AccountId: 011433970860
ContactId: fe98c657-d508-49e4-8be5-917303719f28
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406359 ms
Total Talk Time (AGENT): 148677 ms
Total Talk Time (CUSTOMER): 165874 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/fe98c657-d508-49e4-8be5-917303719f28_20250321T14:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. So I was wanting to know like some information regarding a claim for a patient.
[AGENT][NEUTRAL] OK, and Cat, what is your callback number please?
[CUSTOMER][NEUTRAL] Give me just one second. It's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is your policy number, please? You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Give me just one second. Oh, may I ask you please, uh, the initial of your last name?
[AGENT][NEUTRAL] Yes, the initial of my last name is [PII], first name is [PII].
[CUSTOMER][POSITIVE] Thank you so much. So the member ID you told me, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] For this one, it's gonna be 01755342.
[AGENT][NEUTRAL] OK, I have that as 01755342 and verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] This is gonna be [PII], and the date of birth is on [PII].
[AGENT][NEUTRAL] OK, thank you. And also cat, you're able to check claim status by visiting our secure portal at [PII] and on that website you'll be able to obtain EOBs. You're welcome. And what is that date of service for this member?
[CUSTOMER][POSITIVE] Thank you so
[CUSTOMER][NEUTRAL] It was on [PII].
[AGENT][NEUTRAL] OK, thank you and what are the charges, please? Pillow charges.
[CUSTOMER][NEUTRAL] It was $195.
[AGENT][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] $195. OK.
[AGENT][NEUTRAL] OK, I believe I have it claim here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, shows that we received the claimant denied as services were rendered after the policy term. Um, this claim was received on [PII] and processed and denied on [PII].
[CUSTOMER][NEGATIVE] OK, and it was denied because the, you told me that the patient wasn't having coverage active for that.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Gotcha.
[CUSTOMER][POSITIVE] OK, thank you so much. Uh, let me see. It's OK if I ask you for another patient?
[AGENT][NEUTRAL] Uh, one moment.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] You're welcome. Do you need that claim number so you can get that off that, um, you'll be off the website?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, that claim number is 352-4096.
[CUSTOMER][POSITIVE] 096. Thank you so much.
[AGENT][NEUTRAL] Mhm you're welcome one moment please.
[AGENT][NEUTRAL] OK, [PII], what is the policy number?
[CUSTOMER][NEUTRAL] Thank you. Uh, also, I want to ask you before we go with the next patient. So I have a few claims for different patients, and like most of them share like the same, the same, I don't know, like the same cartridges, I will say.
[CUSTOMER][NEUTRAL] So first we have the primary insurance and they made payments towards the claim and then they left like a remaining amount that is marked as a co-pay or sometimes it's a deductible, co-insurance. So I would like to know if you guys usually cover this type of amount or it's not like worth it to try to.
[AGENT][NEUTRAL] Well, as a supplemental, as a supplemental carrier, we do help with deductible, co-pay, and co-insurance, but it's based on coverage with us.
[CUSTOMER][NEUTRAL] To look for them.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][POSITIVE] OK. Gotcha. Thank you so much. Uh-huh.
[AGENT][NEUTRAL] And again that you're welcome. And again that website is [PII]. What is the um policy number please? Yes, to check claim status.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, so for the next one is gonna be 0182.
[CUSTOMER][NEUTRAL] 34
[CUSTOMER][NEUTRAL] 20.
[AGENT][NEUTRAL] OK, verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] This is gonna be [PII], and the date of birth, it was [PII].
[AGENT][NEUTRAL] OK, and what's that date of service and charge amount?
[CUSTOMER][NEUTRAL] It was on [PII]. It was for $2440.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It shows that the claim was received and we are requesting the explanation of benefits from the primary insurance provider.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] And where we can send the explanation of benefits?
[AGENT][NEUTRAL] You can send it to us with our payer ID of 60801.
[CUSTOMER][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and we have a fax number as well. Our fax number is [PII].
[CUSTOMER][NEUTRAL] 59423. OK.
[AGENT][NEUTRAL] OK, and that claim number is 3543371.
[CUSTOMER][NEUTRAL] 254354.
[AGENT][NEUTRAL] 3543371.
[CUSTOMER][NEUTRAL] 3371. OK. Got it.
[CUSTOMER][POSITIVE] Thank you so much. That was really helpful.
[AGENT][POSITIVE] You're welcome. You're welcome.
[CUSTOMER][NEUTRAL] So I think that's gonna be all for today. May I have please a reference number for the call?
[AGENT][NEUTRAL] You're welcome. Thank you. My reference number will be my name, [PII] last initial [PII], and today's date. We do not provide reference numbers, cat.
[CUSTOMER][POSITIVE] OK, no worries. Thank you so much.
[AGENT][POSITIVE] Thank you for calling APL.
[CUSTOMER][POSITIVE] So, thank you for
[CUSTOMER][POSITIVE] Thank you for all your help. Have a wonderful rest of your day, OK?
[AGENT][POSITIVE] You as well, OK, thanks for calling APL. Take care bye.
[CUSTOMER][POSITIVE] Thank you, bye bye.