AccountId: 011433970860
ContactId: 07788bab-dbfd-4b1f-be3f-1513981a9565
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1494160 ms
Total Talk Time (AGENT): 325772 ms
Total Talk Time (CUSTOMER): 470369 ms
Interruptions: 4
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/07788bab-dbfd-4b1f-be3f-1513981a9565_20250303T21:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, good afternoon. My name is [PII]. My last insured is R as in Romeo. So I would like to check the claim status. Would you be able to help me with that?
[AGENT][NEUTRAL] Yes, ma'am. I can verify claim status for you and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] Yes, sir. The policy number, it is 01742615.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You're welcome. And may I have your name spell with the last name for documentation purpose?
[AGENT][NEUTRAL] Sure. My name is [PII], last initial [PII] and uh [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, sure. The callback number. It is [PII].
[AGENT][NEUTRAL] OK, uh, give me one moment.
[AGENT][NEUTRAL] And verify the patient's name, date of birth.
[CUSTOMER][POSITIVE] Yes, sir. You can take your time.
[CUSTOMER][NEUTRAL] Mhm. Sure. The patient's first name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] It is [PII] with the amount of $80 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Uh, you said the data service 725 of 24, correct, and amount of 80. And what was the balance after primary?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Balance after Prime was $42.96.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] I'm calling from Mercy Clinic.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I show that claim was processed and looks like we paid $42.96. Um, this was processed on, give me a moment, [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. OK. And uh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I yes, thank you so much. And uh you said this claim was paid, right? And may I have the payment information which is like check number, is that a single check or bulk check?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, single check and the check number is 2,025,330.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And what was the issue date?
[AGENT][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] OK. And uh may I know uh whether the check has been cashed or not?
[AGENT][NEUTRAL] I'm showing that it's showing outstanding. The provider has not received the check, um.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So then it can be void and reissued.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And uh may I know what was the uh pay to address the check was sent?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. I think uh that is the incorrect address. Let me confirm that again here. Give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And I'm sure that's the address that was on the claim.
[CUSTOMER][NEUTRAL] Mhm. Yes, actually, that is the incorrect address. That's why I want to confirm that again. So, give me a moment. I'm just checking it here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I really appreciate your patience, [PII]. Uh, kindly give me 2 minutes. I'm looking at here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Come on, come on.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], I'm still looking it here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Just want you to know that I'm still in line, so I really appreciate your patience. I'm just searching it here. I don't know why it doesn't pulling up. Give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][POSITIVE] Yes, I have found it, uh, [PII]. Thank you so much for that. I really appreciate your patience. But in uh double9 form, it shows S [PII]. That is the correct uh pay your address to send, send the check.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, well, that's not the address that was on the claim, and when we process claims, we go by the address on the claim. So if that address was incorrect, then you must submit a corrected claim with the correct mailing address to the provider and we can uh review.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mm. Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, is there any possibilities that we could send the 99 form alone to get it reprocessed?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Uh, can we, uh, submit the W9 form alone to get it reprocessed without submitting me correcting, I mean, correct, uh, claim.
[AGENT][NEUTRAL] No, you must submit a corrected claim because on the claim, it has that address and that's the address we sent the check to. So if that is incorrect, then that must be corrected on the claim and submitted to our office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Mhm. OK. OK. Thank you so much for that. And I do have a few more clients with me. Would you be able to help me with that too?
[AGENT][NEUTRAL] For the same patient or different patient?
[CUSTOMER][NEUTRAL] Different patient.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][POSITIVE] OK. No issues. Take your time.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Well, I
[AGENT][NEUTRAL] Oh, and also just to let you know if you're submitting the correct claim, uh, please also submit a letter stating the reason for the correction.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] OK. And what is the next policy number?
[CUSTOMER][NEUTRAL] OK. Uh, you said we have to submit the letter why uh it was corrected like. Uh, so, uh, uh, I mean, is there any, uh, format that or any, uh, form like a reconsideration that we can send it along with the? OK. Thank you so much.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, just submit a letter stating the reason for the correction, submit a corrected claim.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the policy number? Oh, you're welcome, Ms. [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for
[CUSTOMER][NEUTRAL] OK, the next policy number is 02061534.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, give me one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, uh, to verify claim status for this patient, you will have to contact Web TPA and I can give you their phone number.
