AccountId: 011433970860
ContactId: f164d500-4663-4901-a807-681f72ef1716
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 700150 ms
Total Talk Time (AGENT): 180563 ms
Total Talk Time (CUSTOMER): 213873 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/f164d500-4663-4901-a807-681f72ef1716_20250515T18:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from product office to check on the claim status.
[AGENT][NEUTRAL] OK, I could check on a claim for you. I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, can I get a good callback number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, callback number is [PII]. This is a direct line.
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah. And the number is 01896422.
[AGENT][NEUTRAL] All right, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Member's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] D of service is [PII].
[CUSTOMER][NEUTRAL] And the charge amount is $1,932 even.
[AGENT][NEUTRAL] OK, that was [PII]:30 [PII] 2024 for $1,932.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, I appreciate your patience. uh, so we did receive this claim, uh, looks like we're missing a copy of the primary EOB.
[CUSTOMER][NEUTRAL] Uh, could you tell me the received date?
[AGENT][NEUTRAL] Yes, that was [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] So this claim was denied.
[AGENT][NEUTRAL] Yes, as we are needing a copy of the primary EOB, this is their secondary medical policy.
[CUSTOMER][NEUTRAL] OK. Which one is the patient's primary?
[AGENT][NEUTRAL] I don't have that information. I only see this information, which is their secondary medical.
[CUSTOMER][NEUTRAL] OK. So could you tell me the patient was updated the last COPD?
[AGENT][NEUTRAL] Could you repeat that?
[CUSTOMER][NEUTRAL] Uh, patient was updated the last COPD.
[CUSTOMER][NEUTRAL] Patient, when was the updated COP information, the date?
[AGENT][NEGATIVE] Uh, there is no coordination of benefits for this plan.
[CUSTOMER][NEUTRAL] OK. Could you tell me the claim number?
[AGENT][NEUTRAL] That is 346946.
[CUSTOMER][NEUTRAL] Uh, your voice is in not one more time repeat again the claim number.
[AGENT][NEUTRAL] 3469496.
[CUSTOMER][NEUTRAL] 949 and last number?
[AGENT][NEUTRAL] 496.
[CUSTOMER][NEUTRAL] OK. So this was the claim was uh no claim was uh paid for this claim?
[AGENT][NEUTRAL] Right as we copy of the primary EOB.
[CUSTOMER][NEUTRAL] OK. Because I have a a different claim number of the claim, uh, different claim number of the patient. And the claim was already insurance payment is $121.68 for the same number.
[CUSTOMER][NEUTRAL] Uh, I can confirm the claim number. Uh, that is 02024158501295 Q as in Queen 0 X as in X. Yeah, OK.
[CUSTOMER][NEUTRAL] Yes, this is different, OK.
[AGENT][NEUTRAL] Oh, that's not one of our claim numbers.
[CUSTOMER][POSITIVE] OK, OK, sorry for that. And also this one is the patient's fun, yeah, this one is the patient's fun to be self-funded plan or fully funded plan.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Patient funding type, self-funded policy or fully funded policy?
[AGENT][NEUTRAL] This is through their employer.
[CUSTOMER][NEUTRAL] And also, could you confirm me the record reference number?
[AGENT][NEUTRAL] That would be my first name, last initial, and today's date. Uh, so my name is spelled [PII] And was there anything else I can help you with?
[CUSTOMER][NEUTRAL] I have one more patient, the same patient.
[AGENT][NEUTRAL] It's uh another claim for the same member?
[CUSTOMER][NEUTRAL] Yes, same number, different date, uh sorry, same date of service and different charge amount.
[AGENT][NEUTRAL] What was that charged amount?
[CUSTOMER][NEUTRAL] And the amount is $8,064 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was this through a different provider?
[CUSTOMER][NEUTRAL] Uh, this one is different facility. I can confirm with the tax ID number.
[AGENT][NEUTRAL] That's OK. I did find it, um, so this one we were unable to pay a benefit as their outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this one is the claim was denied.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] For the same reason, or?
[AGENT][NEGATIVE] No, their outpatient benefit for the calendar year had been met, so we were unable to pay anything additional.
[CUSTOMER][NEUTRAL] 01 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so one second, the more.
[CUSTOMER][NEUTRAL] Uh, so this one is, uh, one more time, but again, there is an outpatient benefits, right?
[AGENT][NEUTRAL] Yes, so this policy has a maximum of $2000 per calendar year for their outpatient benefit amount, and that amount had been exhausted prior to this claim. So there was nothing additional for us to pay.
[CUSTOMER][NEUTRAL] OK. So which, uh, which, could you confirm me the patient's account number?
[AGENT][NEUTRAL] Uh, what number? I'm sorry?
[CUSTOMER][NEUTRAL] Patient's account number or claim number?
[AGENT][NEUTRAL] I can give you the claim number that is 35.
[AGENT][NEUTRAL] 22
[AGENT][NEUTRAL] 718.
[CUSTOMER][NEUTRAL] Could you received it and process it.
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] This card was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] And also, could you tell me which dollar amount is $3000 is exhausted, right? Uh, could you tell me the, the patient's account number?
[AGENT][NEUTRAL] I'm sorry, did you say their account number?
[CUSTOMER][NEUTRAL] Uh, that's right. Uh, the patient's account number. This previous, uh, the same patient, and the dollar amount is maximum benefits existed for this claim, right? Uh, that's right. That is the dollar amount is right, yeah, dollar amount is exceeded for this patient. Uh, which, uh, which one is the dollar dollar amount is exist existed for the patient? Could you provide that to this patient's account number or claim number?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] Uh, I'm unable to give that information, [PII], as that was through a different provider.
[CUSTOMER][NEUTRAL] Uh, that one is different provider. Uh, could you tell me the number because I will document that, that one.
[AGENT][NEGATIVE] I'm unable to disclose that information unfortunately.
[CUSTOMER][NEUTRAL] OK, one second, I will document that.
[CUSTOMER][NEUTRAL] OK. And also, could you send you with the fax number, uh, because I don't have any UOB. I can confirm me the number, fax number.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yeah, I'm ready for that when you are.
[CUSTOMER][NEUTRAL] Yeah, uh, the fax number is [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back, make sure I heard that correctly. That was [PII] excuse me, [PII].
[CUSTOMER][POSITIVE] Yes, uh, that's right.
[AGENT][NEUTRAL] OK, I will go ahead and send that now. I should get it within about 10 minutes or so. Uh, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, that's it for the day. And also, attention is my name, [PII].
[AGENT][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] OK. Thank you very much. Have a great day. Bye-bye.
[AGENT][POSITIVE] Of course, thanks for IPL. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.