AccountId: 011433970860
ContactId: e8d5db6d-4440-4bd0-b160-f08bf5e0e605
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1279849 ms
Total Talk Time (AGENT): 387328 ms
Total Talk Time (CUSTOMER): 276787 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/e8d5db6d-4440-4bd0-b160-f08bf5e0e605_20250417T18:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is. How may I help you?
[CUSTOMER][NEUTRAL] Oh, I'm sorry. You're breaking up a little bit. Could you please repeat?
[AGENT][NEUTRAL] Hi, this is [PII] with APL. How may I help you?
[CUSTOMER][NEUTRAL] Oh hi [PII], this is [PII] from Arent Health Services, and I would like to check on other claims status please.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can you please spell your first name for me?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Oh, hi, [PII], I spoke to you earlier today.
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] Yes, um, can I please get your callback number, sir, just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yes, of course. It is [PII].
[AGENT][NEUTRAL] Thank you, sir. And then, what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, let me just take a look at it.
[CUSTOMER][POSITIVE] Oh we have it's right over here.
[CUSTOMER][NEUTRAL] OK, perfect. So the member's ID it is 01986269.
[AGENT][NEUTRAL] OK, thank you. And the name and date of birth, please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Name, it is [PII] and [PII].
[AGENT][NEUTRAL] OK, let me pull up [PII]'s policy real quick.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] The service is December 18, 2024. Bill amount is 165.
[AGENT][NEUTRAL] OK, and then the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] No, well, in this case.
[CUSTOMER][NEUTRAL] I don't see anything here on the file that it was already processed by the primary insurance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So in this case, you're, you're stating that you are
[CUSTOMER][NEUTRAL] So you are not the primary insurance, right? for this patient.
[AGENT][NEUTRAL] No, sir, we're secondary.
[CUSTOMER][NEUTRAL] Your secondary, are you able to check uh which insurance is the primary one?
[AGENT][NEUTRAL] Uh, I can, I can look and see. Let me see real quick. Let me get the patient pulled up. Um.
[CUSTOMER][POSITIVE] Sure. Thank you so much, [PII].
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, it's not giving me a primary on this one let me see if I can.
[AGENT][NEUTRAL] Look through the group and see.
[CUSTOMER][NEUTRAL] OK, perfect, yes, because I'm showing here that you are listed as the primary one, so.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But I need to confirm it with you.
[AGENT][NEUTRAL] Right, that's, um, we are always the secondary on these Medlink policies, the gap insurance. Um, I do show that this policy, uh,
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Did lapse. So let me look on the group real quick.
[AGENT][NEUTRAL] And see what the group um cover had for their coverage for their insured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Ah, that's not giving me the major medical. It does not have the major medical for him, but we are, we will be the secondary insurance. Let me see if he changed groups.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He does have an active policy. Let me look at that one.
[AGENT][NEUTRAL] Let me give you that policy number too because it um it became effective [PII].
[CUSTOMER][POSITIVE] OK, perfect, thank you.
[AGENT][NEUTRAL] And it's active and the policy number is 2566435.
[AGENT][NEUTRAL] And let me see if he has.
[AGENT][NEUTRAL] Uh, his major medical now is Blue Cross Blue Shield of [PII].
[AGENT][NEUTRAL] Now back in [PII] I don't have that information.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Well, no worries about that.
[AGENT][NEUTRAL] Because the policy is no longer active.
[AGENT][NEUTRAL] But let me look for that claim for you.
[AGENT][NEUTRAL] Um, and see if anything has been filed on it.
[AGENT][NEUTRAL] The first policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So regarding this year [PII], so it is Blue Crosby Shield, right, of Oklahoma.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm gonna look on that data service you just gave me.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, uh, that claim that you gave me, let me give you the claim number is 35517007.
[AGENT][NEUTRAL] And it has several uh remarks on it, non-covered service, office visits are not covered by the policy. It also has please provide copies of the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Well thank you so much and well, let me just take a look here. Yes, there are 2 more claims for these members, so can you please help me?
[AGENT][NEUTRAL] Yes sir, let me put my notes on this one and then we'll move on to the next one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's the next data service?
[CUSTOMER][NEUTRAL] The next one is [PII]:30, 2024.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] build amount.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 224.
[AGENT][NEUTRAL] OK. And do you have a
[AGENT][NEUTRAL] After primary amount?
[AGENT][NEUTRAL] On that one
[CUSTOMER][NEUTRAL] No, they are all listed as first. Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm, OK, they're probably all gonna tell us that we need the explanation of benefits, but we're going to check.
[CUSTOMER][POSITIVE] OK, no worries.
[AGENT][NEUTRAL] Yes, this one is given the same remarks need the explanation of benefits from the primary insurance.
