AccountId: 011433970860
ContactId: f3ec774a-80f4-43cb-958c-76955c08a084
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449640 ms
Total Talk Time (AGENT): 152436 ms
Total Talk Time (CUSTOMER): 127189 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/f3ec774a-80f4-43cb-958c-76955c08a084_20250407T19:46_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is So. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling for provider to check on additional information for the claim. Please be informed that this call is being recorded and monitored for quality and training purpose.
[AGENT][NEUTRAL] OK, sure. I can assist you with claims and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] OK. May I have a callback number just in case we get disconnected, Miss [PII]?
[CUSTOMER][NEUTRAL] It is [PII], no extension.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes. It is 02216511, M as in Mike, L as in Lima.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The name of the member is [PII]. Date of [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes. It is one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The date of services.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] And the bill amount here is just right here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $2250 even.
[AGENT][NEUTRAL] OK. That was [PII] for 2250.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, let me see if I can find this claim. OK, one moment.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me pull this up one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it looks like we processed twice. The most recent one must process as a duplicate. So I'm gonna give you information about the original claim, OK?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the original claim was processed [PII], and we send a benefit amount of $200 to the provider. Um, the calendar day benefit, this has a daily benefit of $200 that is the maximum, and that is what we paid.
[CUSTOMER][NEUTRAL] Uh, so it is not denied and it has been paid, right?
[AGENT][NEUTRAL] We pay the $200 which is the maximum per day benefit under this policy.
[CUSTOMER][POSITIVE] OK. Got it. Thank you so much. One moment here.
[AGENT][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] So it was allowed and paid $200 even, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And no member responsibility?
[AGENT][NEUTRAL] Um, if there's any balance left, it's up to the provider's discretion. We are just secondary. We don't have any contractual involvement on the remaining of the claim.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much. One moment here.
[AGENT][NEUTRAL] Mhm sure.
[CUSTOMER][NEUTRAL] So, uh, just a minute here. And what will be the claim number?
[AGENT][NEUTRAL] That is, let's see one moment.
[AGENT][NEUTRAL] OK, the claim number is.
[AGENT][NEUTRAL] 3505069
[CUSTOMER][POSITIVE] Got it. Thank you so much. And uh just a minute here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, here like uh looks like the, uh, can I, can you please tell me like if the primary is United Healthcare, like Neighborhood Health Partnership, United Healthcare?
[AGENT][NEUTRAL] Mm let me check and see if I have that information. Bear with me just a minute, OK.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] It's just say United Healthcare.
[CUSTOMER][POSITIVE] OK, I got it. Thank you so much. One moment here.
[CUSTOMER][NEUTRAL] And here in my end it shows like the primary has reprocessed the claim and they have an EOB so can we submit that reprocess the EOB?
[AGENT][NEUTRAL] You can, but uh it's probably gonna be processed as a duplicate and like the one that it was sent out recently, um, because we already processed and pay the maximum.
[AGENT][NEUTRAL] For the date of service.
[CUSTOMER][NEUTRAL] Um, but, uh,
[CUSTOMER][NEUTRAL] Uh, yeah, like, uh, for the, for the information, like to check uh, check on that, can we submit the reprocessed primary EOP provide me the mailing address.
[AGENT][NEUTRAL] The address is going to be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] And the time refunding limit, please?
[AGENT][NEUTRAL] We don't have timely filing limits for claims.
[CUSTOMER][POSITIVE] OK, no problem. Got it. Thank you so much. Can I have your name and the call reference number, please?
[AGENT][NEUTRAL] My name is [PII]. That's [PII], and we don't have reference numbers, you can use my name in today's name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. Thank you so much for the information you provided. Have a great day. Bye for now.
[AGENT][POSITIVE] You as well. Thank you for calling APL. Have a good day.
[AGENT][NEUTRAL] Bye bye
[CUSTOMER][NEUTRAL] Yes sir.