AccountId: 011433970860
ContactId: ef8488c7-0f02-443f-8fe2-8b33d87efb4c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 399950 ms
Total Talk Time (AGENT): 149855 ms
Total Talk Time (CUSTOMER): 152724 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/ef8488c7-0f02-443f-8fe2-8b33d87efb4c_20250128T15:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], I was calling to check claim status um for a patient, but now that I'm looking at this card, is this just a hospital plan?
[AGENT][NEUTRAL] I can help you with that. I can take a look at that. And may I ask who I'm speaking with?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] And [PII] in case this call is disconnected, may I have your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And do you have the patient's policy number?
[CUSTOMER][NEUTRAL] I do. I have.
[CUSTOMER][NEUTRAL] I'm sorry, my computer.
[CUSTOMER][NEUTRAL] Just rose.
[CUSTOMER][NEUTRAL] OK, 24141.
[AGENT][NEUTRAL] That was 24141?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] I'm not able to pull up anything with that number. It's not enough digits. It's usually a 7-digit number, 7 or 8 digits.
[CUSTOMER][NEUTRAL] This is what we hear.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Do you have a copy of their identification card, their insurance card?
[CUSTOMER][NEUTRAL] Let me see if I can
[CUSTOMER][NEUTRAL] Um, yeah, I'm trying to get it to load right now, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] If not, if you have their social, I can pull up by their full social or first and last name.
[CUSTOMER][NEUTRAL] I have the, the card I have looks like what I gave you was just the group number. um I have a in hospitals benefit certificate number.
[AGENT][NEUTRAL] Yes, that will be the policy number. What is that number?
[CUSTOMER][NEUTRAL] OK, that is 01867031M.
[CUSTOMER][NEUTRAL] L 7.
[AGENT][NEUTRAL] Thank you, and that was 018670318. I'm I'm sorry, ML7.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, correct, 7.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, you say you're calling in regards to a claim?
[CUSTOMER][NEUTRAL] Yes, um.
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] We're a dermatologist's office.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In the bill amount?
[CUSTOMER][NEUTRAL] $509.26.
[AGENT][NEUTRAL] Thank you. So that's for data service of [PII], $23 for $509.26.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] On this particular claim,
[AGENT][NEUTRAL] Looks like we processed this claim on.
[AGENT][NEUTRAL] [PII]. The plan does not cover office visits for the physician fee. It does cover treatment in the office, but it looks like based off the information that we received from the EOB, it appears that the primary care had requested additional information and we were needed, we had requested that corrected explanation of benefits from the primary. I don't show that we've received that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, um, I saw we sent that on [PII].
[CUSTOMER][NEUTRAL] Um, can you confirm, um, how you want that submitted to make sure we did that correctly?
[AGENT][NEUTRAL] You can submit it to us by fax or by our payer ID.
[CUSTOMER][NEUTRAL] OK, it looks like that's what we did.
[AGENT][NEUTRAL] Or you can mail it.
[CUSTOMER][NEUTRAL] Maybe um looks like we did it through the payer ID can you confirm that as well?
[AGENT][NEUTRAL] Sure, that number is 60801.
[CUSTOMER][NEUTRAL] OK, may I have a fax number as well?
[AGENT][NEUTRAL] Sure. Our fax is [PII].
[CUSTOMER][NEUTRAL] And you all are wanting the EOB from the primary?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause it was like what we received it, it was uh they did had requested additional information.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Um, additional information besides the, the EOB or?
[AGENT][NEUTRAL] It looks like from their major medical, they had requested additional information.
[AGENT][NEGATIVE] Looks like they received ins insufficient information incomplete is the remark code on the EOB that we received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's what the the primary is telling you.
[AGENT][NEUTRAL] Yes, that's based off the EOB that was submitted with the claim. That's what it says on the EOB.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, um, once you.
[CUSTOMER][NEUTRAL] So they have to receive additional information and then you guys have to receive the remit from them am I understanding, understanding your place, um.
[AGENT][POSITIVE] Correct, yes, the updated ELP.
[CUSTOMER][NEUTRAL] OK, OK, it looks like maybe they originally processed it incorrectly, um, and which I'll have to call back because again I'm having computer issues I'm frozen on one screen right now, um, once you all receive that information, how long does it take you to process the claim?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It usually takes at least 7 to 10 business days for processing.
[CUSTOMER][NEUTRAL] OK, OK, and may I have a reference number for our call?
[AGENT][NEUTRAL] It'll be just my name and that's [PII] [PII] And can I get the spelling of your name as well?
[CUSTOMER][POSITIVE] Yes, it's [PII].
[AGENT][POSITIVE] Thank you. And Hope, is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] I think that's it. Thank you for your help.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thanks bye.