AccountId: 011433970860
ContactId: e9322728-e59f-474b-9d60-cff56f5ad05f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 931140 ms
Total Talk Time (AGENT): 337886 ms
Total Talk Time (CUSTOMER): 331360 ms
Interruptions: 12
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/e9322728-e59f-474b-9d60-cff56f5ad05f_20250617T17:09_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling on behalf of office regarding client status. How are you doing today?
[AGENT][NEUTRAL] I'm doing fine. Um, and you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yes, of course.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your name again? Your first name, I'm sorry.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's it's OK. It's [PII]. Do you want me to spell it?
[AGENT][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] [PII]. Do you want me to spell it?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, great. Thank you. And your callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you said the first three numbers were [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] OK, thank you and glad how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] You have
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Do you want me to tell the NPA number?
[AGENT][NEUTRAL] I want you to tell me how many, do you only have one claim to check status on?
[CUSTOMER][NEUTRAL] Of the patient provided?
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] One claim, one claim.
[AGENT][NEUTRAL] Yes, I can. OK, and what is the member's policy number, please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, of course. It is 02087885.
[AGENT][NEUTRAL] OK, great, thank you one moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK bye bye.
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][NEUTRAL] And like any information that is provided today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] [PII] and the amount is $1,729.
[AGENT][NEUTRAL] $1,729 is that correct?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK just a moment please.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and what is the tax ID number?
[CUSTOMER][NEUTRAL] It is 82.
[CUSTOMER][NEUTRAL] 31
[CUSTOMER][NEUTRAL] 82
[CUSTOMER][NEUTRAL] 095.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yeah, so like this claim was received. It was received on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] The claim number is 349.
[AGENT][NEUTRAL] 4973.
[AGENT][NEUTRAL] There was a benefit paid on this claim in the amount of $855.80.
[CUSTOMER][NEUTRAL] dollars.
[CUSTOMER][NEUTRAL] Yeah, but uh I have the procedure codes for this. Could you please
[AGENT][NEUTRAL] And that is
[CUSTOMER][NEUTRAL] I have procedure code for this. Could you please tell me whether it has been paid or not?
[AGENT][NEUTRAL] I can, I can
[AGENT][NEUTRAL] Tell you that. What is, OK, so I can just tell you that on procedure code 4921 that was denied.
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEUTRAL] So I believe that.
[AGENT][NEUTRAL] And the reason for the denial is the policy does not provide benefits for any procedure or service not listed in the schedule. That is not covered under this policy, Glade.
[CUSTOMER][NEUTRAL] And the reason for the denial is the policy does not provide benefits for any procedure or service not listed in the schedule.
[CUSTOMER][NEUTRAL] this like.
[CUSTOMER][NEUTRAL] Uh, yeah. For this code, the policy does not provide the eligibility, right?
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] Yes, this policy does not provide, correct. And also for 9630, the same thing.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] 9230, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, OK. Just a minute.
[CUSTOMER][NEUTRAL] Give me a second.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, one second.
[CUSTOMER][NEUTRAL] Give me a second.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][POSITIVE] Thank you. Just a minute.
[CUSTOMER][NEUTRAL] Um, thank you for your patience. You have told me that the policy does not provide eligibility for all the claim, all the procedure codes uh for these procedure codes.
[AGENT][NEGATIVE] Those two procedure codes that I said were denied, the others were paid.
[AGENT][NEGATIVE] Those are the only two codes that were denied.
[CUSTOMER][NEUTRAL] Yeah, OK, just a minute.
[CUSTOMER][NEUTRAL] Yeah, yeah, just a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yeah. Uh, but, uh, you have told me that, uh, other codes have been paid, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, uh, could you please tell me the other codes, uh, patient responsibility and, uh.
[AGENT][NEUTRAL] We do not.
[CUSTOMER][NEUTRAL] Allowed amount for 4381.
[AGENT][NEUTRAL] 4381, there was a benefit. The benefit was $23.60 on this claim because $50 of the uh benefit payable was applied to the calendar year deductible.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Oh, just a minute. Give me a second.
[CUSTOMER][NEUTRAL] At that
[CUSTOMER][NEUTRAL] Yeah, thank you for your patience, sir. Could you please tell me the reason why the 49, yeah, could you please tell me the reason why the 4921 you told that policy does not provide eligibility? Could you please tell me why?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] That is not, that code is not covered by this member's policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Those two codes are not covered. That is correct.
[CUSTOMER][NEUTRAL] Not covered by members policy, right?
