AccountId: 011433970860
ContactId: 125cb724-3c2e-46f2-960e-af4db92e6684
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 769400 ms
Total Talk Time (AGENT): 299885 ms
Total Talk Time (CUSTOMER): 347001 ms
Interruptions: 15
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/125cb724-3c2e-46f2-960e-af4db92e6684_20250515T18:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], good afternoon, um, I'm calling from a doctor's office. My name is [PII]. I need to get um some claims to see if they paid or not because we have sent the EOB and everything, but we haven't received any payment.
[AGENT][NEUTRAL] OK, [PII]. I can help you with claim status. Can I go ahead and get a callback number in case we get disconnected?
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number is 024435161768.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, 02443516 and I'm sorry, I didn't catch the rest.
[CUSTOMER][NEUTRAL] Um, let me see, 02443. Don't worry, let me see, that is too many noise in here. That's why you're not here, OK. The member, yes, it's.
[AGENT][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 204-435-16.
[CUSTOMER][NEUTRAL] ML 7. I don't think that's the correct one. Let me see. Yes.
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Let me check for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] they come.
[AGENT][NEUTRAL] Can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and her date of birth is [PII].
[AGENT][POSITIVE] All right. That is the correct one. Thank you so much for verifying that with me.
[CUSTOMER][NEUTRAL] OK. Oh yes, it's that OBGYN and they bring babies and everything.
[AGENT][POSITIVE] You're having fun over there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the claim numbers or the date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I got the date of service. The first one, it's [PII].
[AGENT][NEUTRAL] OK, let me look that one up first.
[CUSTOMER][POSITIVE] Then I have one on the, sure. OK, perfect. Mhm.
[AGENT][POSITIVE] Oh sorry, let's go one at a time just in case.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And it's all with the same patient, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, just wanted to make sure.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, because they're different.
[CUSTOMER][NEUTRAL] Amount still.
[CUSTOMER][NEUTRAL] that he couldn't.
[AGENT][NEUTRAL] And what was the total bill charge for that?
[CUSTOMER][NEUTRAL] OK, for that one it's $675.
[AGENT][NEUTRAL] Even? OK.
[CUSTOMER][NEUTRAL] Uh huh, yes, even.
[AGENT][NEUTRAL] Give me just a second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Do you need the claim number for that?
[CUSTOMER][NEUTRAL] Um, yes, please. Mhm.
[AGENT][NEUTRAL] OK, OK, give me one second, let me make sure that that is the correct one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh you want you want you want too, right?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right, perfect.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 352.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 4270.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] On the [PII]
[CUSTOMER][NEUTRAL] And the [PII].
[AGENT][NEUTRAL] It looks like we received that claim.
[CUSTOMER][POSITIVE] thank thank you thank you it's better for our all our stations.
[AGENT][NEUTRAL] On [PII], it was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It looks like that claim was denied. Uh, there's two parts to that claim. One is for the office visits, and that part was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because
[AGENT][NEUTRAL] And then the second part was denied because uh we need a copy of the explanation of benefits from the primary insurance carrier. So this particular policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] Mhm, no, because we send it to the, uh huh, this particular policy, yes, OK, tell me.
[AGENT][NEUTRAL] This particular
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I'm so sorry. It's a secondary gap policy, so the major medical has to pay first before this one will can get paid.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. So they already uh pay a part and then they're supposed to send you the second uh to the secondary the rest.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, so we need a copy of the explanation of benefits from that primary insurance provider stating that they've paid and what they've paid towards.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, can you give me the fax number?
[AGENT][NEUTRAL] Because this policy won't won't cover re number, sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 877.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that's a fax number to send. OK, for this one from um [PII], right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] For claim 352-427-0. OK. I'm so sorry. Go ahead.
[CUSTOMER][NEUTRAL] Then I have another one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then I have, no, don't worry about it. The one for [PII].
[AGENT][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm, and let me see how much is that.
[CUSTOMER][NEUTRAL] I it's for 300.
[CUSTOMER][NEUTRAL] For $350?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And do you need the claim number for that one as well?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, it's 353.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] 7656
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look here.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] It looks like we received that claim on [PII]. It was processed on [PII]. It was denied and let me see why.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] For the same reason as the other one, we need a copy of the explanation of benefits from the primary insurance carrier um in order to process this one.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So we need that EOB saying that it it paid.