[CUSTOMER][NEUTRAL] lot
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] OK, their phone number is [PII].
[CUSTOMER][NEUTRAL] Not
[AGENT][NEUTRAL] [PII], option 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][POSITIVE] OK. Thank you so much for that information.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, whenever I'm ready, I'm ready with my next patient here.
[AGENT][NEUTRAL] OK, what is that policy number?
[CUSTOMER][NEUTRAL] It is 02294, sorry, 7, I mean, let me start over it again. So it is 02279404.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is June, sorry, [PII].
[AGENT][NEUTRAL] OK, and the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] The service, it's [PII] with the bill amount of $84 even.
[AGENT][NEUTRAL] Uh, what's the balance after primary?
[CUSTOMER][NEUTRAL] It is $51.29.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the name of the provider's office?
[CUSTOMER][NEUTRAL] It's Mercy Clinic East Communities.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, she'll say it I keey.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I don't know. I don't know.
[CUSTOMER][NEGATIVE] But I don't wanna.
[AGENT][NEUTRAL] Uh, let's
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] Uh, it looks like the claim, um, let me double check one other thing. Give me one moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, no issues, [PII]. You can take your time.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Well, I'm looking and I show the claim had processed and looks like payment had been sent.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] just
[AGENT][NEUTRAL] I might have to send a request uh someone who claims to review this, uh, but it looks like payment had been sent.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But let me double check one other spot.
[CUSTOMER][NEUTRAL] Yes, in my end also, I could see that there is, there has been a check was uh uh issued and it was not cleared and one of our representative has spoke and requested to reissue the check. And they have said uh the turnaround time is 30 days. So, um,
[CUSTOMER][NEUTRAL] They have uh like uh it done it on [PII].
[AGENT][NEUTRAL] I would just have to send, um, I send a request for this to be reviewed, um.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, we'll get this taken care of, but I'll have to send a request for someone in the claims department to review.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] So, uh, can I have the other information like the process date claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it looks like the claim had processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number 349-864-6.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] May I know, uh, would you be paid to address?
[CUSTOMER][NEUTRAL] Not
[AGENT][NEUTRAL] Uh, this one looks like it was sent to, give me a moment.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Option
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, it looks like it was sent to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, so this needs to be sent to the, uh, correct address. So do we have to submit the correct claim or uh you will send the request to the uh claim?
[AGENT][NEUTRAL] I'll send a request for them to review it, but if that's the incorrect address, we will need to correct the claim with the letter stating the r[PII] for the correction, because on the claim it had that address as the billing provider address.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, no issue. So you have also requested the, uh, requested it to the claims department, right?
[AGENT][NEUTRAL] As I stated, I will send a request to our claims department to review.
[CUSTOMER][NEUTRAL] To review it?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK. OK. Thank you so much. Is there any reference ID that uh we could follow the review?
[AGENT][NEUTRAL] Uh, we don't give reference numbers.
[CUSTOMER][POSITIVE] OK, no issues. Thank you so much, [PII], for the information.
[CUSTOMER][NEUTRAL] And yeah.
[CUSTOMER][NEUTRAL] For the same patient, uh, I have a different date of service with me. Would you be able to help me with that too?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, date of service, amount of the charge.
[CUSTOMER][NEUTRAL] The service, it's [PII] and the charge amount is $126 even.
[AGENT][NEUTRAL] OK. Balance after primary.
[CUSTOMER][NEUTRAL] It was $79.58.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And just
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I might be out there.
[AGENT][NEUTRAL] Uh, and I show this claim processed on [PII] and the check was mailed to any amount of $79.58.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was mailed to [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. Can I have the check address? I mean, sorry, check number?
[AGENT][NEUTRAL] 2025604.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Issue date is same as the process date, right?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. Can I have the claim number?
[AGENT][NEUTRAL] 355-8225
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] 8225. Great. Thank you so much. And I have like uh 4 more clients with me. Would you be able to assist me with that too, [PII]?
[AGENT][NEUTRAL] Hold one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Ah, this woman is getting on my last damn nerve. She's this woman.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.