AccountId: 011433970860
ContactId: 26665e28-4afd-4220-b23a-216a0bd7d9b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1116150 ms
Total Talk Time (AGENT): 223786 ms
Total Talk Time (CUSTOMER): 250094 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/26665e28-4afd-4220-b23a-216a0bd7d9b0_20250417T13:06_UTC.wav
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[AGENT][POSITIVE] Thank you for calling. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I'm calling to find out if you received a claim from us for patients.
[AGENT][NEUTRAL] Yeah, [PII], I can check claim status for you today. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure and my name starts with a [PII], so it's pronounced [PII].
[AGENT][POSITIVE] Oh, OK. Thank you.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Um, yeah, the patient's ID number that I have here is [PII] for [PII].
[AGENT][NEUTRAL] OK, perfect. Let's see. And then what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then [PII], what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] I have the data service um of a 2624 total bill is uh hold on.
[CUSTOMER][NEUTRAL] Looks like 1170.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said data services 826-2024?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm I'm not seeing a claim on file for that data service.
[CUSTOMER][NEUTRAL] OK, hold on.
[AGENT][NEUTRAL] Let me, I'm gonna double check and see if she has any other policies with us.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, no, it looks like this is the only one.
[CUSTOMER][NEUTRAL] I mean, that's fine. I mean, I just need to know if you received the claim for that date. Um, can you check, uh, a couple, um, another date for the patient for me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, of course.
[CUSTOMER][NEUTRAL] It's for data service 226 25 for build amounts.
[CUSTOMER][NEUTRAL] Um, and I think I gave you the wrong bill amount for the first one. It wasn't 1170, it was actually 1,296.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what's the bill amount for the 2 2625?
[CUSTOMER][NEUTRAL] Uh, that one is 1280.
[AGENT][NEUTRAL] 2, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do see one claim on file for that data service, but it looks like.
[AGENT][NEUTRAL] It's not for that amount, but we did pay to the provider.
[CUSTOMER][NEUTRAL] For, for the 226.
[AGENT][NEUTRAL] 0, 226. I'm sorry.
[CUSTOMER][NEUTRAL] No, well, which one are you referring to? Because I, since I gave you.
[AGENT][NEUTRAL] Oh, the date.
[AGENT][NEUTRAL] Yes, um, so for data service 226 2025, there is a claim on file, but the total bill amount isn't the $1280 and we did pay that to the provider.
[AGENT][NEUTRAL] I'm thinking it's a different.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] It's a different claim for this one.
[CUSTOMER][POSITIVE] Yeah, cause we're a flo
[CUSTOMER][NEUTRAL] We're Florida Retina Institute, is that who you're seeing the provider as?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEGATIVE] For some reason my system is just slow this morning.
[AGENT][NEUTRAL] Oh, yes, it is for retina.
[AGENT][NEGATIVE] How do you say that vitreous consultants.
[CUSTOMER][NEUTRAL] Yes, consultants LLP, yes.
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] But you're saying you're not seeing that building amount, which is strange.
[AGENT][NEUTRAL] Yeah, because it's not the charge of the bill amount that you gave me, it's for $259.79. It looks like we paid.
[AGENT][NEUTRAL] That amount to the provider.
[AGENT][NEUTRAL] To you guys, um.
[CUSTOMER][NEUTRAL] OK, I'm confused. I said, you said, I'm sorry, what is the bill amount that you're seeing?
[AGENT][NEUTRAL] It's $259.79.
[CUSTOMER][NEGATIVE] For the bill amount that doesn't sound right.
[AGENT][NEUTRAL] Right, I know, so.
[CUSTOMER][NEUTRAL] Because the bill amount should be.
[CUSTOMER][NEUTRAL] It's 1280. There's 3 lines on the claim.
[CUSTOMER][NEUTRAL] Three different CPT codes, so I'm not sure.
[CUSTOMER][NEGATIVE] Why you're only seeing that bill amount because that's not correct.
[AGENT][NEUTRAL] Yeah, I'm thinking that maybe we don't have this claim on file then.