[CUSTOMER][POSITIVE] OK perfect so mhm.
[CUSTOMER][NEUTRAL] OK, perfect. So I'm gonna send it right now and then I'm pretty sure we have the same thing with [PII].
[CUSTOMER][NEGATIVE] Worries I want yeah.
[AGENT][NEUTRAL] [PII], let me go ahead and check just in case.
[CUSTOMER][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] the latest available
[AGENT][NEUTRAL] What was the total amount for that one?
[CUSTOMER][NEUTRAL] It's $671 even.
[AGENT][NEUTRAL] You, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Give me one moment while I look it up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We have
[AGENT][NEUTRAL] You said $671. OK, good, just making sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me, the claim number for that is 356.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4055.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] And let me double check and make sure that is why it was denied.
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] We received that claim on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] so much
[AGENT][NEUTRAL] OK, for this one, the the above referenced claim appears to be a duplicate of the previously submitted expense. The benefit payment has been made to the insured.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] today
[AGENT][NEUTRAL] So it looks like we paid her.
[CUSTOMER][NEUTRAL] Are you paid to the insurance, no.
[AGENT][NEUTRAL] Right, it was paid to the insured instead of to you guys. Mhm.
[CUSTOMER][NEUTRAL] OK, how much was you pay the 671?
[AGENT][NEUTRAL] I believe so, yes, let me double check.
[CUSTOMER][NEUTRAL] How much?
[CUSTOMER][NEUTRAL] Uh huh and can you give me the check number, please?
[AGENT][NEUTRAL] Um, it was paid to her.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't believe I can give you the check number for that. Let me make sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We don't have insurance, but um it's yeah it's um.
[CUSTOMER][NEUTRAL] The difference is $400.
[CUSTOMER][POSITIVE] So you wanna, you wanna make next year.
[CUSTOMER][NEUTRAL] next appointment? No, I'm gonna wait.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] It looks like she submitted it on [PII] and it was processed on [PII] and because she submitted it before you were able to submit it, we went ahead and paid her.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm on the
[CUSTOMER][NEUTRAL] OK, so you pay the $671 to her.
[AGENT][NEUTRAL] Uh, we paid $426.32.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] have
[CUSTOMER][NEUTRAL] 400 and what? I'm sorry?
[AGENT][NEUTRAL] You make sure this is the correct one.
[AGENT][NEUTRAL] I think I clicked on the wrong one. Give me just a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Have you
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Guinness.
[AGENT][NEUTRAL] Mhm. OK. That was the correct one. It looks like we paid $426.32 to her.
[CUSTOMER][POSITIVE] Alright perfect uh can you give me a
[AGENT][NEGATIVE] So she did not receive the full, mhm.
[CUSTOMER][NEUTRAL] OK, can you give me a reference number for this call? Do you need me to send everything again to this fax number?
[AGENT][NEUTRAL] Yes, you can send the primary EOBs to uh to that fax number I gave you for those claim numbers. I would put the.
[CUSTOMER][NEUTRAL] Attention to claim department?
[AGENT][NEUTRAL] Yes, ma'am, and I would reference that claim number as well for each one so that we know which one it goes to.
[CUSTOMER][NEUTRAL] You wanna go
[CUSTOMER][NEUTRAL] Yes, oh, I'm talking to them you have like a.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I'm gonna put in the reference the claim number is of each one that you gave me, right?
[AGENT][NEUTRAL] Right, ma'am.
[CUSTOMER][NEUTRAL] OK, and can you give me a reference number please, [PII]?
[AGENT][NEUTRAL] We don't have reference numbers, but you can use my name in today's date, I'm sorry, my name and my last initial in today's date, so it'd be [PII], in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Mhm alright perfect so I'll send it right now then OK?
[AGENT][POSITIVE] All right, thank you so much, [PII], and if there's nothing else I can help you with, thank you for calling APL.
[CUSTOMER][POSITIVE] Alright thank you very much OK.
[CUSTOMER][POSITIVE] No, that, that'd be all. You're welcome bye bye.
[AGENT][NEUTRAL] Alright bye.