AccountId: 011433970860
ContactId: 089eca9f-da5b-43d0-b3b5-ed462f79302a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 599700 ms
Total Talk Time (AGENT): 142505 ms
Total Talk Time (CUSTOMER): 326472 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/089eca9f-da5b-43d0-b3b5-ed462f79302a_20250114T18:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good afternoon [PII]. My name is [PII]. I'm from the Trident Surgery Center billing department, and this call today is to follow up on the status of a claim that was requesting medical records, please, and they were faxed over, uh, like about 5 days ago.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I can assist you. What's the policy number?
[CUSTOMER][NEUTRAL] The policy number is 02550705.
[AGENT][NEUTRAL] What's a good phone number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and you said you're calling on behalf of the provider's office?
[CUSTOMER][NEUTRAL] Yeah, uh, actually, it's the facility Trident Surgery Center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. What's the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] This patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you. And you stated that the medical records were faxed to APL about 5 days ago?
[CUSTOMER][NEUTRAL] Um, they were faxed on, let me be exact, the date they were faxed on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Are the medical records, the information that was requested?
[CUSTOMER][NEUTRAL] Yes, it was the um pathology report that was requested and some other document, the patient documentation.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I show a claim was processed on the [PII].
[AGENT][NEGATIVE] It denied as a duplicate. What's the provider's name?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Trident Surgery Center.
[AGENT][NEUTRAL] Trident. What's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It may be a duplicate claim because when I called on [PII], I spoke with [PII]. She advised me no matching claim, so we faxed the claim to [PII]. We received uh correspondence and requesting the patient information, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you, can you verify the total bill?
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Yes, yes, yes, the total bill charge of this claim would have been, let me go and go in my system. I got to pull this queue up um let me see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me pull out my charges in one.
[AGENT][POSITIVE] No problem, no rush.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] 345, it's a high dollar claim.
[CUSTOMER][NEUTRAL] Um, I say it was $32,525.88.
[CUSTOMER][NEUTRAL] I have a claim number no.
[AGENT][NEUTRAL] Mhm. And, and what is that?
[CUSTOMER][NEUTRAL] Hold on for a minute. Let me.
[CUSTOMER][NEUTRAL] Have to get into another system.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you see anything? No?
[AGENT][NEUTRAL] I do go ahead and confirm the claim number that you have.
[CUSTOMER][NEUTRAL] Alrighty, the claim number is 0.
[CUSTOMER][NEUTRAL] Let's see, we got that front sheet here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have that claim number, the policy number 353-7981.
[AGENT][POSITIVE] OK, thank you. Give me one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, now that claim number is under a different policy number for [PII].
[CUSTOMER][NEUTRAL] That is what was sent to the facilitya. We received a letter.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] And the letter.
[CUSTOMER][NEUTRAL] The letter says.
[CUSTOMER][NEUTRAL] Uh, policy number.
[CUSTOMER][NEUTRAL] 0255070404 well I guess I guess [PII].
[AGENT][POSITIVE] It's 04704 is correct.
[CUSTOMER][NEUTRAL] OK, and it says data service 10-9-2024 Trident Surgery Center. It is, it came from America Public Life Insurance Company, the EOB.
[AGENT][NEUTRAL] OK, so we're just basically requesting the the uh pathology report?
[CUSTOMER][NEUTRAL] Um, the information that we sent over included the pathology report. It says in order to give consideration to this procedure, please provide the pathology report for the data service.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said the date of service is [PII]?
[CUSTOMER][NEUTRAL] Um, I have a data of service that's been, hold on for a minute, my correction, the date of service is [PII].
[AGENT][NEUTRAL] Or is it [PII]?
[AGENT][NEUTRAL] OK. That's what I show as well.
[AGENT][NEUTRAL] And is this the surgical charge procedure 19301?
[CUSTOMER][NEUTRAL] Facility for the facility mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And was the pathology report submitted by the provider?
[CUSTOMER][NEUTRAL] Well, I, I can't speak for the provider, the ordering physician, but I know we submitted over towards the facility, uh, what was requested we pulled from the patient's chart and we submitted it. Could you, can you locate that information?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can't show it received from the facility. No, ma'am.
[CUSTOMER][NEUTRAL] Wow, that's interesting. Is that fax number right? because that's the same fax number I used for the claim.
[AGENT][NEUTRAL] Mhm, verify the fax number you submitted it to, please.
[CUSTOMER][NEUTRAL] Um, that fax number is the same number that I used for the claim, but hold on, I have that number as [PII].
[AGENT][NEUTRAL] OK. OK.
[AGENT][POSITIVE] That is correct. Give me one moment.
[AGENT][NEUTRAL] Mm.
[AGENT][NEGATIVE] I'm not showing it received from the facility.
[CUSTOMER][POSITIVE] That's interesting.
[CUSTOMER][POSITIVE] Wonder why? because we definitely, I got confirmation that it was received the same day within like at, let me see.
[CUSTOMER][NEUTRAL] On my outbox it said it was received at [PII].
[CUSTOMER][NEUTRAL] EST yep.
[AGENT][NEUTRAL] On, on what day?
[CUSTOMER][NEUTRAL] Um, the time it was received on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. That's the date I was looking for. OK, I'm not showing it received from the, from the hospital.
[CUSTOMER][NEUTRAL] And it says [PII]. It says 12:[PII].
[CUSTOMER][NEUTRAL] I'm not understanding how that could have occurred because
[CUSTOMER][NEGATIVE] It's the same fax number. That is so odd.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Wow, is there another fax number?
[AGENT][NEUTRAL] Yeah, that's the fax number to our claims department, so that's correct.
[AGENT][NEUTRAL] But I'm not showing that we've received it from the facility. You are on behalf of the surgery center?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is crazy. We are, we are on the behalf of the surgery center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And I'm refaxing it right now as I speak, and this is so odd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm refaxing it right now 877 because it programs our fax numbers in once they.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, um, entered the first time 365 there it is 3659423. I just sent it.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK. All righty.
[AGENT][NEUTRAL] And so when you fax it, it could take up to 24 to 48 hours to see it in the patient's file, so you may want to start it back around that time.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Unfortunately, I won't be here. I'm going on vacation, so I don't know.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Documents are not they are not.
[AGENT][NEUTRAL] On file?
[CUSTOMER][NEUTRAL] About
[CUSTOMER][NEGATIVE] Not located.
[CUSTOMER][NEUTRAL] As a confirmation.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][POSITIVE] Accepted. OK. All right then, I will.
[CUSTOMER][POSITIVE] Probably follow up when I come back. I don't know what's going on. Thank you. Have a great day and take care. Stay safe. Uh-huh. Thank you. Uh-huh. I believe that's gonna be it. Mhm. Thank you. Uh, same to you. Uh-huh. Bye-bye. Bye-bye. Bye bye.
[AGENT][NEUTRAL] OK. That'll be fine.
[AGENT][NEUTRAL] All right, [PII], any other questions we can help out with today?
[AGENT][POSITIVE] All right, thanks for calling APL. Have a good day. Bye bye.