AccountId: 011433970860
ContactId: f5f7b3e7-66a0-4029-902b-d2cc1bd997c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 737280 ms
Total Talk Time (AGENT): 280925 ms
Total Talk Time (CUSTOMER): 256211 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/f5f7b3e7-66a0-4029-902b-d2cc1bd997c5_20250425T14:45_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] calling from product office to check on a claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, sure. It's going to be [PII], with the extension of [PII]. And the policy number is going to be 01944012 M as in Mike L as in Lima H.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's going to be [PII] The last name is [PII] The date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] with the bill amount of $299 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] So I'm not showing a claim on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] Oh, I have the claim number. Can you verify with that?
[AGENT][NEUTRAL] Oh sure, what's the claim number?
[CUSTOMER][NEUTRAL] It's going to be 357-935-5.
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, it's a different policy number. OK, hold on one moment, let me go to that policy.
[AGENT][NEUTRAL] So that's processed under policy number 2556472 and I'm, I'm pulling that up now so I can get into the claim.
[CUSTOMER][NEUTRAL] I need a claim status for the policy number which I have given now.
[AGENT][NEUTRAL] You just need the policy number?
[CUSTOMER][NEUTRAL] Yeah, I brought the policy number already, right? It's 01944012. M as in Mike L as in Lima 88.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, but what I'm explaining to you is the claim that you're asking for was processed under another policy number, which is the 2556472.
[CUSTOMER][NEUTRAL] OK. It's for the different um patient, right?
[AGENT][NEUTRAL] No, it's the same patient, it's a different policy number. So the 1944012 is no good for this claim.
[AGENT][NEUTRAL] The claim 3579355 was processed under policy number 2556472.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 2556472
[AGENT][POSITIVE] Mhm. Yeah, that's right.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Did you, and then I'm sorry?
[CUSTOMER][NEUTRAL] It's the same number?
[CUSTOMER][NEUTRAL] It's the same member?
[AGENT][NEUTRAL] Yes, ma'am, it's still [PII]. It's just she had that the 1944, that policy is no longer active, and the active policy is the 255 policy number and that's where your claim was processed under.
[CUSTOMER][NEUTRAL] OK. May I know the claim status for the claim which I given the product the claim number, right? I need the claim status for that.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII]?
[AGENT][NEGATIVE] And it was denied because this is not a covered loss under the plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Non-covered under the plan, under the member's plan?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And it's totally member responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] Oh, you said it's not covered under the member's plan, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And then it's a patient responsibility. OK. And uh may I know the call reference for this claim? I have 2 more claims left for the different number.
[AGENT][NEUTRAL] So there's no call reference number for the entire call. It will be my name and today's date, which is [PII] [PII] [PII] is [PII].
[CUSTOMER][NEUTRAL] OK. And uh can you want the next one? When you're ready.
[AGENT][NEUTRAL] Um, hold on one moment, let me process this this, um, these notes and then we can move on to the next one, OK?
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's going to be 01982113.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. The member's first name is going to be [PII] [PII] The last name is [PII] The date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] the bill amount 193.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's University of Miami Medicine.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So the claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3579255.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied because this is not a covered loss under the plan.
[CUSTOMER][NEUTRAL] But, it's the same reason, right? Not covered under the member's plan?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK, and it's totally member responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK. Then can we move on to the last one, the last number?
[AGENT][NEUTRAL] Yes, hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the next number?
[CUSTOMER][NEUTRAL] Yeah. The next member ID is going to be 02564433.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. The first name is going to be [PII] The last name is [PII] The date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. Again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Yeah, the date of service is going to be one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, the rate of service is going to be 18 of $2025 but the amount of $730 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And would this be the same provider or a different provider?
[CUSTOMER][NEUTRAL] Uh, it's same provider, University of Miami Medicine.
[AGENT][NEUTRAL] Alright, so the claim was received on [PII]?
[CUSTOMER][NEUTRAL] Just one more minute.
[AGENT][NEUTRAL] The claim, OK.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] [PII] it was received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim number is 3582914.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because office visits are not covered on, well, actually, there's a few. So 99205 was denied because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The other three codes I didn't.
[CUSTOMER][NEUTRAL] 99204.
[AGENT][NEUTRAL] 5.
[CUSTOMER][NEUTRAL] It's 4. I'm having the 4. It's 99204.
[AGENT][NEUTRAL] OK, well, the claim that we received.
[CUSTOMER][NEUTRAL] It's still office seat number.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] It's through the office this CPD, right?
[AGENT][NEGATIVE] Right, but the one that was sent over to us is 99205. Regardless, it's denied because office visits are not covered on the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The other 3.
[CUSTOMER][NEUTRAL] It's not covered under the policy?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The other three codes, 8,742,687,880 and 87804 were all denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] The other 3?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, you need the primary UB?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And uh may I know the payer ID to submit it?
[AGENT][NEUTRAL] Sure. So it's 60.
[AGENT][NEUTRAL] 80
[AGENT][NEUTRAL] One.
[CUSTOMER][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] And uh may I know the mailing address to someone?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the effective dates and the update of this number?
[AGENT][NEUTRAL] So the policy is still active and it's been effective since [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. And may I know the timely filing limit to submit the claim? I mean, the submit the UB.
[AGENT][NEGATIVE] There's no timely filing. There's no timely filing.
[CUSTOMER][NEUTRAL] And there is any fax number to somebody?
[AGENT][NEUTRAL] Yes, it's 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] With that in enough.
[AGENT][NEUTRAL] I'm sorry. Attention APL claims department.
[CUSTOMER][NEUTRAL] Attention.
[CUSTOMER][NEUTRAL] APO
[CUSTOMER][NEUTRAL] APO claims.
[AGENT][NEUTRAL] APL like Larry.
[CUSTOMER][NEUTRAL] Oh, APL, OK.
[CUSTOMER][NEUTRAL] Claims Department EPL.
[CUSTOMER][NEUTRAL] OK, and um may I know the call you said that already, right, the one, so.
[AGENT][NEUTRAL] Mhm. I'll just be my name and today's date.
[CUSTOMER][NEUTRAL] Yeah, for the one member responsible for the two claims and the last claim you wanted the UB. OK, thank you for that and uh thank you for helping me today and bye-bye. Take care.
[AGENT][POSITIVE] You're welcome. And was there anything else I can help with?
[CUSTOMER][POSITIVE] No, that's it. Thank you for that.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] Yeah.