AccountId: 011433970860
ContactId: 09e5303b-69bc-4ea5-ab35-bd6f05510486
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 708809 ms
Total Talk Time (AGENT): 180669 ms
Total Talk Time (CUSTOMER): 198522 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/09e5303b-69bc-4ea5-ab35-bd6f05510486_20250321T14:05_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good day. My name is [PII], calling on behalf of Bates County Memorial Hospital to check on the payment status. Please be informed that this call is being recorded and monitored for quality and training purposes. Could you please spell your name for me?
[AGENT][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] OK, I can check claim status for you, [PII]. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, the policy number will be 01835977.
[AGENT][NEUTRAL] And [PII], do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient name will be [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] And what's the date of service for that claim?
[CUSTOMER][NEUTRAL] Date of service will be [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And do you have the bill amount?
[CUSTOMER][NEUTRAL] That will be $39,688.52.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, let me see what we've got a couple of claims on file. Let me look at these real quick if you don't mind.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Sure, please take your time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sure
[AGENT][NEUTRAL] OK, it looks like.
[AGENT][NEUTRAL] Looks like we made a payment of 107,430.
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] And that was on.
[CUSTOMER][NEUTRAL] Yes, actually, I do have a specific question with this claim. Can I go ahead with my question?
[AGENT][POSITIVE] Yeah, absolutely.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] All right. Thank you so much. I can see uh the primary payment for this claim is $33,319.75. And the primaries leftover will be uh $1,074.20 to the CPT code. Um, I don't have the CPT code for that. I can see only 0250.
[CUSTOMER][NEUTRAL] But the primaries left over after their payment is only $1,074.20. But uh you have paid $1,074.30. You have paid an additional uh payment of 10 cents. Is there any specific reason why you have paid more than the primaries left over?
[AGENT][NEUTRAL] Um, let's see, so we paid in excess of 10 cents.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, let me, let me check on that. Can you hold on one moment, please?
[CUSTOMER][POSITIVE] Sure, sure. You please take your time.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you hear that?
[AGENT][NEUTRAL] OK, so I'm trying to, I guess, I guess we paid in excess of 10 cents. I.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] 3567855
[AGENT][NEUTRAL] Well he says that all that was left over. I'm trying to pull up an on base all that was left over.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] was
[AGENT][NEUTRAL] Let me see provider EOB.
[AGENT][NEUTRAL] And where's the claim?
[AGENT][NEUTRAL] Because we shouldn't we do coordinate this is med link so we coordinate with primary so we shouldn't pay an excess of the primary allowed or whatever is left over.
[AGENT][NEUTRAL] You're saying we overpaid by 10 cents, but I'm trying to pull up the.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, so the primary EOB says the patient responsibility was 107,420 and we paid 107,430.
[AGENT][NEGATIVE] Yeah, so we overpaid.
[AGENT][NEUTRAL] So do we request uh um overpayment request for 10 cents? Goodness gracious.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, OK, so just let them know that we'll, I'll get a request to our claims department to get a corrected explanation of benefits so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's a dime.
[AGENT][POSITIVE] Goodness gracious. OK
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, alright, perfect.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK. OK, perfect. Thank you so much.
[AGENT][NEUTRAL] OK bye.
[AGENT][POSITIVE] OK, thank you so much for holding, [PII]. I'm gonna.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To get this claim sent over for review, um, which takes about 5 to 7 working days and we'll determine if we we can send out a corrected EOB and or if.
[AGENT][NEUTRAL] We'll do a refund request for that 10 cents.
[CUSTOMER][NEUTRAL] One moment. Before we proceed further, one moment.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] So right now
[CUSTOMER][NEUTRAL] So, may I know how the claim has been processed, whether it is primary or secondary?
[AGENT][NEUTRAL] Um, this is a supplemental secondary policy.
[CUSTOMER][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And you said your name is spelled as [PII], right? [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Another paid amount under this claim?
[AGENT][NEUTRAL] Uh, the paid amount was 1,074.30.
[CUSTOMER][NEUTRAL] Perfect. And could you verify the CPT code for whichever you have paid? Do you have the CPT code details?
[CUSTOMER][NEUTRAL] The procedure code.
[AGENT][NEUTRAL] Uh, no, it looks like it paid off of the facility claim, so.
[CUSTOMER][NEUTRAL] No CPT code, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right. May I know the mode of payment whether it is check EFT or virtual credit card?
[AGENT][NEUTRAL] Um, it is a check.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] You indicated that you paid for the facility claim, right?
[AGENT][NEUTRAL] Yes, that's what was submitted.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] You said the mode of payment is paper check, and may I have the check number, please?
[AGENT][NEUTRAL] The check number.
[AGENT][NEUTRAL] 2029591
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] 20295991.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] May I know whether it is a single check or a bulk check?
[AGENT][NEUTRAL] A single check
[CUSTOMER][NEUTRAL] All right. Could you uh provide me the proper reason why you have paid more than the primary uh left over?
[AGENT][NEUTRAL] Um, that's why I'm gonna send it back for review to figure that out.
[AGENT][NEUTRAL] So we're gonna send it for review the claim for review.
[CUSTOMER][NEUTRAL] As of now, you don't have any reason, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] You're not aware why they have been more than the primary left over, so you're going to send the claim back for a review.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] May I know the time frame, how many days it will take for you to review this claim?
[AGENT][NEUTRAL] Uh, it takes 5 to 7 working days, business days.
[CUSTOMER][NEUTRAL] 5 to 7 business days.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So I'll just reconfirm all the information, whichever you give.
[CUSTOMER][NEUTRAL] The claim has been processed as secondary and you paid $1,074.30 and there is no CPT code on your end. You paid for the facility claim and you said the mode of payment is paper check and the check number will be 2029591. And it's a single check for $1,074.30. And you don't, you're not aware why you have paid more than the primaries left over. So you're going to send the claim back for a review and it will take 5 to 7 business days, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] May I have the call reference number for this?
[AGENT][NEUTRAL] Uh, the call reference number would be my first name.
[AGENT][NEUTRAL] My last initial is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, thank you so much, [PII]. That's all I have for today. Have a great day. Bye for now.
[AGENT][POSITIVE] OK, thank you for calling APL have a good day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye.