AccountId: 011433970860
ContactId: 233c676a-d34c-4e27-b6a9-8e58e0167312
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1321530 ms
Total Talk Time (AGENT): 375609 ms
Total Talk Time (CUSTOMER): 417197 ms
Interruptions: 12
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/233c676a-d34c-4e27-b6a9-8e58e0167312_20250421T21:01_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APO. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII].
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] [PII] is uh calling from provider's office to check on a clear. Can you please help me with that?
[AGENT][NEUTRAL] Yeah, of course, I can help you with claim status today. Do you have the policy number?
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] Um, OK, note down the policy, please.
[AGENT][NEUTRAL] Do you have the policy? Oh, so it would be.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, policy er number or member number?
[CUSTOMER][NEUTRAL] Um, I have with me the, uh, member ID actually.
[AGENT][NEUTRAL] OK, what is it, um, what numbers are those?
[CUSTOMER][NEUTRAL] Uh, OK. 02491434. M as in Mike. L as in Lima, 8.
[AGENT][POSITIVE] OK, perfect. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What else do you want, ma'am? Yeah, that will be 61.
[AGENT][NEUTRAL] OK and then what's a good callback number?
[AGENT][NEUTRAL] Guess what, what's a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said [PII], what after that?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And then patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, patient's first name and the last name will be [PII] and the date of birth will be [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and then do you have a claim number or a date of service?
[CUSTOMER][NEUTRAL] Um, do I have the date of service with me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that would be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Did you say [PII]?
[CUSTOMER][POSITIVE] Correct. Yes, correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] OK, and what's the charge amount?
[CUSTOMER][NEUTRAL] It's 17 $20 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, just one moment.
[AGENT][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what facility are you calling from?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, the facility name will be Gastro Health.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] If I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi, I'm still here just a second. I'm looking through each one of these claims to find the provider's office.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Please, um,
[AGENT][NEUTRAL] I think
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm not finding a charge amount of 720.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] You're not able to find any dealer service that is um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So yes, I do have a few claims for that date, but I'm just not seeing that charge amount as $720.
[CUSTOMER][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] Do you have a procedure code by chance?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Wait a minute.
[CUSTOMER][NEUTRAL] OK. Can you check with the claim number in, in case you have it?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] Um, 3542646.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I do see that one,
[AGENT][NEGATIVE] And it looks like this one was denied.
[AGENT][NEUTRAL] Because we are.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We're needing the EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] T U B
[AGENT][NEUTRAL] Yes, the explanation.
[CUSTOMER][NEUTRAL] Uh, like you need, um, uh, this document?
[AGENT][NEUTRAL] Yes, we need an explanation of benefits.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And uh you need, you before that, you are denying this claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So, may I get the received date, denial date in case you can, you have that with you?
[AGENT][NEUTRAL] Yes, I do have that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like the received date is [PII].
[AGENT][NEUTRAL] And the process date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And they denied date, ma'am. Do you have that?
[AGENT][NEUTRAL] That should be the.
[AGENT][NEUTRAL] That should be the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] OK, give me a moment, please.
[AGENT][NEUTRAL] OK. No, you're fine.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] One minute, please.
[AGENT][POSITIVE] OK, you're OK.
[AGENT][NEUTRAL] OK, so it looks like um I found another claim on file.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it has another denial code and it says insured major medical coverage provided full benefits. So that's why
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We did not provide benefits. It's because their major medical covered the amount.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] Um, like, um, is there any medical records?
[CUSTOMER][NEGATIVE] Not available.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Let me write down that claim number.
[AGENT][NEUTRAL] OK, so, yes, it looks like we denied 1500.
[AGENT][NEUTRAL] And that was because the major medical, yeah, that's because the major medical covered it.
[CUSTOMER][NEUTRAL] 1500.
[CUSTOMER][NEUTRAL] Uh, you're saying the medical coverage is terminated?
[AGENT][NEUTRAL] No, so this is a secondary policy to their major medical.
[CUSTOMER][NEUTRAL] Is that not.
[AGENT][NEUTRAL] So, whatever major medical doesn't pick up, then this insurance will pick up the rest.
[CUSTOMER][NEUTRAL] I I.
[AGENT][NEUTRAL] Depending on what it is, but.
[AGENT][NEUTRAL] It says that their major medical already picked this up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Major medical is already picked up?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, you could say it has paid the amount.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You're saying the secondary policy, um, like you're saying the uh primary one has paid the
[CUSTOMER][NEUTRAL] Maximum amount.
[CUSTOMER][NEUTRAL] Are you think that?
[AGENT][NEUTRAL] So, so this is, so you guys sent in an EOB?
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And um it says this remark code says that their major medical covered this expense. So there was nothing for us to pay on that one.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You're saying the uh the primary is paid already?
[AGENT][NEUTRAL] Yes, it says their prime, their major medical, their primary has already paid.
[CUSTOMER][NEUTRAL] Ah, open this on a la the name and I open it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you uh, you want the primary, you be, uh, right?
[AGENT][NEUTRAL] No, we don't, I
[CUSTOMER][NEUTRAL] As in the document, right?
[AGENT][NEUTRAL] Sorry, no, so the claim number that I have that you also have, um, it looks like you guys ended up sending the EOB to us and then our claims department, uh, went over the documents and then did, I guess they determined that the primary insurance had covered this cost, the 1500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh-huh. OK.
[CUSTOMER][NEUTRAL] OK. Give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, hello.
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hello. Hey, thank you for your patience. I was asking, uh, uh, what was the allowed amount and anything about the payment things? Mhm.
[AGENT][NEUTRAL] The allowed amount?
[CUSTOMER][NEUTRAL] Do you have?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Um, I see.
[CUSTOMER][NEUTRAL] Do you have the allowed amount, the paid amount with you, ma'am?
[CUSTOMER][NEUTRAL] Mm, yes.
[AGENT][NEUTRAL] So it looks like major medical covered 1500.
[AGENT][NEUTRAL] Which is why we deny, yes, 1500 even, which is, that was the one that was, that we denied because Major medical picked it up.
[CUSTOMER][NEUTRAL] Even.
[CUSTOMER][NEUTRAL] So you're saying this is the allowed amount and the paid amount and later you denied because the primary is already paid?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What we can do is like, can you send me the UB?
[AGENT][NEUTRAL] Um, I do not have the EU. Well, hold on, let me see in my system really quick.
[AGENT][NEUTRAL] If we uploaded it.
[CUSTOMER][NEUTRAL] Do you have the UB or?
[CUSTOMER][NEUTRAL] She.
[CUSTOMER][NEUTRAL] You don't have to.
[AGENT][NEUTRAL] Um, here, I'm trying to look it up really quick, just a minute.
[AGENT][NEUTRAL] OK, I did find that.
[AGENT][NEUTRAL] Would you like me to fax you the?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, please, uh, can you fax me the UB.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, what is your fax number?
[CUSTOMER][NEUTRAL] Uh yeah, the fax number will be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, and I can fax that over to you. Did you have any further questions?
[CUSTOMER][NEUTRAL] Uh, what would be the turnaround time and uh
[CUSTOMER][NEUTRAL] Like getting the UV?
[AGENT][NEUTRAL] It's usually, well, it would just be about 5 minutes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and the, uh, let's double verify the claim number that is 3542646.
[AGENT][NEUTRAL] So it looks like this was processed under a different claim number after we received the EOB. So this claim number would be 355.
[AGENT][NEUTRAL] 6441.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yeah, so, um, let's double verify, please, bear with me. It was received on [PII] and processed on, um, sorry, [PII] and processed on [PII] and then denied it date is same as the process date, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, so the, so the first claim that you gave me was 12-16-24 was the received date. The process date was [PII], and then we denied that because we were awaiting the EOB. So it looks like we received the EOB and then this claim number that I gave you is the received date was [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the process date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's the same day.
[CUSTOMER][NEGATIVE] Um, OK, and it was still denied.
[CUSTOMER][NEUTRAL] Due to a different reason on the same day it was denied, correct?
[AGENT][NEUTRAL] So
[AGENT][NEGATIVE] Yes, it was denied because major medical picked it up.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it looks
[CUSTOMER][NEUTRAL] Under the claim number 3556441.
[AGENT][NEUTRAL] Mhm. And it looks like, uh, we, our insurance company, APL pay 2974.
[CUSTOMER][POSITIVE] Yes ma'am. Please go ahead.
[CUSTOMER][NEUTRAL] 2974.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, if you'll pay that.
[AGENT][NEUTRAL] Yes, we pay 29.74.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No patient responsibility?
[AGENT][NEUTRAL] We do not determine patient's responsibility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, so have you proceeded, uh, uh, like, uh, for the UB?
[CUSTOMER][NEUTRAL] Have you faxed me, ma'am?
[AGENT][POSITIVE] Yes, ma'am. I can fax that over to you right now, OK?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, yeah, OK. And meanwhile, can you give me your name and your conference number?
[AGENT][NEUTRAL] Yes, so my name is [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Yes, ma'am. Mhm. And then the reference number would be my, yeah, would be my first name, my last initial [PII]
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, please fax me the UB ma'am. I'll, uh, yeah, that's all.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You have a great day ahead. Thank you. Bye-bye.
[AGENT][POSITIVE] Yeah, thanks for calling APO. Have a good day. Thanks, you too. Bye.
[CUSTOMER][POSITIVE] Take care.
[CUSTOMER][NEUTRAL] Bye-bye.