AccountId: 011433970860
ContactId: 0195af26-e37e-445e-9260-ff3a082192c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322739 ms
Total Talk Time (AGENT): 114849 ms
Total Talk Time (CUSTOMER): 109383 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/0195af26-e37e-445e-9260-ff3a082192c1_20250418T21:53_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, good afternoon. Uh, I am a provider and, uh, would like to ask you some questions.
[AGENT][NEUTRAL] OK. Uh, may I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Um, may I have a call back number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. And may I have uh the name of the facility or the provider you're calling from?
[CUSTOMER][NEUTRAL] The facility name is Haiti Limos Inc.
[AGENT][NEUTRAL] OK. Do you have a policy number for me, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes, 024.
[CUSTOMER][NEUTRAL] 969.
[CUSTOMER][NEUTRAL] 29.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is uh [PII].
[AGENT][POSITIVE] Thank you. And how may I assist you with this number?
[CUSTOMER][NEUTRAL] Yeah, I submit to you a claim that was.
[CUSTOMER][NEUTRAL] Supposed to be denied by Aetna, the private insurance, and then I submit to you to be covered.
[CUSTOMER][NEGATIVE] You are the secondary, and I received, I just received a letter from you saying that uh it was denied. So before I call the patient, I was wondering why did you deny it.
[AGENT][NEUTRAL] What is the claim number?
[CUSTOMER][NEUTRAL] Is
[CUSTOMER][NEUTRAL] Claim number 358.
[CUSTOMER][NEUTRAL] 9042.
[AGENT][NEUTRAL] OK, let me pull the image on that. One moment.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] OK, um, gonna be one more minute.
[AGENT][NEUTRAL] OK, so there are 2 denial reasons. Um, there's some codes that are just not covered.
[AGENT][NEUTRAL] Um, and then there's some that are denied indicating that the insured sent a claim. So it was already processed under the insured.
[CUSTOMER][NEUTRAL] What, what? Say again, the insurance what again?
[AGENT][NEUTRAL] The insured has submitted a claim, so it was processed under the insured. Yeah, the insured, the owner of the insurance.
[CUSTOMER][NEUTRAL] The insured
[CUSTOMER][NEUTRAL] And, and how is that possible if
[AGENT][NEUTRAL] They send the claim before we receive the provider's claim.
[CUSTOMER][NEUTRAL] I didn't
[CUSTOMER][NEGATIVE] I didn't get it.
[CUSTOMER][NEUTRAL] So, now I have the situation.
[AGENT][NEUTRAL] You need to send that, you need to send the bill back to the insured.
[CUSTOMER][NEUTRAL] I, when I called you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That that's weird.
[CUSTOMER][NEUTRAL] His words, so I'm gonna call him.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Because I remember when I called you, you said I just go ahead and do the treatment and submit to me the claim that's what I did.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like how is that possible he, he, he cleaned it?
[AGENT][NEUTRAL] He signed a claim.
[CUSTOMER][NEUTRAL] If uh
[AGENT][NEUTRAL] It's normal. It's a no if they submit the claim their sales and we get their claim before we get the provider's claim, we'll go ahead and process their claim first. um, by the time you receive your submission, he already sent the claim in for that same date of service and the same charges.
[CUSTOMER][NEUTRAL] OK, I got
[CUSTOMER][NEUTRAL] OK. And how much did you pay him? Because I sent you $2,073.
[AGENT][NEUTRAL] We can uh release that information.
[AGENT][NEUTRAL] We cannot release that information.
[CUSTOMER][POSITIVE] I'm gonna call him right now. I'm gonna call him right now. Let's see what he say. Thank you.
[AGENT][NEUTRAL] Yeah, you just need to send the bill to him, to the insured, OK?
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, do I, do I, do you have a, may I have a, uh, uh.
[CUSTOMER][NEUTRAL] Conversation number for this call ID number.
[AGENT][NEUTRAL] We, we don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Your name is?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, I'm gonna call you right now. Thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling APO. Have a good day.
[CUSTOMER][POSITIVE] Yeah for you.
[AGENT][NEUTRAL] Bye-bye, Mr. [PII].