AccountId: 011433970860
ContactId: 057a7cf1-f69d-44f2-a14e-02f2459806a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 538739 ms
Total Talk Time (AGENT): 116108 ms
Total Talk Time (CUSTOMER): 120364 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/057a7cf1-f69d-44f2-a14e-02f2459806a9_20250620T15:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from provider office check claim status.
[AGENT][POSITIVE] Great, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh yes, the callback number is [PII].
[AGENT][NEUTRAL] OK, you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yes. Uh, the member ID number is um.
[CUSTOMER][NEUTRAL] It is 02443352.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Number is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Their service is [PII] with the total charge of $1,273 even.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that was received on [PII] process [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Oh, it looks like that was a duplicate. Let me find the original.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, original claim was received 8-16-24, processed 8-2124.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We paid 8173 with a single check.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you need the check number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Uh, yes, thank you.
[AGENT][NEUTRAL] Uh, check number 1869285.
[CUSTOMER][NEUTRAL] And is there any patient responsibility?
[AGENT][NEUTRAL] Um, we can't determine patient responsibility since we're a secondary policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and can you also please provide me the allowed amount?
[AGENT][NEUTRAL] Um, it's, there's not like an allowed amount. This is secondary, so we just pay according to the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh thank you. And can you also please uh confirm the mailing address where it was paid to?
[AGENT][NEUTRAL] Uh, mailing address was
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEGATIVE] Looks like the check has been voided though.
[CUSTOMER][POSITIVE] OK, uh thank you so much.
[AGENT][NEUTRAL] seeing what's the
[CUSTOMER][NEUTRAL] Uh, you said, uh, the check is voided?
[AGENT][NEUTRAL] Yes, we sent a letter on [PII] to that mailing address.
[AGENT][NEGATIVE] Um, regarding the check was never cashed.
[CUSTOMER][NEUTRAL] That one.
[CUSTOMER][NEUTRAL] OK, check
[CUSTOMER][NEUTRAL] Let's see uh.
[CUSTOMER][NEUTRAL] OK, uh, thanks so much, [PII] and [PII], do you also have a reference number for our call?
[AGENT][NEUTRAL] Reference number is my name, [PII], first initial to last name [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much [PII]. And [PII], before you hang up, I do have one more claim. Can you help me with that as well?
[AGENT][NEUTRAL] Uh, yes, give me one moment. Is it for the same patient or a different one?
[CUSTOMER][NEUTRAL] Uh, different patient.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is 2,473,050.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And data service and bill charges?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Their of service is [PII]. The total charge is $724 is that?
[AGENT][NEUTRAL] OK, it looks like we received the claim 11-1-2024. Process 114-2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, it looks like benefits are only payable if major medical insurance provides benefits.
[AGENT][NEUTRAL] If the claim is later paid, we would need a copy of the explanation of benefits.
[CUSTOMER][NEUTRAL] Uh, so you need a copy of EOB by, uh, by the primary.
[AGENT][NEGATIVE] No, we received the primary EOB, but the primary EOB did not show anything was considered on the claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we would need a copy of the EOB showing how it applied to deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK, but.
[AGENT][NEUTRAL] If it doesn't show that then we can't process the claim.
[CUSTOMER][POSITIVE] OK. Uh, thank you so much.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. Thanks for the information. You have a good day. Bye-bye and take care.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye bye.