AccountId: 011433970860
ContactId: f81d8440-e5a5-4649-b9f5-e6641a592b15
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 859969 ms
Total Talk Time (AGENT): 225915 ms
Total Talk Time (CUSTOMER): 302209 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/f81d8440-e5a5-4649-b9f5-e6641a592b15_20250130T20:07_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider's office regarding the claim status.
[AGENT][POSITIVE] Alright, I'm happy to check on a claim for you today. What is the patient's policy number?
[CUSTOMER][NEUTRAL] Sorry, one moment. 016.
[CUSTOMER][NEUTRAL] 22,990 ML 8.
[AGENT][NEUTRAL] Thank you for that. And then may I please have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, patient's first name is [PII]. Last name is [PII].
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII], total bill amount is $237 even.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Alright thank you one moment please.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, may I know which can you provide me, uh, is the name?
[CUSTOMER][POSITIVE] That's good.
[CUSTOMER][NEUTRAL] So that uh.
[CUSTOMER][NEUTRAL] And can you uh can you provide it.
[AGENT][NEUTRAL] Thank you for your patience and waiting on that. So it looks like we did receive the claim. The claim was received on [PII].
[AGENT][NEGATIVE] Claim was denied. Office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim was denied [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need the claim number?
[CUSTOMER][NEUTRAL] May I know the claim number, please? Yes, please.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] 352.
[AGENT][NEUTRAL] 4294.
[CUSTOMER][POSITIVE] 353. Thank you so much. I would like to request that you be for this claim.
[AGENT][NEUTRAL] OK, what's a good fax number, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 353 6
[CUSTOMER][NEUTRAL] Attention on my name.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] OK, I am faxing that now, should be there in about 5 minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you please spell out your name for me for the documentation?
[AGENT][NEUTRAL] My name is spelled [PII].
[CUSTOMER][POSITIVE] Thank you so much and call reference for this claim.
[AGENT][NEUTRAL] It's going to be my last, my first name with my last initial than today's date last initial to my name is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for that. I have 2 more members to verify. Can you please go for it?
[AGENT][NEUTRAL] Uh, yeah, just give me a moment to finish documenting this and then we can move on to the next one.
[CUSTOMER][POSITIVE] Yeah, please take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, I know that, uh, do you, why are you not able to spend this, uh, [PII], 3 week again? Is there any issue?
[AGENT][NEUTRAL] All right. What's the next policy number?
[CUSTOMER][NEUTRAL] 0200
[CUSTOMER][NEUTRAL] 3103 M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] I apologize, [PII], will you give that to me one more time?
[CUSTOMER][NEUTRAL] Yes, please. Sure. 02003103 M as Mary, L as in Lima.
[CUSTOMER][NEUTRAL] Number 7.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you. And patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and then what is the date of service?
[CUSTOMER][NEUTRAL] [PII], total bill amount is $2,862 even.
[AGENT][POSITIVE] Alright thank you one moment.
[AGENT][NEUTRAL] Thank you for your patience in that. So it looks like this claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the claim was denied requesting the primary EOB.
[CUSTOMER][NEUTRAL] Mm. OK.
[AGENT][NEUTRAL] Claim was processed on [PII].
[CUSTOMER][POSITIVE] Mhm. Thank you so much.
[AGENT][NEUTRAL] And the claim number on this one is going to be 351.
[AGENT][NEUTRAL] 639 8.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Did you need this one faxed as well?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, I'm sending that now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have a question. Uh, in, for the previous patient, uh, [PII], uh, the claim was denied for the not eligible for office visits, right? Uh,
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Or can we appeal the claim?
[AGENT][NEUTRAL] Appeals have to be done within 180 days of the decision. Um, the member's plan, yeah, it does not cover office visits, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that EOB has been sent, is there another account we need to check or did you need anything else from this today, [PII]?
[CUSTOMER][NEUTRAL] Yes, I have another account to check.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] It's gonna be the last one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] 021
[CUSTOMER][NEUTRAL] 8919
[CUSTOMER][NEUTRAL] M as Mary, L as in Lima.
[CUSTOMER][NEUTRAL] Number 7.
[AGENT][NEUTRAL] And you said 021-891-9?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's not coming up. Can you repeat it one more time?
[CUSTOMER][NEUTRAL] Sure. 021.
[CUSTOMER][NEUTRAL] 8919.
[CUSTOMER][NEUTRAL] Ms. [PII].
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] Do you have a claim number or anything for this patient?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I do not have the claim number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][POSITIVE] Thank you for your patiencely waiting. Uh, I'm, I'm very sorry that I missed the number because in, in our documentation it is mentioned incorrectly. I just verified with the insurance card.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 02189.
[CUSTOMER][NEUTRAL] 197
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, OK. Let's take a look at that moment.
[CUSTOMER][POSITIVE] good.
[AGENT][POSITIVE] Thank you so much. And then what is the patient's name and date of birth on this?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII], and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII] and total bill amount is $4,288 even.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This in the lot.
[AGENT][NEUTRAL] All right, thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so it looks like we did receive this claim on [PII].
[AGENT][NEUTRAL] Uh, the claim was denied [PII]. We received the primary explanation of benefits, however, it does not list the amounts that were applied towards the deductible, co-pay or co-insurance, so we need a more detailed explanation of benefits for further consideration.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for that.
[AGENT][NEUTRAL] Claim number on this one is 354-073-3.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or can we submit the detailed explanation of AOB?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, uh, my question is, how can we submit the detailed EOP?
[AGENT][NEUTRAL] It can be submitted via fax, um, or sent in the US postal mail.
[CUSTOMER][NEUTRAL] OK. Do I have the main number?
[AGENT][NEUTRAL] Uh, the address is going to, yeah, the address is going to be at uh [PII].
[CUSTOMER][NEUTRAL] What is the name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] attention claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the fax number is 877.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yeah, that's it from my end. Thank you for patiently assisting today.
[AGENT][POSITIVE] You're welcome. Have a good day. Bye-bye.
[CUSTOMER][POSITIVE] Have a great day. Bye-bye. Take care.