[AGENT][NEUTRAL] Hold on, just one moment. Let me um speak to my colleague about this one, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you. Just a minute.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you mind if I give you a call back on this one?
[CUSTOMER][NEUTRAL] Sure, I'm sorry, what was the amount that you said that you saw?
[AGENT][NEUTRAL] I, I'm seeing $259.79.
[CUSTOMER][NEUTRAL] OK, so I think because I was looking at the um the EOB again.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that is the, because the patient has a primary with um.
[CUSTOMER][NEUTRAL] United um Healthcare, um, of all states. So they processed the claim and applied that same amount towards the deductible. So, um, but, um.
[CUSTOMER][NEUTRAL] I'm not sure why you didn't see the total bill as opposed to just the deductible amount, but that's what's, that's the deductible amount from the primary. Well, how, um, was it a crossover claim that you received or was that a direct bill from us?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It says provider Retina Veturis Consultants.
[AGENT][NEUTRAL] Um, and it says it was paid to the provider.
[CUSTOMER][NEUTRAL] Well I, I know that's, I know that's the payee, but I'm saying how, how was the claim received? Was it a crossover from the primary or did we bill you guys the claim?
[AGENT][NEUTRAL] I'm not sure. I can't see that on my end. Um.
[CUSTOMER][NEUTRAL] OK. All right, that's fine. All right, don't worry. Um, so you're saying that amount was paid, um, the full 25979?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And on what date?
[AGENT][NEUTRAL] It was paid on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, what's the claim number?
[AGENT][NEUTRAL] It is 358-7725.
[CUSTOMER][NEUTRAL] OK, uh, is there an EFT or track number?
[AGENT][NEUTRAL] Yes, the check number is 203.
[AGENT][NEUTRAL] 83
[AGENT][NEUTRAL] 60.
[CUSTOMER][NEUTRAL] And is that a single or bulk?
[AGENT][NEUTRAL] It's a single.
[AGENT][NEUTRAL] It's together.
[CUSTOMER][NEUTRAL] I'm sorry, what do you mean this together?
[AGENT][NEUTRAL] So it's, it's um $259.79. It's just one check.
[CUSTOMER][NEUTRAL] OK, all right, no problem, um.
[CUSTOMER][NEUTRAL] What platform for your EBs, what is the platform?
[CUSTOMER][NEUTRAL] Or do you guys mail out your own ELBs?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Oh, let me ask. Sorry, I'm kind of new.
[AGENT][NEUTRAL] Just a minute.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so my colleague said that each time a claim is processed an EOB is mailed.
[CUSTOMER][NEUTRAL] OK, so you don't have like a platform like Echo or Zalus that you that we can obtain an an EB.
[AGENT][NEUTRAL] No. Mm.
[CUSTOMER][NEUTRAL] When was the, it'll be mailed for um.
[CUSTOMER][NEUTRAL] For this one, for the 226, because it was paid in towards the end of um February and we're now in mid-April.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Or would you be able to at least or email me a copy of the EOB?
[AGENT][NEUTRAL] Yes, I can mail you a copy of the EOB.
[CUSTOMER][NEUTRAL] No, not mail email.
[AGENT][NEUTRAL] Email? Yes. Yes, ma'am. Uh, what is your email?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's [PII], [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so I'm sorry, I'm looking at the check and it says that the issue date for this check was [PII].
[CUSTOMER][NEUTRAL] Oh, OK. All right, then, never mind. You don't have to email then. So it's, I'm not sure why it took so long. Yeah, that's OK. Um, we'll just wait for it to receive it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, yeah, I'm not sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much for, and your name again, I'm sorry?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Do you guys give reference numbers?
[AGENT][NEUTRAL] Yes, ma'am. So it would be my first name and then my last initial, which is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK. All right, no problem. Thank you, [PII]. You have a good day.
[AGENT][POSITIVE] OK. Thanks for calling APL. Have a good day.
[AGENT][NEUTRAL] OK. Bye.
[CUSTOMER][NEUTRAL] Bye bye.