AccountId: 011433970860
ContactId: 2c145ed5-3171-47a8-8f15-ee55dde24091
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 438339 ms
Total Talk Time (AGENT): 198985 ms
Total Talk Time (CUSTOMER): 215969 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/2c145ed5-3171-47a8-8f15-ee55dde24091_20250326T17:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I guess I had a question about trying to provide more information on a claim. I got a letter in the mail from APL and in the notes it says to provide the um explanation of benefits from the primary which I have so I'm trying to log on but I'm just trying to understand.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] If I send it, how do you know where to apply it?
[AGENT][NEUTRAL] Sure, OK, yeah, um, I can get that claim pulled up, um, and I can walk you through how to do all of that. Uh, what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] It's [PII] Last name is [PII], [PII]
[AGENT][NEUTRAL] OK, and then [PII], uh, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's not this number. I'll give you my cell, uh [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have your policy number?
[CUSTOMER][NEUTRAL] Yeah, uh, let's see.
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] 01975793 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you. I'm just gonna verify some information really quick.
[AGENT][NEUTRAL] Her date of birth please?
[CUSTOMER][NEUTRAL] I'm sorry, it was breaking up. Say that again.
[AGENT][NEUTRAL] Oh sorry about that. um, can I get your date of birth please?
[CUSTOMER][NEUTRAL] Oh yeah, [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. The last thing I need is the email address we've got on file for you. Uh, looks like it is a [PII] account.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you for verifying that um and who was this claim for was this for you or for one of the dependents?
[CUSTOMER][NEUTRAL] It was for me.
[AGENT][POSITIVE] It was OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Have a claim number if that helps you on the paper.
[AGENT][POSITIVE] Oh, that'd be great, yes please.
[CUSTOMER][NEUTRAL] OK, 357-855-1.
[AGENT][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yes, OK, so you did say that you have the explanation of benefits from your primary insurance?
[CUSTOMER][NEUTRAL] Yeah, and I, I mean it's something I could email or I, I could probably upload it. I just do I just go to where it says upload, yeah, so.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Absolutely, yes.
[AGENT][NEUTRAL] Yes, that is perfectly fine. Um, we'll be able to match those dates with the original information that you had submitted previously and as that's all it's showing that we're missing, um, that should be sufficient so we would be able to continue getting that processed.
[CUSTOMER][NEUTRAL] OK then I'll put that in. I I think I can figure that out. I just, what I noticed is that um on the same day on the same provider it was a procedure and I noticed it was broken up into like different claims I guess because.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Maybe they sent something to a lab or something. Is there any way that you can see if there's other claims that were attempted to be made that haven't been successful on the same date?
[AGENT][POSITIVE] Absolutely for the same date of service, yes, give me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that was
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] For [PII], let's see.
[AGENT][NEUTRAL] OK, yes, so there is another claim number so the first claim number that you gave me, it did show some of those as duplicates, um, except for the ones that, you know, of course needed the, uh, EOB, the primary EOB, but I did find the original claim for those others and that's just needing the primary EOB as well. So if you have that for that all of that date of service, it was just those two claims um and it's so essentially that one claim, the 551 has everything on there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, we just need the primary EOB for all of those.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So if I submit to 551, the EO for whatever reason I have two EOBs.
[CUSTOMER][NEUTRAL] But for the same day of service, same, you know, same location, it was all the same event. Do I submit them both to 551 or should I submit 1 to 551 and another to another one?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] If you can
[AGENT][NEUTRAL] You can um usually we're we're pretty good about uh putting them where they go, you know, we know what's missing and um where we had that original information um so that should be perfectly fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I mean, OK, it looks like I've uploaded the one already to 551, and so then I'll search for the other UOB and do it again, and that shouldn't be an issue. They'll both come in under 551, but that's OK, alright, I appreciate it. I think I, I think I got it, yeah, go ahead.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Well they might need different claim numbers assigned to them. No, that's OK. I'm sorry. They might have different claim numbers assigned to them, uh, as you know, if they're gonna be processed that way just so that there's no confusion on your end. So this claim technically denied because we were just needing that information. So once we have this, it will be assigned a new claim number just so that you know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but um, well, alright, I understand, but I do, I guess since I have two different EOBs, I'm gonna upload them separately, but both of 551.
[CUSTOMER][NEUTRAL] Claim, I guess.
[AGENT][POSITIVE] That that is perfectly fine, yes.
[CUSTOMER][MIXED] OK, and you've been very helpful I appreciate it, but if, if you don't mind, can you look into letting me know if another claim was submitted for um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] From another provider for, oh, you know what? it doesn't say the data service. Oh yeah, it does for for um it's from Baptist Health Orthopedics is the name of the provider and I got a bill in the mail. I just wanted to.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Understand if they have sent you a claim it's for.
[CUSTOMER][NEUTRAL] Uh, [PII] of this year, [PII].
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Service on that date and it was like an X-ray.
[CUSTOMER][NEUTRAL] Um, and an office visit, so.
[AGENT][NEUTRAL] And this was for you still correct?
[CUSTOMER][NEUTRAL] Yeah, it's for me and it's under Baptist Health Orthopedic, or the name of the doctor was [PII]. It might be under his name.
[AGENT][NEUTRAL] Sure, um, I'm not showing that we've received any claims for that date of service so it does not look like they gave that to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Alright, so in that case I should reach out to that provider and have them I guess send in a claim is that that's the proper way to do it? Yeah, OK.
[AGENT][POSITIVE] I definitely would.
[AGENT][NEUTRAL] I definitely would just because it's easier it would be easier for you um but if for some reason they give you any sort of push back or it seems like it just be too much it all providers are different so they might be easy to work with, but if not you can file that claim yourself so that and they'll have that information. All we need is of course the primary EOB and then the itemized statement that shows uh diagnosis and procedure codes, and they will have all of that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you. I'm gonna reach out to them first and we'll take it from there. Alright, I appreciate all your help thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh, you're very was there anything else I could help you with?
[CUSTOMER][POSITIVE] No, that should be all, thanks so much.
[AGENT][POSITIVE] Alright, you're welcome thanks for calling APL have a great rest of your day.
[CUSTOMER][POSITIVE] OK you too bye bye.
[AGENT][POSITIVE] Thanks bye bye.