AccountId: 011433970860
ContactId: ffd1ffe3-0cb8-4d36-b29f-1222139d82c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 656619 ms
Total Talk Time (AGENT): 264810 ms
Total Talk Time (CUSTOMER): 300287 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/ffd1ffe3-0cb8-4d36-b29f-1222139d82c1_20250225T18:20_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] Hello, [PII]. My name is [PII]. I'm calling from the provider's office. I, and I just need your help in the claim.
[AGENT][POSITIVE] OK, I'm so sorry.
[CUSTOMER][NEUTRAL] So my name is spelled as
[AGENT][NEGATIVE] Yes, spell your name for me because I'm having trouble hearing you.
[CUSTOMER][NEUTRAL] Mhm. Sorry?
[CUSTOMER][NEUTRAL] Uh, just a minute. Now it's OK, or?
[AGENT][POSITIVE] That's better. That is better.
[CUSTOMER][NEUTRAL] Mm mhm. OK. So my name is [PII], spelled as [PII]. It's [PII] and my last initial is [PII].
[AGENT][NEUTRAL] Thank you. And I do you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Uh, I need the claim status.
[AGENT][POSITIVE] Yes, I can help you with that and [PII], what is your call back number?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] It's [PII]. And [PII].
[CUSTOMER][NEUTRAL] Please
[AGENT][NEUTRAL] OK, that was [PII]. Is that correct? [PII].
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Thank you and I wonder how many claims do you have to check status on?
[CUSTOMER][NEUTRAL] Uh, only one.
[AGENT][NEUTRAL] OK, what is your patient's policy number, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] insurance, OK. Uh, so my patient's ID number is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Again, I'm starting to have trouble hearing you again, [PII]. Did you say 02137783?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I'm really sorry for that trouble, but I can't do anything because my mic is uh just in front of my
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] Yeah, so we, we'll do the best we can. I'll just let you know if it starts fading out to where I'm having too much trouble hearing you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then and any information that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII]. And the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Sure. The date of service is [PII].
[CUSTOMER][NEUTRAL] [PII] with the amount of $290 290.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1112.
[AGENT][NEUTRAL] OK, so [PII], we do not have a claim on file for this number for that data service and total bill amount.
[CUSTOMER][NEUTRAL] You don't know the bill, mm.
[AGENT][NEUTRAL] You said the billed amount is 290. Is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Was there no claim on file.
[CUSTOMER][POSITIVE] The member is correct, right?
[CUSTOMER][NEUTRAL] The member's name is Mr. uh
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] You said [PII]. [PII], with that date of birth that you gave me, there is no claim on file for that data service and build them out. You said the date of service is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes sir no claim on.
[CUSTOMER][NEUTRAL] OK. Can you please check uh on uh [PII]?
[AGENT][NEUTRAL] And the total bill amount for that data service?
[CUSTOMER][NEUTRAL] With the bill amount of?
[CUSTOMER][NEUTRAL] It's 222, that is $220.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim was received. One moment, I'll provide you that information.
[CUSTOMER][NEUTRAL] And this one
[AGENT][NEUTRAL] Yes, this claim was received on a, you already have that information?
[CUSTOMER][NEUTRAL] Uh, actually, I have that.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes, I was just checking that the patient is uh that my information is correct or not that for this claim.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this one, so this one you, uh, you didn't receive, right? The [PII], right?
[AGENT][POSITIVE] Uh, I'm so sorry.
[CUSTOMER][NEUTRAL] So I'll just do the refill.
[AGENT][NEUTRAL] You need to file the claim, yes, so you need to file the data service 12-18, and you also need to include a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] So you didn't
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Uh, OK, and there's one more bit of service.
[AGENT][NEUTRAL] Along and then
[AGENT][NEUTRAL] OK, well, just one moment because, OK, give me just one moment. I'm sorry. And you didn't say that you had multiple dates of service for this member so just one moment please.
[CUSTOMER][NEUTRAL] of January.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] No, not, no.
[CUSTOMER][NEUTRAL] Not, uh, just last date of service.
[CUSTOMER][NEUTRAL] I just want to know that this one is uh on the claim is not uh on file or not.
