AccountId: 011433970860
ContactId: ed902df9-ae03-4150-97d1-a355f7c4a751
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 510260 ms
Total Talk Time (AGENT): 212716 ms
Total Talk Time (CUSTOMER): 141961 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/ed902df9-ae03-4150-97d1-a355f7c4a751_20250509T13:29_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling from Doctor [PII] and this board's office. How are you today?
[AGENT][NEUTRAL] I am fine, but would your voice cut out when you were in the middle of saying your name?
[CUSTOMER][NEUTRAL] Sure, it's [PII]
[AGENT][POSITIVE] OK, [PII], thank you. And how can I help you today?
[CUSTOMER][NEGATIVE] I wanted to check to make sure that you had received two claims that were um submitted one when I called the original it was I was told it wasn't received and so resent it and I resent recent one so I just wanted to see if um they have received on our being processed.
[AGENT][NEUTRAL] OK, are these two claims that you're wanting to check if they were received for the same number?
[CUSTOMER][NEUTRAL] Same member.
[AGENT][NEUTRAL] OK, yes, ma'am, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please, M.
[CUSTOMER][NEUTRAL] It is 1,169,480.
[AGENT][POSITIVE] Thank you, one moment please.
[AGENT][NEUTRAL] And and then any information provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the first date of service and total bill amount?
[CUSTOMER][NEUTRAL] So the first one is [PII] and the total bill amount was $348.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, bear with me just one second, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so on this, I do see that this claim was received and yet.
[AGENT][NEUTRAL] The receipt date on this was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, alright, so it's just processed.
[AGENT][NEUTRAL] The claim number
[AGENT][NEUTRAL] Mhm. The claim number is 359-914-9.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it going to the patient?
[AGENT][NEGATIVE] This claim is actually denied and give me just a moment and I can give you the remark on here.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so it does show the denial remark as stating the policy benefits for these dates of service were directly paid to our insured.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Oh, so almost like it was a duplicate?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Because she called to check on the status, so I just wanted to make sure. OK, so that one was already paid. Are you able to tell me when it was?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I can't, I can't, no, yeah, you would have to contact her to find that out. But yes, ma'am, that will, that is the remark on that claim.
[CUSTOMER][NEUTRAL] Or what she needs her, huh, OK, OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then can you
[AGENT][NEUTRAL] Uh-huh. And you have another data service.
[CUSTOMER][NEUTRAL] OK, and then can you tell me the one, yes, that one is for [PII].
[AGENT][NEUTRAL] And what is the billed amount for that one, please?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That one is $252.
[AGENT][NEUTRAL] 252, OK.
[AGENT][NEUTRAL] And again you said the data service is 324.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 2025, correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was also received. It was received on.
[AGENT][NEUTRAL] 51, it was processed on 58.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 359.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 9030.
[AGENT][NEUTRAL] There has been a benefit paid on this claim in the amount of $210.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is on single check, 204-3335.
[AGENT][NEUTRAL] And that is going to the provider.
[CUSTOMER][NEUTRAL] Oh, that's coming to us, OK.
[AGENT][NEUTRAL] And on this, yes, ma'am. And on claim, I'm sorry, not claim code 1206, that one was denied and the reason for the denial it states that the policy does not provide benefits for any procedure service not listed in the schedule. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Before I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so that was you said 58 was when it was processed?
[AGENT][NEUTRAL] Yes, ma'am. That is correct. Yeah, it should have, um, yeah, the check on let's see, yes. So it was just went through our nightly processing last.
[CUSTOMER][NEUTRAL] So it'll be coming any day, OK, alright.
[AGENT][NEUTRAL] Site, so the check should be being mailed out today.
[CUSTOMER][NEUTRAL] OK, just trying to figure out how that one, that one is coming to us, but the other one went to the patient. Let me see, do we process it? How do we send it differently? Give me a second. So this you do allow assignment of benefits for um this plan.
[AGENT][POSITIVE] That is correct. Mhm. It just, yes, we do.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] OK, alright, I will let her know and I'll know for uh for future reference. OK, well thank you so much for your help I appreciate it.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, you're welcome. And then just one last thing, [PII], for future reference, um, when you all file claims with us, we do have a portal in which you should also be able to check claim status once it's been processed, and our website is located at secured.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Secured uh [PII]
[AGENT][NEUTRAL] Uh-huh. [PII].
[CUSTOMER][NEUTRAL] [PII] uh huh.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect thank you so much for your help I appreciate it.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Well, absolutely, it was my pleasure. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it thanks very much have a great weekend.
[AGENT][NEUTRAL] OK, well then.
[AGENT][POSITIVE] I hope you do too, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.