AccountId: 011433970860
ContactId: f5a2af49-3819-48e8-b995-9742aac0d3c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2126719 ms
Total Talk Time (AGENT): 643284 ms
Total Talk Time (CUSTOMER): 733419 ms
Interruptions: 17
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/f5a2af49-3819-48e8-b995-9742aac0d3c4_20250421T12:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, I'm [PII] Last time I saw it's [PII] calling from the provider's office to check up on the claim.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yeah, like I have one claim.
[AGENT][NEUTRAL] Yes, I can help you with that, [PII]. What is your callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's 02509841.
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today 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] Patient's name is [PII]. Date of birth, it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] The date of service, it's [PII] and the bill amount is 80,000.
[CUSTOMER][NEUTRAL] $359 even.
[AGENT][NEUTRAL] I'm so sorry. OK, so 80,000 and then how.
[AGENT][NEUTRAL] Many, what was after the 80,000?
[CUSTOMER][NEUTRAL] Uh, it is 80.
[CUSTOMER][NEUTRAL] Like, uh, yeah, it's 803-5900 like uh $359.00 even.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Thank, thank you very much. One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Play
[CUSTOMER][NEUTRAL] It sounds like.
[CUSTOMER][NEUTRAL] I'm I'm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] more.
[AGENT][NEUTRAL] OK, [PII], as of now, there is
[CUSTOMER][NEUTRAL] Uh, I can provide you the claim number.
[AGENT][NEUTRAL] No claim on file for that data serve it.
[AGENT][NEUTRAL] You can give me the claim number, but there is no claim on file. Go ahead.
[CUSTOMER][NEUTRAL] Yeah, OK, so the claim.
[CUSTOMER][NEUTRAL] Claim number, it's
[CUSTOMER][NEUTRAL] Just give me one second. It's, yeah, it's 35.
[CUSTOMER][NEUTRAL] 755.
[CUSTOMER][NEUTRAL] 43.
[AGENT][NEUTRAL] OK, now that is not a claim number for this member for that data service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] up
[CUSTOMER][NEUTRAL] Uh, let me just see, like, I'll just uh check it like, uh, in the claim form what we have built, right? So it will be clear for us.
[CUSTOMER][NEUTRAL] Uh, can you just spell your name, please?
[AGENT][NEUTRAL] My name is spelled [PII]
[CUSTOMER][NEUTRAL] OK, [PII]. Uh, let me just check that.
[CUSTOMER][NEUTRAL] OK. So the date of service is from
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. So you, let me check.
[CUSTOMER][NEUTRAL] Uh, and let me see the charges, um.
[AGENT][NEUTRAL] OK, so let me check the different date of service because you gave me [PII] as the date of service.
[CUSTOMER][NEUTRAL] Yeah, and the bill amount will be the same, uh, uh, and only the date of service will be from.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] 113 2 1:15.
[AGENT][POSITIVE] Yes sir, OK, so that does make a difference in the having the correct.
[AGENT][NEUTRAL] Data service, [PII]. So yes, that call, that is the claim number and this claim was denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and let me just see like, uh, previously if our colleagues have make some.
[CUSTOMER][NEUTRAL] She like, uh, like send you guys or not. Let me just confirm that. OK, like uh it is not sent to you. Can you just provide me your fax number if you have? So we can just send you over that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, the claims fax number is [PII]. Attention claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So the fax number is [PII], right, [PII]?
[AGENT][POSITIVE] That is, that is correct. Yes. Attention [PII].
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, if you need a copy of this explanation of benefits, [PII], you can print that now that you have that claim number by going to [PII].
[CUSTOMER][NEUTRAL] Yeah, attention claims. So,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, uh, uh, like, uh, we can send over by fax and by mail also like the email.
[AGENT][NEUTRAL] It has already been mailed, and if you need a copy of it, you can print it from our portal at the website that I just gave you.
[CUSTOMER][NEUTRAL] Like if we have that uh correspondence from your insurance.
[CUSTOMER][NEUTRAL] Uh, like, uh, for the claim to be processed, we'll just send you the primary insurance CO, OK, [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That'll be fine, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, can you provide me the call reference number?
[AGENT][NEUTRAL] Yes, sir, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK. And to see, like, uh, what if we, uh, I'll search for other claims for your insurance? Is, is there any other claims? So can you help me with that?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Uh, like, uh, crazy, like if I, I search for other claims for your insurance, like for other member's account, can you just help me with that too?
[AGENT][NEUTRAL] Yes. How many do you have, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, like I just, uh, like, uh, check it in the system, like what, how many is there, it is showing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, like there are multiple. Let me just see. OK.