[AGENT][NEUTRAL] OK, what is, what is the data service and total bill, uh, yes, data service and total bill amount, please.
[CUSTOMER][NEUTRAL] Just confirm.
[CUSTOMER][NEUTRAL] Mhm yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 2025.
[CUSTOMER][NEUTRAL] With bill amount of $290 290 dollars.
[AGENT][NEUTRAL] OK, and you said that's [PII] for 290, correct?
[CUSTOMER][NEUTRAL] Yes, correct. 290.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, so we do not have for 290, no, sir, there is no claim on file for that bill amount.
[CUSTOMER][NEUTRAL] You have any claim on file for the date of service?
[AGENT][NEGATIVE] Not for the billed amount that you're providing for me.
[CUSTOMER][NEUTRAL] Like, uh,
[CUSTOMER][NEUTRAL] OK. So I think the bill amount is then, just a minute.
[CUSTOMER][NEUTRAL] Which one is it for?
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][NEUTRAL] It's 104.
[AGENT][NEUTRAL] We do have a claim on file for that billed amount. So is the billed amount 104 or 290?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Actually, we have two CPTs and uh for primary, we have uh the primary has paid the second CPT as a whole uh whole uh uh.
[CUSTOMER][NEUTRAL] Allowed amount. So that's why the only one CPT is on your side.
[AGENT][NEUTRAL] OK, so the claim, OK.
[CUSTOMER][NEUTRAL] So you have the claim. Mhm.
[AGENT][NEUTRAL] For $104. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Do you already have that claim number as well?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Uh, actually, no, no.
[CUSTOMER][NEUTRAL] I just need full information.
[AGENT][NEUTRAL] So that claim number is 3558776.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $60.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was paid on single check, 202582-6.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh claim number, it's, it's paid on, paid on?
[CUSTOMER][NEUTRAL] It has paid on?
[AGENT][NEUTRAL] Yes, sir. You're needing the date.
[CUSTOMER][NEUTRAL] The payment
[CUSTOMER][NEUTRAL] The payment date, yes.
[AGENT][NEUTRAL] Was issued on [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, OK. Thank you so much for this one. And can you please confirm me that uh for date of service of [PII] with the bill, uh 104 bill amount?
[AGENT][NEUTRAL] OK, so is this a different claim or you're changing the billed amount for that data service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No. The same is also there because uh Cigna is the primary for this patient. So the Cigna has been
[AGENT][NEUTRAL] Is it
[AGENT][NEUTRAL] Cause you had given me 290. Uh-huh.
[CUSTOMER][NEUTRAL] Actually Cigna has paid for the full whole allowed amount of the, for 11 of the claim. That's why on your side there's only one CPT.
[CUSTOMER][NEUTRAL] That's why it's showing that you are, you only one separate.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And what is the amount?
[CUSTOMER][NEUTRAL] It's 104.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Actually, there's 20 as a.
[AGENT][NEUTRAL] So that.
[AGENT][NEUTRAL] OK, so this claim.
[CUSTOMER][NEUTRAL] $20 for transfer. Mhm.
[AGENT][NEUTRAL] Was received for 104. The claim number is 355914.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] There was a benefit paid in the amount of $20.
[AGENT][NEUTRAL] And that was paid on single check.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The check number is 202.
[AGENT][NEUTRAL] 4643.
[CUSTOMER][NEUTRAL] Done.
[AGENT][NEUTRAL] And the check that check was issued on [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for this one. Can you please spell me your good name for, can you please spell me your good name?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] [PII] yes, [PII], and my name along with today's date will be your call reference number.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. uh.
[CUSTOMER][NEUTRAL] [PII] sir, right? It's [PII], sir.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, OK, [PII], uh, I'm sorry.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you so much, [PII], for this information. I really appreciate it.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] You're welcome. You're certainly very welcome. And if that's all then that I can, oh, well you too [PII] and thank you again for calling APL if that's all I can help you with.
[CUSTOMER][POSITIVE] And have a good day.
[CUSTOMER][NEUTRAL] Mhm I got
[CUSTOMER][POSITIVE] Mhm. Have a good day.
[AGENT][POSITIVE] Uh, you too. Thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK.