AccountId: 011433970860
ContactId: 2064565d-511c-4827-a76f-403bc0add3a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 569130 ms
Total Talk Time (AGENT): 158033 ms
Total Talk Time (CUSTOMER): 137153 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/2064565d-511c-4827-a76f-403bc0add3a2_20250220T20:59_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from the provider's office to check on the claim status. And before we proceed, I would like to inform you that this call is being recorded for quality and training purposes. Is that OK with you?
[AGENT][POSITIVE] Yes, it would be my pleasure to assist you with claim status as well, [PII]. What is the callback number?
[CUSTOMER][NEUTRAL] That would be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Policy number for this one is 007.
[CUSTOMER][NEUTRAL] 3258. Sorry, sorry, that's not the policy number. Hold on.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The policy number is 023126777.
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] That's my
[CUSTOMER][NEUTRAL] Uh, [PII]. Date of birth is [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] Um, I do have a claim number.
[AGENT][NEUTRAL] And that is?
[CUSTOMER][NEUTRAL] The claim number is PSO. It's 3514369.
[AGENT][NEUTRAL] 351-436-9
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 351-436-9 is for a different patient.
[CUSTOMER][NEUTRAL] 349.
[CUSTOMER][NEUTRAL] 1882.
[AGENT][POSITIVE] All right. That one is for [PII]. I can help you with that. Not a problem at all.
[CUSTOMER][NEUTRAL] Sorry, sorry.
[AGENT][NEUTRAL] And that's for data service 1212 23?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you. I can help you with that for [PII].
[AGENT][NEUTRAL] It looks like we were needing the.
[AGENT][NEUTRAL] EOV
[AGENT][NEUTRAL] From the primary insurance.
[AGENT][NEUTRAL] Now we did receive the claim again on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it was processed on [PII]. However, the EOB was not attached, so that was denied as a duplicate.
[CUSTOMER][NEUTRAL] OK. So for that one, it was sent for reprocessing because actually you have paid $196.28 previously when we submitted the primary UOB.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh the primary had allowed $212.29. So we still had a remaining balance of $16.01. So that was sent back for reprocess because the uh UB was initially submitted in September. With reference to that it was sent because this is also uh the leftover by the primary and that has to be also paid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me check that CPT bear with me just one moment.
[CUSTOMER][POSITIVE] No problem. Take your time.
[AGENT][NEUTRAL] I'll get that submission pulled up let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now was that for the CPT 77,080?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for your patience, [PII]. I'm getting that pulled up and I'll check on it for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] I'm checking these EOBs for the CPT 77,080.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And all I'm showing is the deductible of 19628.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] Let me look again.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm reviewing it again just to make sure I didn't overlook something.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] Yeah, I don't see that $16 difference. The EOB states the deductible of $19628 which is what we paid.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't have a.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So if there's an updated EOB, it was not attached to this document.
[CUSTOMER][NEUTRAL] and
[AGENT][NEUTRAL] Do you have an updated EOB that does show that amount?
[CUSTOMER][NEUTRAL] Mm, hold on, checking.
[CUSTOMER][NEUTRAL] Just a moment, OK?
[AGENT][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] I'm checking whether I have updated you. You're not in a letter, OK?
[AGENT][POSITIVE] OK. Take your time.
[CUSTOMER][NEUTRAL] me.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so then the remaining uh is provided right of then?
[AGENT][NEUTRAL] We don't determine patients responsibility.
[AGENT][NEUTRAL] That would be determined by the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it OK if I place your call on hold for a minute?
[AGENT][NEUTRAL] Yes ma'am, that's fine.
[CUSTOMER][NEUTRAL] Hello, ma'am. Still there?
[AGENT][NEUTRAL] Yes, ma'am. I'm still here.
[CUSTOMER][NEUTRAL] No problem. Provide me the reference number for the call then.
[AGENT][NEUTRAL] The reference number would be my name and today's date, and I spell my name [PII] initial.
[AGENT][NEUTRAL] Last name [PII], if you do have an update, did the EOB reflecting that $16.01 you can go ahead and fax that and we, we can, we can review it for additional benefits, but we.
[CUSTOMER][NEUTRAL] No, no, no, actually, no, no, that was my mistake. You were right. There's no difference of $150 sorry.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] All right. Anything else I can help you with today?
[CUSTOMER][POSITIVE] No problem. Thank you so much for your assistance and have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] I hope you have a wonderful day as well, [PII]. Thank you for calling APL. Bye-bye.