AccountId: 011433970860
ContactId: 09a605d5-575d-4de6-96f5-829f7ee2560e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 751460 ms
Total Talk Time (AGENT): 180621 ms
Total Talk Time (CUSTOMER): 127088 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/09a605d5-575d-4de6-96f5-829f7ee2560e_20250117T21:19_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], this is [PII] calling with ENT Medical Services, and I'm calling in regards to an explanation of benefits I got on a claim for a patient.
[AGENT][POSITIVE] OK, and I'm so sorry your name again may I have
[CUSTOMER][NEUTRAL] Is [PII]
[AGENT][POSITIVE] Thank you [PII] and your call back number if we were disconnected?
[CUSTOMER][NEUTRAL] Is [PII] option 3.
[AGENT][POSITIVE] Thank you so much and what is the policy number, please?
[CUSTOMER][NEUTRAL] Um, I have 01849102.
[AGENT][NEUTRAL] OK, thank you and verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] And patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much for that verification process, [PII] and what is that claim number that's on the ELB please if you can share that with me.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I don't, oh there it is uh 354-3348.
[AGENT][POSITIVE] OK, thank you very much one moment please.
[AGENT][NEUTRAL] OK, thank you for your patience. We are requesting a more detailed explanation of benefits that shows charges applied to the deductible, copay, or co-insurance.
[CUSTOMER][NEUTRAL] OK, are you able to look at what we sent because this is all we have from Blue Cross Blue Shield. It breaks it out for the claim lines below and then at the top it says member responsibility is $100 that it's a co-payment.
[CUSTOMER][NEUTRAL] So I'm not sure what else you guys need.
[AGENT][POSITIVE] OK, yes, I am able to view that one moment.
[AGENT][NEUTRAL] Bear with me. Let's get an image pulled up with the claim pulled up.
[AGENT][NEUTRAL] [PII], may I place you on a brief hold please? I'm waiting for the images to pull up. Thank you.
[CUSTOMER][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. Yeah.
[AGENT][POSITIVE] OK, thank you so much for your patience, [PII]. I'm looking at the.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You'll be well marked Blue Cross Blue Shield.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] 51037.
[AGENT][NEUTRAL] OK, I do show where it said. I'm sorry, I do see where it shows copayment $100.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Under member responsibility and the charge amount of $150 initially $150.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I can ask the adjuster to review the claim um but it does not show um give me, can I place you on hold and reach out to the adjuster please.
[CUSTOMER][NEUTRAL] Yeah, I mean on the bottom does it show claim lines? Does it break out the 150, 37, and the 45?
[AGENT][NEGATIVE] It does, however, it does not show the procedure codes. It shows um line 123 and message PXN where it should have the procedure codes.
[CUSTOMER][NEUTRAL] OK, well that's how we have that's how they print off off the website, so.
[AGENT][NEUTRAL] Um, so.
[AGENT][NEUTRAL] I can reach out to the adjuster and ask her to review the claim um but she is asking for a more detailed explanation of benefits but I will reach out to her and ask her if she would review the claim.
[AGENT][NEUTRAL] Um, showing stating that um.
[AGENT][NEUTRAL] The co-payment shows $100 based on what was submitted in.
[CUSTOMER][NEUTRAL] I mean other than getting out my bulk EOB and copying pasting that I mean this is what it prints off the website so.
[CUSTOMER][NEUTRAL] I mean I guess you can ask her otherwise I'll, I guess resend it with the details from the actual 100 and some page EOB that we get.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] The bulk EOB.
[AGENT][NEUTRAL] Um, I will reach out to her and ask if she will review the claim, but that is why she's asking for more detailed explanation benefits for the, uh, member for this state of service.
[CUSTOMER][NEGATIVE] OK, this is frustrating. OK, um, is it, are we able to fax it to you guys or?
[CUSTOMER][NEUTRAL] Does it have to be remailed or?
[AGENT][NEUTRAL] Of course, of course.
[AGENT][NEUTRAL] We have a fax number. We also have an electronic payer ID as well, but I can provide you with our fax number when you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, can you repeat that? It, it, the phone cut out so I didn't, I got 8. That was all I got.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, no problem, [PII].
[CUSTOMER][NEUTRAL] OK, I'm just gonna repeat it because it keeps cutting out [PII]?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK, so do you want another like a new HIFA as well as the EOB with it? Do I reference this claim number? How, what do I need to do?
[AGENT][NEUTRAL] You're gonna just please reference this claim number, we will only need the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is there anybody's particular attention or?
[AGENT][NEUTRAL] No, just for the attention claims department, and once you reference the claim number, we'll know exactly where it needs to go to be attached to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, is there a call reference number for our call?
[AGENT][NEUTRAL] No, please use my name [PII], last initials [PII], and today's date, please [PII]. Thank you.
[CUSTOMER][POSITIVE] All right, thanks for your help.
[AGENT][POSITIVE] You're welcome [PII]. Thanks for calling APL. Take care bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm bye bye.