AccountId: 011433970860
ContactId: f747a07e-a9ab-4216-baf3-cd81a4e6f30f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1181040 ms
Total Talk Time (AGENT): 199408 ms
Total Talk Time (CUSTOMER): 536644 ms
Interruptions: 5
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/f747a07e-a9ab-4216-baf3-cd81a4e6f30f_20250612T13:43_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] calling for the provider to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So may I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] Do you have a phone number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] Calling from
[CUSTOMER][NEUTRAL] It's [PII]. It's a direct line.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 01617049 M as in Mike L as in Lima 8 and the number 8 at the end.
[AGENT][NEUTRAL] And the patient's name?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][NEUTRAL] Thank you [PII] and you were needing claim status?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, I can help you with that one day of service.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] And the total bill amount will be $100 OK, the total bill amount is $213 even.
[AGENT][NEUTRAL] OK, hold on one moment please.
[AGENT][NEUTRAL] And that was 225 of 25.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] No claim on file.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, just a second, bear with me.
[CUSTOMER][NEUTRAL] $213 even OK.
[CUSTOMER][NEUTRAL] to see just what your payment.
[CUSTOMER][NEUTRAL] Could you please help me with the, is the member active on the date of service?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, they are active for that data service.
[CUSTOMER][NEUTRAL] As you say.
[CUSTOMER][NEUTRAL] Ms effective date and term date.
[AGENT][NEUTRAL] There is no term date. It's still active. The effective date is [PII].
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] OK, [PII]. Perfect. OK. Are you primary or secondary for the member?
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Do you have any information regarding the coordination of benefits? When was the last coordination of benefits were updated?
[AGENT][NEUTRAL] We only do the coordination of benefits when we receive the claim in.
[CUSTOMER][NEUTRAL] OK just one
[CUSTOMER][NEUTRAL] OK, so it was never updated.
[CUSTOMER][NEUTRAL] OK, may I know your name?
[AGENT][NEUTRAL] It usually comes with the claims, so.
[CUSTOMER][NEUTRAL] Am I right?
[AGENT][NEUTRAL] We don't get the updated coordination of benefits. This is just a secondary policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So you don't update the coordination of benefits, am I right?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and could you please help me with the claim submission timely filing limit?
[AGENT][NEGATIVE] We do not have timely filing.
[CUSTOMER][NEUTRAL] age
[CUSTOMER][NEUTRAL] What will be the claim mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Could you please repeat again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. And what will be the pay ID?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] And the preferred mode of submission will be either both electronic and paper.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] And the call reference number will be your name and today's date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, perfect. Just a second. And shall we move to the next claim?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[CUSTOMER][NEUTRAL] Date of birth is the [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] of services for [PII] and this is 493001.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] I'm sorry, I'm sorry, sorry.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Are you there [PII]?
[CUSTOMER][NEUTRAL] It's 7712751.
[CUSTOMER][NEUTRAL] Uh, [PII], are you there?
[CUSTOMER][NEUTRAL] Are we still connected?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes we are. I'm having I'm putting notes in our system, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, yes, the name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and the amount is $252.38.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, how many claim statuses do you have?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I do have more 4 claims on the file.
[AGENT][NEUTRAL] I can help you with 2 more, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the next policy number?
[CUSTOMER][NEUTRAL] Yeah. The next policy number will be 683-892-159.
[AGENT][NEUTRAL] That's not one of our policy numbers. We don't have that many.
[AGENT][NEUTRAL] Policy number, numbers in our policy numbers.
[CUSTOMER][NEUTRAL] OK, so could you please check with the name?
[CUSTOMER][NEUTRAL] People difference would be.
[AGENT][NEUTRAL] OK. What's the name?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The member's first name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what state is he in?
[CUSTOMER][NEUTRAL] Mm mm mm.
[CUSTOMER][NEUTRAL] State is [PII].
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] And you know what I
[AGENT][NEUTRAL] I don't have a [PII] in [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You don't have [PII] in [PII]?
[AGENT][NEUTRAL] I do not.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Do you have the social security number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And just a second, yeah, I do have the social security number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] And what is that?
[CUSTOMER][NEUTRAL] Yeah, [PII]ve me.
[CUSTOMER][NEUTRAL] Yeah, just a second, it's loading.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I do not have that.
