AccountId: 011433970860
ContactId: 285b692d-4b42-4cc9-ba3d-c5f808bfc876
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 359179 ms
Total Talk Time (AGENT): 119918 ms
Total Talk Time (CUSTOMER): 85277 ms
Interruptions: 0
Overall Sentiment: AGENT=2.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/285b692d-4b42-4cc9-ba3d-c5f808bfc876_20250130T20:54_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, hi, um, good afternoon. My name is [PII], and last name initial [PII]. I'm calling from provider's office regarding claim status.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with claim status today, [PII], and do you mind if I get a good call back number from you real quick?
[CUSTOMER][NEUTRAL] Yeah, sure, definitely. The callback number is [PII]. It is a direct line.
[AGENT][POSITIVE] Thank you very much. And what is the policy number we wanted to pull up today?
[CUSTOMER][NEUTRAL] Yeah, just a moment. It's loading.
[AGENT][POSITIVE] No worries. Take your time.
[CUSTOMER][NEUTRAL] OK. Thank you. Um, the policy number is 02408915M for Mary, L for Lima 8.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Give me a second while I get all of that loaded for you.
[AGENT][NEUTRAL] And I'm so sorry, one second, it's loading a little slower than normal, but it's almost there.
[CUSTOMER][NEUTRAL] Yeah, sure, sure.
[AGENT][NEUTRAL] All right. And thank you. Uh, could you verify for me, please, your insured's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK. The patient name is [PII] and the date of birth, [PII].
[AGENT][NEUTRAL] Perfect, I do see Tito here and what is the date of service on the claim we want to look at?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge $4,288 even.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And um let me see.
[AGENT][NEUTRAL] What was that uh total charge after primary?
[CUSTOMER][NEUTRAL] It's $4,288 even.
[AGENT][NEUTRAL] OK, so that was after primary, got you.
[CUSTOMER][NEUTRAL] Like.
[AGENT][NEUTRAL] And what was the name of the facility on file for this?
[CUSTOMER][NEUTRAL] Uh, it's Gastro Health LLC.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] It looks like I found your claim. I am showing that we received your claim on [PII]. We processed the claim on [PII], and it looks like the claim number is 3510952.
[AGENT][NEUTRAL] Um, and I am showing that that claim was denied. I have two reasons stating that.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It looks like we have the incorrect EOB. It says receipt of the reference claim is acknowledged, however, in order for us to proceed or to process this claim, we need the explanation of benefits that matches the claim information.
[CUSTOMER][NEUTRAL] Like you received the incorrect EOB, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Incorrect primary OB OK payer receiving primary OB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Star.
[CUSTOMER][NEUTRAL] OK, and may I know the time you're filing to submit the claim?
[AGENT][NEUTRAL] Oh, OK, yeah, um, so you can submit that at any time or we don't, we don't have a timely filing limit and you don't even need to resubmit the claim. You just need to send the EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] question primary. OK.
[CUSTOMER][POSITIVE] Thank you so much and.
[CUSTOMER][NEUTRAL] May I know your name, I mean, can you please spell your name?
[AGENT][NEUTRAL] Oh yeah, the name, my name is [PII], first initial last name, [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the call reference number?
[AGENT][POSITIVE] Oh, I'm so sorry. Call reference number is also just my name and today's date.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you and thank you for giving this information. Have a nice day.
[AGENT][POSITIVE] Yes, my pleasure. You too, take care. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.