AccountId: 011433970860
ContactId: 1dfce8bf-29e5-4c87-af48-4ac8ec0c62b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 361820 ms
Total Talk Time (AGENT): 202448 ms
Total Talk Time (CUSTOMER): 78985 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/1dfce8bf-29e5-4c87-af48-4ac8ec0c62b9_20250423T15:08_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh hi, my name is [PII]. I'm calling from a doctor's office regarding a claim denial.
[AGENT][NEUTRAL] OK, I can help with the claim. And what is that policy number, please?
[CUSTOMER][NEUTRAL] 02572501.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] My name of the patient is [PII]. The date of birth is [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Uh, uh, sure, it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Data service, please. And you said it's Sydney, right? Is that correct?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, [PII] patient's name.
[AGENT][POSITIVE] Uh, perfect. And, and the date of service for Sydney please?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, thank you. Is there a particular build amount that I should look at?
[CUSTOMER][NEUTRAL] $315 even.
[AGENT][NEUTRAL] OK, thank you. It looks like your claim number on this.
[AGENT][NEUTRAL] It's 35.
[AGENT][NEUTRAL] 777.
[AGENT][NEUTRAL] 27. 357-7727.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And let me just check here.
[AGENT][NEGATIVE] And see why it was denied.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] It looks like the explanation of benefits was not um.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] It's not correct. So let me just look at that and see what uh.
[AGENT][NEUTRAL] What is going on with it, um.
[AGENT][NEUTRAL] Just pull it up here. So, because this is a secondary insurance, we have to have an explanation of benefits from the major medical and uh it looks like there was a problem with that. So I'm just pulling up the paperwork now to see what the problem is so that we can get that corrected.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I think it's something a little different, so let me just see what we've got here.
[CUSTOMER][NEUTRAL] Also, we have already attached the primary EOP from the United Healthcare, which is the primary insurance.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] And there was a deductible of $14,040.70 yes.
[AGENT][NEUTRAL] Yes, I think that's, yeah, I think that may not be a problem.
[AGENT][NEUTRAL] Uh, OK, I think, OK, I see what the problem is. So, uh, a HICA form or a, a 1500 form was submitted.
[AGENT][NEUTRAL] For this, and it lists the wrong date of birth. So [PII]'s date of birth is not [PII]. Um, Sydney is a
[AGENT][NEUTRAL] We need to have [PII]'s birthday. Um, [PII] is, is a child, um, so what we need to do is that the date of birth on the HIFA form is, uh, is incorrect. So what we would do is we would, we would need in this case, another, um, HIPA form.
[AGENT][NEUTRAL] So that's why this was.
[CUSTOMER][NEUTRAL] So it will be a corrected claim or.
[AGENT][NEUTRAL] Yes, to correct the claim form so that it looks like the EOB in this case, usually it's the EOB that we have a problem with, uh, in this case we do not, the, um, problem, uh.
[AGENT][NEUTRAL] The error is uh the date of birth of the uh patient.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So we would need to have the correct date of birth for [PII] to on this, on this form. Now once uh we have that, then we can finish processing so you don't need to send another EOB. In this case, that is not the problem. In this case it's the, the, the HIPAA form or the claim form itself which needs to be corrected.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] And if we could just get that.
[CUSTOMER][NEUTRAL] So, do we have to submit another claim form with correct details?
[AGENT][NEUTRAL] Would you, yes, if you would please, and if you don't mind referencing the claim number that I gave you the 35.
[AGENT][NEUTRAL] 77727 that would be helpful, but that is, that is what has happened here is that uh the um uh form itself is incorrect and so we just need to, to have that corrected. And if we could do that, please, that, that would be, that would solve the problem, we can get that fixed and, and pay out.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Now, is there any other claim that we need to look at?
[CUSTOMER][POSITIVE] Thank you so much for the help, right.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, and do you also have a fax number?
[AGENT][NEUTRAL] I do. It's
[CUSTOMER][NEUTRAL] To submit the claim forms.
[AGENT][NEUTRAL] Absolutely, yeah, you can submit it online or you can submit it by fax or mail. Now our fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 94
[AGENT][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] 87736594 23, right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][POSITIVE] OK, thank you so much. Rely me a reference number. That's it.
[AGENT][POSITIVE] OK, well thank you very much for contacting ATL have a good.