[AGENT][NEUTRAL] Social security number in my system.
[CUSTOMER][POSITIVE] OK, perfect. Let's move to the next claim.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] But you.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Yeah yeah.
[CUSTOMER][NEUTRAL] The next policy number is 02405479 M as in Mike L as in Lima and the number 8.
[AGENT][NEUTRAL] Patient's name?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is
[CUSTOMER][NEUTRAL] [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Data service?
[CUSTOMER][NEUTRAL] Uh, date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the date of services.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Procedure code?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Procedure just a second.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 69,210.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah that's.
[AGENT][NEUTRAL] And what's the total charge?
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] $295.06.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was the total charge for that one procedure code or was there more procedure codes on that bill?
[CUSTOMER][NEUTRAL] There are more procedure codes on that.
[CUSTOMER][NEUTRAL] I send you.
[AGENT][NEUTRAL] I have that date of service and have that procedure code but not that bill amount.
[CUSTOMER][NEUTRAL] Just a second, let me double check with the bill amount.
[CUSTOMER][NEUTRAL] Do you have any claim on file for the $75 even $75.04?
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] I have one for 7506.
[CUSTOMER][NEUTRAL] 754 6.
[CUSTOMER][POSITIVE] Yeah, yeah. It's correct. 756.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] OK, we did get that claim in. It was denied. Anything done in the doctor's office is not covered.
[CUSTOMER][NEUTRAL] OK. Receive the denial date and the claim number.
[AGENT][NEUTRAL] Claim number 3582793.
[AGENT][NEUTRAL] It was received 327-25.
[AGENT][NEUTRAL] And it was processed 33125.
[CUSTOMER][NEGATIVE] It's not.
[CUSTOMER][NEUTRAL] 331, just 331 2025 and the claim number is 3582793. Am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And could you please tell me, uh, have you received any recent claim on file?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For that data service?
[CUSTOMER][NEUTRAL] Yes, and the for same bill amount.
[AGENT][NEGATIVE] Yes, and it was denied as a duplicate.
[CUSTOMER][NEUTRAL] OK. Could you please help me with the received date, denial date, and the claim number for the duplicate one?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] The claim number 359.
[AGENT][NEUTRAL] 4561.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You know
[AGENT][NEUTRAL] It was received 4 25 25.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] And it was denied.
[AGENT][NEUTRAL] 428 25.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] 2025.
[CUSTOMER][POSITIVE] OK, perfect. And could you please help me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Office visits are not covered, am I right?
[AGENT][NEUTRAL] Office visits or anything done in a doctor's office is not covered.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Post office.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yes, OK, perfect. Uh, and it's not got under the member's plan, am I right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, which CPT code is not covered under the member's plan?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Which CPT code is not covered under the member's plan?
[AGENT][NEGATIVE] None of the ones that was on that bill.
[CUSTOMER][NEUTRAL] OK, all the CPT codes are not covered. Am I right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and policy timely filing, what will be the timely filing limit to submit the corrected claim?
[AGENT][NEGATIVE] We do not have timely filings.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The address will be the same which you gave me for the previous one.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And for the time, uh, for appeal, that is also remains same.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For the what now?
[CUSTOMER][NEUTRAL] Uh, for the mailing address to submit an appeal, the address will remain the same.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, what will be timely filing limit to submit an appeal?
[AGENT][NEGATIVE] We do not have timely falling.
[CUSTOMER][NEUTRAL] OK, is there any specific form for an appeal?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. Do you require denied UB while submitting the claim or while submitting the corrected claim or an appeal?
[AGENT][NEUTRAL] Do what now?
[CUSTOMER][NEGATIVE] Denied EUB.
[AGENT][NEUTRAL] What about it?
[CUSTOMER][NEUTRAL] Do you require the copy of denied EUB while submitting the corrected claim or an appeal?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] but it's like it's been 2025.
[CUSTOMER][NEUTRAL] OK, shall we move to the next one?
[AGENT][POSITIVE] I've helped you with 3 already.
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] OK, so could you please transfer my call back in the queue.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day, OK?
[CUSTOMER][POSITIVE] Yeah that's gonna be good.
[CUSTOMER][NEUTRAL] Bye bye.