[AGENT][NEUTRAL] I'm gonna place you on a brief hold, [PII], OK, while you're checking.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Uh, I'm almost done.
[AGENT][NEUTRAL] I'm gonna place you on a brief hold for a moment, [PII]. One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm still here.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK, what is the next policy number?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] [PII], can you hear me?
[CUSTOMER][NEUTRAL] Uh yeah, it's
[CUSTOMER][NEUTRAL] Yes, I can hear you.
[AGENT][NEUTRAL] OK, cause I had asked several times and you didn't say anything, so I didn't know if you could hear me or not.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, no, I can hear you.
[AGENT][NEUTRAL] OK, so how many claims total do you have?
[CUSTOMER][NEUTRAL] Like, uh,
[CUSTOMER][NEUTRAL] Uh, like I have multiple claims, like there are around 14, uh, like, sorry, 10 to 15 claims. Like, uh, 10 to 15 claims are there. Like, uh, how many you can assist me like?
[AGENT][NEUTRAL] How many?
[CUSTOMER][NEUTRAL] Maybe like uh they are denied due to primary UV and like that denial on that.
[AGENT][NEUTRAL] I, I can help all of them, [PII].
[AGENT][NEUTRAL] OK. So if they're denied for a primary EOB then then we would need the primary explanation of benefits for further review.
[CUSTOMER][NEUTRAL] You can help all of them?
[CUSTOMER][NEUTRAL] No, like, uh, there are scenarios, [PII], like, uh, uh, we have sent you one time or two times, but, uh, you are not receiving that or something like that scenarios on that. So like we, we can.
[CUSTOMER][POSITIVE] Uh, get it done by on call, so it will be very, uh, easy for us.
[AGENT][NEUTRAL] What is the next patient's policy number?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah, it's uh 019.
[CUSTOMER][NEUTRAL] 30691.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK, and [PII], you will use my name for each reference number that you need also any.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Information that I provide for you on any claim that I show verification of benefits and not a guarantee of payment. And lastly, if you do need a copy of any of the explanation of benefits, you will need to print them from that portal by going to [PII].
[AGENT][NEUTRAL] OK. So what is the next patient's policy number?
[CUSTOMER][POSITIVE] OK, no issues.
[AGENT][NEUTRAL] I'm sorry, what is, you said 01930691. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah right. Yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And I'm sorry, there's, there, there is a lot of background noise where you're located that's making it difficult for me to hear you.
[CUSTOMER][POSITIVE] OK, sorry for that.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's way
[AGENT][NEUTRAL] And the date of service and total bill amount.
[CUSTOMER][NEUTRAL] Date of service is [PII]. And the total bill amount it's 12,000.
[AGENT][NEUTRAL] To 6:26.
[AGENT][NEUTRAL] How much?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, it's for $12,839.
[CUSTOMER][NEUTRAL] Even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] like
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so this claim was most uh recently received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Your voice is uh like uh in between we cannot hear you like.
[AGENT][NEUTRAL] A 25.
[AGENT][NEGATIVE] Processed and denied on.
[AGENT][NEUTRAL] OK, I'm so sorry, but there is nothing. Yes, sir. I'm sorry, there's nothing I, I cannot, I'm sorry, I have no control over that.
[CUSTOMER][POSITIVE] Sorry to for that, sir.
[AGENT][NEGATIVE] I'm having trouble with you, hearing you too, boy, [PII].
[CUSTOMER][NEUTRAL] Yeah, OK, no issues. Can you just repeat that?
[CUSTOMER][NEUTRAL] really
[CUSTOMER][NEUTRAL] Yeah, can you just please repeat that, [PII].
[AGENT][NEUTRAL] This claim was received.
[AGENT][NEUTRAL] On [PII]
[AGENT][NEUTRAL] Received to 7 denied to [PII].
[AGENT][NEUTRAL] The claim number is 3,562,350.
[AGENT][NEUTRAL] And the reason for the denial on this claim states that kinesiology, speech, or occupation.
[AGENT][NEUTRAL] Occupational therapy are not covered methods under this policy.
[AGENT][NEGATIVE] The member's plan does not cover this.
[CUSTOMER][NEUTRAL] OK, so it's non-covered as per patient plan. And which plan does the patient hold? What is the plan need?
[AGENT][NEUTRAL] This is a supplemental medical. This is a supplemental medical called Medlink.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] Midli, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what is the patient responsibility?
