AccountId: 011433970860
ContactId: fcb4fd9b-c965-4796-8996-150d19b15321
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 875140 ms
Total Talk Time (AGENT): 276442 ms
Total Talk Time (CUSTOMER): 399428 ms
Interruptions: 17
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/fcb4fd9b-c965-4796-8996-150d19b15321_20250131T18:17_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. 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][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and how many claims [PII] do you have?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Um, I have 2 claims for the day.
[AGENT][NEUTRAL] OK. Are they for the same patient or different patients?
[CUSTOMER][NEUTRAL] Uh, it is for the different patient.
[AGENT][NEUTRAL] OK, so you will use my, I can help you with both. And a few things, um [PII] for you to know, you will use my name that I gave you along with today's date. If you need a call reference number.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, can you please spell out your name for me?
[AGENT][NEUTRAL] Also, any information that I do.
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] And any information, uh, you're welcome that I provide for you will be a verification of benefits and not a guarantee of payment. And lastly, [PII], if we do have the claims on file and you need a copy of either of the explanation of benefits, you may obtain those by going to our portal and printing them, and the website for our portal is [PII]. [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so what is your first patient policy number, please?
[CUSTOMER][NEUTRAL] OK. 01963652.
[AGENT][NEUTRAL] 01966652. Is that correct?
[CUSTOMER][NEUTRAL] No, it's 01963652.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII]. Last name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] that.
[AGENT][NEUTRAL] And what is the date of service and total bill amount please, [PII]?
[CUSTOMER][NEUTRAL] [PII] and total bill amount is $396 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] No. [PII].
[AGENT][NEUTRAL] And you did say [PII]. Is that correct?
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] And the total bill amount is 396, is that correct?
[CUSTOMER][NEUTRAL] $71230245.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for this member for that data service and that total bill amount.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because this is a supplemental policy to her primary insurance or his primary insurance, you must also send us a copy of the primary insurance company's explanation of benefits along with the claim for our review.
[CUSTOMER][NEUTRAL] OK. Can you please?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, give me a moment. Mm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And upon checking here.
[CUSTOMER][NEUTRAL] Um, we already sent an uh explanation of benefits of the primary payer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] And uh
[AGENT][NEUTRAL] OK, we do not have a claim on file for a total bill amount of 39396. We do not have that on file.
[CUSTOMER][NEUTRAL] Mm claim was all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. Can you please provide me the policy effective date and term date of the member?
[AGENT][NEUTRAL] The effective date is [PII]. There is no term date.
[AGENT][NEUTRAL] Policy is active.
[CUSTOMER][POSITIVE] Mhm. OK, thank you.
[AGENT][POSITIVE] Mhm, you're welcome.
[CUSTOMER][NEUTRAL] OK. And uh what is the timely filing limit to submit the claim?
[AGENT][NEGATIVE] There is no, there is no timely filing limit.
[CUSTOMER][NEUTRAL] Yes, timely filing limit to submit the claim.
[AGENT][NEGATIVE] None 0 that we do not have a timely filing. There is no timely filing limit.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And uh what is the payer ID and mailing address so that we can resend the claim?
[AGENT][NEUTRAL] OK, what did you show on file?
[AGENT][NEUTRAL] And I can verify if that's correct or not.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. 60801 is the payer ID.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] I can see.
[CUSTOMER][NEUTRAL] OK. And uh mailing address is [PII], [PII], [PII].
[CUSTOMER][NEUTRAL] Sorry, it's [PII].
[AGENT][NEUTRAL] Yes, [PII], [PII]. Mhm.
[CUSTOMER][NEUTRAL] And [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the ZIP code.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that is also the correct payer ID.
[CUSTOMER][NEUTRAL] And can we go for another claim number?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][POSITIVE] OK. Thank you for that. And can we go on.
[CUSTOMER][NEUTRAL] Can we go for another member ID?
[AGENT][NEUTRAL] Just one moment, please.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK, and what is the next patient's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 252-40.
[AGENT][NEUTRAL] OK, that's not a policy number.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] Mhm. OK. Give me one moment.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEGATIVE] Yeah, no.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sorry, it is, I think it is a group number.
[AGENT][NEUTRAL] Mhm. There should be another number on the ID card.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 30
[CUSTOMER][NEUTRAL] 4876
[AGENT][NEUTRAL] Was that 48?
[CUSTOMER][NEUTRAL] M as Mary, L as Lim.
[CUSTOMER][NEUTRAL] 4876
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima.
[CUSTOMER][NEUTRAL] And 7.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth.
[CUSTOMER][NEUTRAL] My first name is [PII] and last name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] And the date of service place and total bill amount.
[CUSTOMER][NEUTRAL] [PII] and total bill amount is $410 even.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 77.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You need to.
[CUSTOMER][NEUTRAL] 73997.
[CUSTOMER][NEUTRAL] Um, so.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] but
[AGENT][NEUTRAL] OK, so this claim was received by APL and just one moment and I'll provide you that information. This claim was received.
[CUSTOMER][POSITIVE] You love that.
[AGENT][NEUTRAL] On 3-11-2024.
[AGENT][NEUTRAL] It was processed and denied on 3-13-2024.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 343-0754.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And the reason for the denial is office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The patient's plan, the member's plan does not cover office visits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I would like to request the denial you before this claim.
[AGENT][NEUTRAL] Yes, so I gave you the website. You may print that at [PII]. Now that you have the claim number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any chance of faxing the UOB?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It's still trying to load the information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And the fax will only make so many attempts to go through. So if the line is busy and it's doesn't go through, then you would just need to print that from the portal that I gave you.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's it from my end for today.
[AGENT][NEUTRAL] OK, and what, um, well, just a moment, [PII].
[CUSTOMER][POSITIVE] Thank you for your patiencely assisting.
[AGENT][NEUTRAL] Well, just a moment.
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] I'm gonna try and fax this one to you, so does it need to be put to your attention?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Are you the only [PII]? What's the first initial to your last name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your fax number please [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, again, that's [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so I have faxed that to you, so provided that your fax line is open and able to receive that, you should be receiving that very shortly.
[CUSTOMER][POSITIVE] Thank you so much for your assistance.
[AGENT][POSITIVE] You're very welcome. And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No, I've done my time.
[AGENT][POSITIVE] OK, well then, thank you for calling APL [PII]. I hope you have a nice weekend.
[CUSTOMER][POSITIVE] A you the same. Bye-bye. Thank you.
[AGENT][POSITIVE] Uh, thank you. Bye.