[AGENT][NEUTRAL] Let me put my note for this one.
[CUSTOMER][NEUTRAL] OK. And also the
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So, and also that is non-covered, right?
[AGENT][NEUTRAL] Right, office visit.
[CUSTOMER][NEUTRAL] OK, so, uh, well, what do you think [PII] in this kind of cases, um, about those remark codes, because, uh, well, even if we can send you, uh, the, the primary COB so the office visits, visits will not cover, right? Or what do you think?
[AGENT][NEUTRAL] Correct. Right. Um, you can send the, uh, the explanation of benefits from the primary for any other, uh, procedures, but as far as the office visit itself, it's not covered by the patient's policy.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] And we don't have a timely filing limit so as long as uh the insured's policy was active on the date of service you can file at any time.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][POSITIVE] Oh, OK. Thank you so much.
[CUSTOMER][NEUTRAL] So yes, but well, those specific specific procedures, so they are not covered.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, the office visit isn't. Now, the treatment in the office, there's a possibility that that could be covered, so you may wanna go ahead and send in the claim.
[AGENT][NEUTRAL] With the EOB
[CUSTOMER][NEUTRAL] With the EOB, OK, and for future cases, once we are able to, to fax you the EOBs, do we need to attach the the claims as well or only the EOBs?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, I would attach the claim to so they know which claim you're sending the EOB in for.
[CUSTOMER][POSITIVE] Oh, OK. Perfect. Thank you, [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Are you able to send me via fax those little bits that you just checked?
[AGENT][NEUTRAL] Yes, I can fax, yes, I can fax them to you, um, and I'll need to get your fax number again please, sir.
[CUSTOMER][NEUTRAL] Sure. It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, alright, I'm gonna put you on a quick hold. I'm gonna get those faxes ready for you and I'll be right back, sir.
[CUSTOMER][NEUTRAL] Thank you again, thank you. Before that, and there's only one missing claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that OK for you?
[AGENT][POSITIVE] Yes, let's go ahead and look up that one.
[CUSTOMER][NEUTRAL] OK, it is January.
[CUSTOMER][NEUTRAL] 17
[CUSTOMER][NEUTRAL] 2025.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And 224.
[AGENT][NEUTRAL] 224. OK, let me look up that one.
[CUSTOMER][NEUTRAL] OK, and I'm showing here it looks like it was already processed by the primary one.
[CUSTOMER][NEUTRAL] Um, let me see.
[AGENT][NEGATIVE] And this one is uh also denied office visits are not covered by the policy.
[AGENT][NEUTRAL] And does not provide a benefit for services in which no charges were incurred and then it also says please provide copies of your explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. Sorry, well, that's all I needed to know so far.
[CUSTOMER][NEUTRAL] So, yes, please send me those UBSPF bags.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold I'll be right back sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], what is um.
[AGENT][NEUTRAL] Your fax number that you want these to go to?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, quick hold again I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh, come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you for holding for me. I've got those faxes on the way to you now.
[CUSTOMER][NEUTRAL] OK, thank you so much, [PII]. Uh, well, the last question that I have because I'm, I'm showing here other claims for other patients, and do you have like a limited number for checking claims?
[AGENT][NEUTRAL] Uh yes, sir. Um, if you want to go ahead and um call back on um the same line that you did.
[CUSTOMER][NEUTRAL] OK, I understand. Sorry. And
[AGENT][NEUTRAL] Those 3 have been sent to you. Yes, sir.
[CUSTOMER][NEUTRAL] OK, and apart of that, is there any like a payer portal we can check them or it's only by calling?
[AGENT][NEUTRAL] Oh no, you can, you can sign up for the online service center and you would use your payer or your um patient account number that you guys assigned to the patient.
[AGENT][NEUTRAL] Like on this one, [PII]'s patient account number is [PII], which is your number, so you'll have to sign up um and put in your tax ID number.
[AGENT][NEUTRAL] For your facility and then your patient account number.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And you can look up claims on there.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Oh, it would be great. And what's the website?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] It's [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you're gonna choose that you're the provider.
[CUSTOMER][POSITIVE] OK. Perfect. Yes, well, actually, I'm on it right now. Thank you. I appreciate it.
[AGENT][POSITIVE] Yes, OK, awesome.
[AGENT][NEUTRAL] All right. Is there anything else before we go? Yes.
[CUSTOMER][NEUTRAL] Yeah, that's let me let you know. Oh, you have a one.
[CUSTOMER][POSITIVE] No, nothing else. Thank you so much. Hope you have a wonderful Easter weekend.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. You have a blessed Easter weekend too, [PII]. Thank you so much for calling APL.
[CUSTOMER][POSITIVE] Thank you so much bye bye.
[AGENT][NEUTRAL] Bye-bye.