[AGENT][NEUTRAL] We do not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] OK, like, uh, we can just build a patient for that like for the whole amount.
[AGENT][NEUTRAL] Again, that is not up, that is not up to us to make that determination. That would be up to the provider.
[CUSTOMER][NEUTRAL] OK, so the patient plan, like the, there is a some, uh, OK, like, uh, it was non covered due to the consology, right, be and something like that.
[AGENT][NEUTRAL] The supplemental policy does not cover kinesiology, speaker speech or occupational therapy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And is there any other insurance located for this member after your, you guys?
[AGENT][NEUTRAL] You would have to
[AGENT][NEUTRAL] You would have to contact.
[AGENT][NEUTRAL] The insured to find that out.
[CUSTOMER][NEUTRAL] OK, and the call reference number will be your name and to this date, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK, thank you for that. Let me just uh look up on to the next account, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I'm just, uh, jump into the new account and I'll just, uh, do you need the policy number or you have, you need more time.
[AGENT][NEUTRAL] I do, in order, uh, you can give me the policy number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, it's 017.
[CUSTOMER][NEUTRAL] 80,690.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Data service and total bill amount please.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] for the bill amount of $16,719 even.
[AGENT][NEUTRAL] I say the build out one more time, please, [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah, it's 16.
[CUSTOMER][NEUTRAL] $719 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so this claim has been received twice. The most recent was denied as a duplicate of previous.
[AGENT][NEUTRAL] Please submitted expenses, the original claim.
[AGENT][NEUTRAL] That claim number is 3513902.
[AGENT][NEGATIVE] And it was denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] And crazy like uh from my side like we have sent you guys multiple times primary insurance here.
[AGENT][NEGATIVE] OK, we have not received it.
[AGENT][NEGATIVE] Yes, we have not received it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So you want it one more time?
[AGENT][NEUTRAL] If you want to send it again, we have not received the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] No, no, like [PII], like you're saying that we have not received that, so.
[AGENT][NEUTRAL] I'm saying that we have not received it. If you want to, I mean, that's up to you.
[CUSTOMER][NEUTRAL] Is that we have to send it again?
[AGENT][NEGATIVE] But we've not, if you have sent it, we have not received it.
[CUSTOMER][NEUTRAL] OK, like we'll just send it over to you that, uh, to that fax number which you have provided us, OK?
[AGENT][NEUTRAL] Uh, that'll be correct. Mhm.
[CUSTOMER][NEUTRAL] OK, let me just uh put to the new account, OK? I'll like uh
[AGENT][NEUTRAL] We do not need the claim. We only need the EOB. Mhm.
[CUSTOMER][NEUTRAL] OK, no, we'll, we'll just send you the primary will be.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Like, uh, yeah, like we'll just, uh, go for 2 more accounts, OK.
[AGENT][NEUTRAL] OK, is that all the information you need on this number?
[CUSTOMER][NEUTRAL] Yeah, right. Like to, to get it processed only.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the next policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the next policy number, it is going to be 020.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 034.
[CUSTOMER][NEUTRAL] 86.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And the date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] D of service, it's 5-17 of 2024 and the total bill amount is $2,857 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] know.
[AGENT][NEUTRAL] OK, for data service 5 1724 there is no claim on file.
[CUSTOMER][NEUTRAL] Uh, not on file, OK, and let me just see.
[CUSTOMER][NEUTRAL] Uh, just can you just give me one second, let me just see where we have sent this claim to.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'll just take a minute. Just bear with me.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] OK, so like we have with you guys, uh, by mailing address and can you just provide me your mailing address? Can you just confirm me that, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, like, uh, OK, OK, like I'll see. OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Like we have billed on [PII] only to that.
[AGENT][NEUTRAL] OK, that's not the correct address.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so for this one, can you just provide me your pay ID if you have?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK. It's 4801.
[AGENT][NEUTRAL] And on this one, we will also have to have.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] 0801.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Uh, so is this, uh, this is what? 60801?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, like, uh, what is this number? Like, uh, what is that?
[AGENT][NEUTRAL] You ask for the payer ID.
[CUSTOMER][NEUTRAL] So do you have 2 payer IDs?
[AGENT][NEUTRAL] No, we do not.
[CUSTOMER][NEUTRAL] Like, uh, then what is the 4801, this number?
[AGENT][NEUTRAL] I, I, I did not say 401.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Like 4801.
[AGENT][NEUTRAL] No, sir, that's not what I said.
