AccountId: 011433970860
ContactId: 10f0ba7e-d049-4fc2-ac09-77665f68c5f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1175010 ms
Total Talk Time (AGENT): 272188 ms
Total Talk Time (CUSTOMER): 264314 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/10f0ba7e-d049-4fc2-ac09-77665f68c5f7_20250106T17:29_UTC.wav
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[AGENT][POSITIVE] Thank you for calling and APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider office checking on claim status.
[AGENT][NEUTRAL] OK [PII], I can help you with claim status. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII] is direct line. There is no extension.
[AGENT][NEUTRAL] Thank you. And then what is the insured's name?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The patient.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Well, can you spell the first name for me, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. And then what is the patient's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And patients policy number?
[CUSTOMER][NEUTRAL] 01846260 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, let me repeat that 0184626.
[AGENT][NEUTRAL] 0 ML 8.
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] OK, good. All right, and what is the date of service?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] $15,382.
[AGENT][NEUTRAL] OK, and what's the charges after Primary paid their part?
[CUSTOMER][NEUTRAL] Yes, she's secondary.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] What is the charges after primary paid their part?
[CUSTOMER][NEUTRAL] When was the claim received?
[AGENT][NEUTRAL] I'm sorry, what did you say?
[CUSTOMER][NEUTRAL] What is primary? Please repeat once again?
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] The um major medical, the primary insurance carrier.
[CUSTOMER][NEUTRAL] No, it's United Healthcare Primary.
[AGENT][NEUTRAL] OK, alright and then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Holy Cross Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold [PII] while I look up that claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Yes
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII], this is [PII] back with you again. So looking at data service of [PII], I do not find a claim in the amount that you have given me.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] 15,382.
[AGENT][NEUTRAL] Yes, sir. I do not find a claim in that amount.
[CUSTOMER][NEUTRAL] I have claim number.
[AGENT][NEUTRAL] Do you have a claim number? OK, what is the claim number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 352-630-4.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look up that claim number.
[AGENT][NEUTRAL] OK, I do find that claim number, but it's not the amount that you've given to me and it's already been paid.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] When was the claim received?
[AGENT][NEUTRAL] Let me look for you just real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, the uh claim was received on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, what is the paid amount?
[AGENT][NEUTRAL] Let me look for you real quick.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The amount paid was 2.
[AGENT][NEUTRAL] $149.75.
[CUSTOMER][NEUTRAL] Uh, so, OK, it's paid through check or EFT.
[AGENT][NEUTRAL] It was paid by check.
[CUSTOMER][NEUTRAL] Mm OK you the check number?
[AGENT][NEUTRAL] 2012005.
[CUSTOMER][NEUTRAL] 201,200.
[AGENT][NEUTRAL] 5.
[CUSTOMER][NEUTRAL] Uh, when was check issued?
[AGENT][NEUTRAL] Check was issued on [PII].
[CUSTOMER][NEUTRAL] On processed day only.
[AGENT][POSITIVE] The check has cleared.
[CUSTOMER][NEUTRAL] On the same date?
[AGENT][NEUTRAL] Check cleared on [PII].
[CUSTOMER][NEUTRAL] OK. Can I pay to address?
[AGENT][NEUTRAL] Yes, it was paid to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. What is the bulk check amount?
[AGENT][NEUTRAL] There's not a bulk check.
[CUSTOMER][NEUTRAL] Just a single check.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please fax the your bill for me?
[AGENT][NEUTRAL] Yes, what's your fax number?
[CUSTOMER][NEUTRAL] 248
[CUSTOMER][NEUTRAL] 233-245 2.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I fax that to you so I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me [PII]. I have that fax on its way to you.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Hello, thank you for holding for me. I have the fax on.
[CUSTOMER][NEUTRAL] But we
[AGENT][NEUTRAL] The way to you.
[CUSTOMER][NEUTRAL] We send it
[CUSTOMER][NEGATIVE] No, we're not still no, you're not receiving the fax.
[AGENT][NEUTRAL] Yes I did.
[CUSTOMER][NEUTRAL] In order to receives till now. Uh how many
[AGENT][NEUTRAL] Well, it's gonna take a few minutes for it to get there. It's
[AGENT][NEUTRAL] It's gonna take a couple of minutes for it to go through the phone system to get to you.
[CUSTOMER][NEUTRAL] OK. Uh, and I have one more, few more, one more claim. Could you please assist me with this?
[AGENT][NEUTRAL] OK. What is the insured's name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. What's the insured's date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the patient's policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 02361637 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, and then what is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] $289.81.
[AGENT][NEUTRAL] And then what is the charge after primary paid their part?
[CUSTOMER][NEUTRAL] There's
[CUSTOMER][NEUTRAL] $139.
[AGENT][NEUTRAL] OK, and is it the same facility Holy [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I look up that claim for you, [PII], and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again on this claim, uh, number 3452697.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] The claim has been denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Could you please repeat one second the claim number?
[AGENT][NEUTRAL] 3452697.
[CUSTOMER][NEUTRAL] 3459627.
[AGENT][NEUTRAL] No, 3452697.
[CUSTOMER][NEUTRAL] You need primary UB, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Can I get the fax number?
[AGENT][NEUTRAL] Yes, sir. The fax number is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] Uh, whose attention to send the fax?
[AGENT][NEUTRAL] Claims.
[CUSTOMER][NEUTRAL] Uh, what is the timely filing limit?
[AGENT][NEUTRAL] There isn't one.
[CUSTOMER][NEUTRAL] 120 days.
[AGENT][NEUTRAL] There is not one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When was the claim received for you?
[AGENT][NEUTRAL] OK, let me look that up for you.
[AGENT][NEUTRAL] Claim was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 9637.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, received May.
[CUSTOMER][NEUTRAL] It's [PII], right?
[AGENT][NEUTRAL] Received [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Uh, this claim was uh sent to examiner review on 9-23-2024. What is the status of this one?
[AGENT][NEUTRAL] We don't show the claim.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, I, I have a call reference of uh reference of picky 09-232024. You send the claim back for the process.
[AGENT][NEUTRAL] OK. We have
[AGENT][NEUTRAL] We do not see it
[CUSTOMER][NEUTRAL] Any re process.
[AGENT][NEUTRAL] Yes, you need to resend the EOB.
[CUSTOMER][NEUTRAL] You be
[CUSTOMER][NEUTRAL] No, we already submitted you with that's the reason. Um
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] I'm sorry, but I do not have the EOB.
[CUSTOMER][NEUTRAL] OK. OK. OK. Can I get the call reference story?
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][NEUTRAL] Uh, how can you spell out your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thank you. Have a great week. Take care. Bye-bye.
[AGENT][POSITIVE] You too [PII], thank you for calling APL bye bye sir.
[CUSTOMER][NEUTRAL] Oh