AccountId: 011433970860
ContactId: 16abc33d-bf52-4a60-8209-7b0e5ee51072
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419359 ms
Total Talk Time (AGENT): 165191 ms
Total Talk Time (CUSTOMER): 131697 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/16abc33d-bf52-4a60-8209-7b0e5ee51072_20250102T16:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from provider office to check on a claim status. Could you assist me?
[AGENT][POSITIVE] It would be my pleasure to assist you with claim status, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] Uh, callback number [PII]. And that's a direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Policy number 02131571.
[AGENT][NEUTRAL] Patient's name and date of birth please sir.
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] [PII], date of birth, [PII].
[AGENT][POSITIVE] Alright, thank you, and it would be my pleasure to assist you with that claim status. [PII], do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] I don't have claim number, the date of service, [PII] in the amount $1,422 even.
[AGENT][NEUTRAL] Thank you. And what is the facility name?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I said the name is.
[CUSTOMER][NEUTRAL] Dogwood anesthesia Providers LLC.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] We did receive that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Process on [PII].
[AGENT][NEUTRAL] And the claim was denied?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As benefits are payable only if the primary insurance provides benefits.
[AGENT][NEUTRAL] And if the major medical reprocesses the claim and applies something to the deductible co-pay and coinsurance, that updated EOB can be submitted for further consideration.
[CUSTOMER][NEUTRAL] Uh, do you have primary U be on file?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEGATIVE] And you said it denied because the primary payer didn't pay anything.
[AGENT][NEUTRAL] Didn't provide benefits. This policy only pays toward the deductible, co-pay or co-insurance of the major medical.
[AGENT][NEUTRAL] Therefore, no benefits are payable if there's nothing applied.
[CUSTOMER][POSITIVE] 8P. Thank you so much. And can you help me with the claim number for this one?
[AGENT][NEUTRAL] Claim number is 352.
[AGENT][NEUTRAL] 9339.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] It's 352.
[CUSTOMER][NEUTRAL] 352-933-9, right?
[AGENT][POSITIVE] Yes, sir, that's correct.
[CUSTOMER][NEUTRAL] And this patient plan only covered deductable coinsurance and co-pay, right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] And may I, may I know the patient plan name?
[AGENT][NEUTRAL] [PII], that's [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, got you. I mean the like [PII]. And can I move to the next date of service for the same patient.
[AGENT][NEUTRAL] Sure, what's that next data service?
[CUSTOMER][NEUTRAL] It's same 322, [PII] in the amount $11,422 even.
[AGENT][NEUTRAL] The same bill amount?
[CUSTOMER][NEUTRAL] Uh, it's same build amount. Just the provider is different. any provider is different on both the claim.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm checking that for you, bear with me.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that claim.
[AGENT][NEUTRAL] was received on.
[AGENT][POSITIVE] Sorry about that. Let me get that received date for you.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Process on [PII] and denied for the same reason.
[CUSTOMER][NEUTRAL] Can you repeat it one more time?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] The denial reason.
[AGENT][NEUTRAL] Bear with me just one second. I apologize. My system is.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I apologize, my, it's moving now. Benefits are only payable if the major medical uh provides benefits.
[CUSTOMER][MIXED] Benefit, not payable.
[AGENT][NEUTRAL] Benefits are payable only if the major medical insurance provides benefits.
[CUSTOMER][NEUTRAL] Major
[CUSTOMER][NEUTRAL] information
[CUSTOMER][NEGATIVE] It's denied because
[CUSTOMER][NEUTRAL] Uh, be because benefits payable only if the major information provide, right?
[AGENT][NEUTRAL] Only if the major insurance provides benefits.
[CUSTOMER][NEUTRAL] If the major.
[AGENT][NEUTRAL] It's the same reason, so the policy only pays toward the deductible copay, or co-insurance of the major medical.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you, major medical. And can you help me with the claim number?
[AGENT][NEUTRAL] Claim number is 352.
[AGENT][NEUTRAL] 9161.
[CUSTOMER][NEUTRAL] And can you please like the UV.
[AGENT][NEUTRAL] You know, these are obtainable on our provider portal at secured and that's SEC U R E D. A.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. Thank you so much. Can you help me with the call reference number.
[AGENT][NEUTRAL] Call reference number is my name is today's date.
[AGENT][NEUTRAL] I spell my name
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Do you need me to spell my name?
[CUSTOMER][POSITIVE] Uh, no, it's OK. Thank, thank you so much, [PII] and you have a wonderful day. Thank you.
[AGENT][POSITIVE] I hope you have a wonderful day as well, [PII]. Thank you for calling APL and it was a pleasure to assist you with that claim status.
[AGENT][POSITIVE] Take care.
[CUSTOMER][NEUTRAL] Bye. Take care, bye.
[AGENT][NEUTRAL] Bye-bye.