[CUSTOMER][NEUTRAL] OK, Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah, just give me a second, OK?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just a minute.
[CUSTOMER][NEUTRAL] Yeah, thank you for your patience. Could you please uh give me the patient responsibility for 492-19630?
[AGENT][NEUTRAL] We do not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] OK. Um, yeah, but, but uh you have told that the codes.
[AGENT][NEUTRAL] And if you need a
[AGENT][NEUTRAL] Yes sir, yes sir, and I've told you that APL does not determine patient responsibility that would be up to the provider and if you need a copy of that explanation of benefits with those remarks, you should be able to print that by using the claim number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] I'll think that with that you should be able to spread that by using the cell phone.
[AGENT][NEUTRAL] By going to our portal located at [PII].
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um, yeah, but, but, uh, I can understand that, uh, you have told me that, uh, other than, other codes have been paid, right? Could you please tell me the other codes, patient responsibility, allowed amount, and, uh, this thing?
[AGENT][NEUTRAL] As I've explained to you multiple times, Slade, APL does not determine patient responsibility. The two codes that were denied are not covered under the member's plan, and all of the other codes were covered and were paid.
[CUSTOMER][NEUTRAL] the member's plan, the other more covered and were paid.
[CUSTOMER][NEUTRAL] Yeah, uh, that's what I'm asking the other codes for other codes paid, uh, could you please tell me the paid amount and the patient refund?
[AGENT][NEUTRAL] Because they are covered.
[AGENT][NEUTRAL] No, sir, because I can't, again, and I, I don't know how else to explain it. I cannot tell you what patient responsibility is.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have to see through the portal, right?
[AGENT][NEUTRAL] And you may get a copy of that explanation of benefits by going to our portal.
[CUSTOMER][NEUTRAL] Yeah. Uh, OK, I'll be, uh, could you please, uh, tell me the claim number once again, please?
[AGENT][NEUTRAL] 349-497-3
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Uh, uh, could you please send me the copy of your with your fax number?
[AGENT][NEUTRAL] Do you not have the ability to go online and print?
[CUSTOMER][NEGATIVE] Yeah, the one more. That's it there, this is the last plan.
[AGENT][NEUTRAL] Yes sir, that portal that I gave you, I will fax this one for future reference. You can go to that portal, use the claim number that you're provided, and you should be able to print them yourself.
[CUSTOMER][NEUTRAL] Could you, could you please?
[AGENT][NEUTRAL] The explanation of benefits that you're needing?
[CUSTOMER][NEUTRAL] OK. Uh, could you please tell me the, yeah. Yeah, could you please tell me the portal?
[AGENT][POSITIVE] Yeah, so give me just a second to get it loaded and I will, the portal website again is secured.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] How
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, could you please tell me the card reference number for this?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes sir, it is my name along with today's date.
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][NEUTRAL] Could you please spell your name, please?
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] Could you please
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And if you'll give me one moment, I will go ahead and fax the COB to you just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does it need to be put to your attention, [PII]? Uh, just a moment, [PII].
[CUSTOMER][NEUTRAL] OK. Uh, you need the
[CUSTOMER][NEUTRAL] Yeah, but you need the, yeah, do you need the fax number?
[AGENT][NEUTRAL] I will in a moment, not yet.
[AGENT][NEUTRAL] Does it need to have your name on the fax?
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, the fax number is [PII].
[AGENT][NEUTRAL] No, sir. Wait just a minute, [PII], you're not answering my question. Does your name need to be on the fax?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, tell me.
[AGENT][NEUTRAL] Do I need to put attention [PII]?
[CUSTOMER][NEUTRAL] No, this is the, this.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Do I? Yes or no?
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, and now what is your fax number, please?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I'm gonna repeat that. [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK. All right. So that has been faxed to you, so you should be receiving that very shortly.
[CUSTOMER][NEUTRAL] Within 1 to 2 hours.
[AGENT][NEUTRAL] I'm sorry, what did, what was your question, Glade?
[CUSTOMER][NEUTRAL] Yeah, I'll be you within 1 to 2 hours.
[AGENT][POSITIVE] You'll be receiving it soon.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] It has already been sent.
[AGENT][NEUTRAL] Yes, you must definitely should be able to receive it before 1 to 2 hours.
[CUSTOMER][POSITIVE] OK, OK. Um, yeah, thank you for the information and have a nice day. Bye-bye.
[AGENT][POSITIVE] All right, well, you're very welcome. So again, if that's all I can help with, thank you for calling APL and I do hope you have a nice day also.
[CUSTOMER][NEUTRAL] Bye.