PII]. I'm sorry.
[AGENT][NEUTRAL] Thank you for that, and you're fine and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I do have a one plane.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, the member's policy is
[CUSTOMER][NEUTRAL] 02287960
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, the member's first name is [PII] and the last name is.
[CUSTOMER][NEUTRAL] [PII] and its date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And [PII], may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Sure, the rate of service for this claim is, just a moment.
[CUSTOMER][NEUTRAL] Data service for this claim is [PII] and the total charge amount is just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the total charge amount is $318 even.
[AGENT][NEUTRAL] 318
[CUSTOMER][NEUTRAL] Yes, 18.
[AGENT][NEUTRAL] 380 or 318?
[CUSTOMER][NEUTRAL] 18.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, the provider's office here we having is [PII].
[CUSTOMER][NEUTRAL] MDP.
[CUSTOMER][NEUTRAL] Sent to.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, the claim received on?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The claim number is 3471096.
[CUSTOMER][NEUTRAL] The claim number is 3471096.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. May I know the claim is?
[AGENT][NEUTRAL] And I
[CUSTOMER][POSITIVE] Yes, I'm sorry for interrupting.
[AGENT][NEUTRAL] On [PII], the claim was processed.
[AGENT][NEGATIVE] And it was denied requesting.
[CUSTOMER][NEUTRAL] A gym
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I'm sorry, it's denied?
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Yes, the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] But it looks like it was reissued I mean it was resubmitted. Hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then it looks like it was resubmitted again on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim number is 3511082.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment. It's 3510108.
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] 2. After that, the claim has been submitted, right? So it's um submitted on September.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] of 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's processed and paid, right?
[AGENT][NEUTRAL] Yes, on [PII], the claim was processed and we paid $65.60 to the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. May I know the uh large amount? The process date and pay date is same?
[AGENT][NEUTRAL] OK, hold on one moment. So the process, so the received date is [PII]. The process date is [PII].
[CUSTOMER][NEUTRAL] OK. The pay date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So it's the same date, right?
[AGENT][NEUTRAL] The day it process is the day the claim was paid, yes.
[CUSTOMER][NEUTRAL] Processed and paid.
[CUSTOMER][NEUTRAL] OK, so may I know the allowed amount?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So for outpatient, the calendar year max is $6600.
[CUSTOMER][NEUTRAL] I'm sorry, uh, for this claim, may I know the allowed amount?
[AGENT][NEUTRAL] Yes, that's the number I just gave you. The outpatient benefit that was used, the allowed amount.
[AGENT][NEUTRAL] It's $6600.
[AGENT][NEUTRAL] For the year.
[CUSTOMER][NEUTRAL] OK, just.
[CUSTOMER][NEUTRAL] OK, so the remaining uh complete balance you have been paid for this claim. $65.60 you have been paid, right?
[AGENT][NEUTRAL] Right, that's the amount that was paid, the $65.60.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so the allowed amount, could you please help me with the, the one more time? Sorry for that.
[AGENT][NEUTRAL] Are you asking what the claim was billed, the total billed or they allowed for the benefit that was used?
[CUSTOMER][NEUTRAL] Uh, the allowed amount for this claim.
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] So this is their secondary insurance. This doesn't work like primary insurance. So for this secondary insurance, the calendar year max was $6600 but for what was billed, we paid the full amount. You, you billed us for $20.68 for code 97,140 and we paid that $20.68.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So there is no particular allowed amount for this claim, right? You completely paid.
[AGENT][NEUTRAL] The claim was paid in full from what was billed, yes.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] So there is no patient responsibility, right?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility at APL, but the total was paid, so.
[CUSTOMER][NEUTRAL] OK. So may I know it's paid through check or EFT?
[AGENT][NEUTRAL] It was a single check. Would you like the check information? I can get that for you.
[CUSTOMER][NEUTRAL] OK. Yes. Could you please help me with the check number?
[AGENT][NEUTRAL] OK, so the check number is 2004856.
[CUSTOMER][NEUTRAL] So which is a single check, the amount is $60.60. Uh the check number is 2004856. That's right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. So may I know the pay to address?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, it was paid to address [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Let me verify the address, page your address is [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. So may I know the cash to date?
[AGENT][NEUTRAL] I'm showing that the check is still outstanding. If you'd like, I can send this over to our representative to check on the check and have it reissued.
[AGENT][NEUTRAL] If need be,
[CUSTOMER][NEUTRAL] So there is no cash date?
[AGENT][POSITIVE] No, the check is still outstanding.
[CUSTOMER][NEUTRAL] OK. So, just a moment. Yes, could you please uh help me with, let me verify the claim number that you provided.
[CUSTOMER][NEUTRAL] So, for this claim, the paid claim, claim number is?
[CUSTOMER][NEUTRAL] 351100826. Let me repeat that again. 35110826. That's right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Could you please send a copy of COV through fax?
[CUSTOMER][POSITIVE] it's like a nice you know.
[AGENT][NEUTRAL] Yes, what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's [PII], sorry, it's [PII]. Let me repeat that. It's [PII]. And his attention to the patient account number which is [PII].
[CUSTOMER][NEUTRAL] Uh, so this is the patient account number, right?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, and that was [PII]?
[CUSTOMER][NEUTRAL] Yes, that is the patient account number. That, that is correct in your end.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so I'm sending the request over to have the check um looked at and reissued to you. Um, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Sure. Could you please help me with the call reference number?
[AGENT][NEUTRAL] Sure, there's no call reference number, but you can use my name, which is [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK. Your name is [PII], and your initial is [PII], right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] So this is a call reference number.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, the, uh, you said there is no a large amount, particularly in this claim. You just pay the complete amount that was billed to you at, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So and you just a moment.
[CUSTOMER][NEUTRAL] So, could you please help me with the annual allowed amount?
[AGENT][NEUTRAL] Yes, um,
[AGENT][NEUTRAL] Again, the total for the calendar year for this policy is $6600 for their outpatient benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 6600 right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, $6600 even.
[CUSTOMER][POSITIVE] Yes, [PII]. Thank you for your wonderful assistance. May I know when I will, I will get the copy of UB?
[AGENT][NEUTRAL] I'm faxing that to you now and I'm also sending the request over, so you should have the explanation of benefits. I would give it at least an hour. It's being sent by fax.
[CUSTOMER][NEUTRAL] Oh, when will it will be received in our end?
[AGENT][NEUTRAL] I can't, I can't guarantee when it will be received on your end. We usually say for fax is to give it at least an hour. If you have not received it, um,
[AGENT][NEUTRAL] By [PII], I guess you can say today you can give us a call back and we can resend it, but it has been sent.
[CUSTOMER][NEUTRAL] OK, so it will be received in an hour, right?
[AGENT][NEUTRAL] Uh, I do not have a guaranteed time. I don't have a guaranteed time of when you'll receive it. For faxes, we typically say to wait at least an hour. If you haven't received it by end of day today, you can give us a call back and we'll be more than happy to send it again.
[CUSTOMER][NEUTRAL] Otherwise, we can give a call back and
[CUSTOMER][POSITIVE] OK, sure, [PII]. Thank you for your wonderful assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.