[AGENT][NEUTRAL] Our payer ID Eric is 6.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] 0
[AGENT][NEUTRAL] 8
[AGENT][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] OK. And what is the time finding limit?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][NEGATIVE] No timely filing limit.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And can you just provide me the policy effective and terminate for this number?
[AGENT][NEUTRAL] Effective date is [PII] and there is no termination date. It is active.
[CUSTOMER][NEUTRAL] OK, and can you just provide me the
[CUSTOMER][NEUTRAL] Planning
[AGENT][NEUTRAL] Medin supplemental.
[CUSTOMER][NEUTRAL] Medli, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what is the plan type?
[AGENT][NEUTRAL] Supplemental.
[CUSTOMER][NEUTRAL] OK. And can you just provide me the group name and group number?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Group number is 19031.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The group name is The Alarm Depot.
[CUSTOMER][NEUTRAL] Can you spell that please?
[AGENT][NEUTRAL] Of South Florida Incorporation.
[AGENT][NEUTRAL] The entire thing?
[CUSTOMER][NEUTRAL] Uh, yeah, like I just tell it in alphabets.
[AGENT][NEUTRAL] The first word is the T H E.
[AGENT][NEUTRAL] Second word, alarm, A L A R M.
[AGENT][NEUTRAL] Next word, D E P O T.
[AGENT][NEUTRAL] Next word O F.
[AGENT][NEUTRAL] Next word S O U T H.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Next word, FL.
[AGENT][NEUTRAL] O R I D A.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Next word INC.
[CUSTOMER][POSITIVE] OK, no issues like uh.
[CUSTOMER][NEUTRAL] And is the net, what is the network?
[AGENT][NEUTRAL] There is no network. This is a supplement primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thanks for that. And the member ID is uh right, right? 02003486.
[AGENT][NEUTRAL] Yes, and make sure to send the primary insurance company's explanation of benefits along with the claim. It is required.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Uh, like in the member ID that is like, uh, in the last, uh, that is ML 7. So what is that like? Is it combined?
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] That just indicates inpatient or outpatient. The policy number is actually the very first part of the number that ends after the 6th.
[CUSTOMER][POSITIVE] OK. So that's it. OK, no issues.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, just put the, your name into today as a call reference number, OK?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, like, uh, we'll just uh move on to the last one, OK?
[CUSTOMER][NEUTRAL] Li
[CUSTOMER][NEUTRAL] I'm gonna
[AGENT][NEUTRAL] OK, well.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] OK. So, I'll just
[CUSTOMER][NEUTRAL] Uh, got the account and
[AGENT][NEUTRAL] What is that next number?
[CUSTOMER][NEUTRAL] Yeah, it is going to be 02.
[CUSTOMER][NEUTRAL] 3 consecutives, 4.
[CUSTOMER][NEUTRAL] 783.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the date of service and total bill amount for her, please.
[CUSTOMER][NEUTRAL] Yeah, it's.
[CUSTOMER][NEUTRAL] [PII] for the bill amount of 21,000.
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] $487.
[AGENT][NEUTRAL] Even
[CUSTOMER][NEUTRAL] Yeah, it's even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was received, the received date is [PII].
[AGENT][NEUTRAL] 5
[AGENT][NEUTRAL] Pro
[AGENT][NEUTRAL] And denied on [PII].
[AGENT][NEUTRAL] The claim number is going to be 357.
[AGENT][NEUTRAL] 4253
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The reason for the dial on this thing?
[AGENT][NEUTRAL] states we have received the primary insurance explanation of.
[AGENT][NEUTRAL] Benefits that was submitted with the claim, how
[AGENT][NEUTRAL] The explanation of benefits received does not list the amounts applied to the deductible, co-pay, or co-insurance. Please submit a more detailed explanation of benefits that shows these amounts for further consideration of your claim.
[AGENT][NEUTRAL] So we need a detailed explanation of benefits from the primary insurance showing the amounts applied to the co-pay, deductible, or co-insurance.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, like we have that. We'll just send you to, to you guys, OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, perfect. And you can send it to that same fax number I gave you. Mhm.
[CUSTOMER][NEUTRAL] To that
[CUSTOMER][POSITIVE] OK, no issue. And your call reference number will be the same and thank you for your assistance, [PII].
[AGENT][POSITIVE] That's correct. Well, you're welcome. Is there anything else that I can help you with at the moment, [PII]?
[CUSTOMER][POSITIVE] No, thank you. Thank you for your assistance. Bye.
[AGENT][POSITIVE] You're welcome. Yes, sir. You're welcome. Have a great day and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yeah, bye.
[AGENT][NEUTRAL] Um, bye bye.