AccountId: 011433970860
ContactId: 31d680b5-dc09-43ca-8605-892442eecb91
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 887780 ms
Total Talk Time (AGENT): 392272 ms
Total Talk Time (CUSTOMER): 203049 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/31d680b5-dc09-43ca-8605-892442eecb91_20250509T18:14_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. Last initial is [PII], and I need to check status on claim, please.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Uh, my phone number is [PII]. That's a direct line, uh.
[CUSTOMER][NEUTRAL] And I'm sorry, the facility is Saint Anthony Health Center?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] 01907877.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I have the policy here. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Uh, 3124 $23,881.40 and this was uh faxed on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] And did you say your name was [PII] or [PII]?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] And OK, thank you.
[AGENT][NEUTRAL] You're welcome. OK, so.
[AGENT][NEUTRAL] All right, [PII], do you mind if I place you on just a brief hold while I look through the claims?
[CUSTOMER][NEUTRAL] That's time.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, wait a minute, now what's happening?
[AGENT][NEUTRAL] That's a whole total different, I mean total different, that's a whole different balance.
[AGENT][NEUTRAL] Let's just go through it just to be on the safe side.
[AGENT][NEUTRAL] 128
[AGENT][NEUTRAL] 1:30.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 837.
[AGENT][NEUTRAL] 573 was voided, but how much was it? Just uh.
[AGENT][NEGATIVE] Inconsistent.
[AGENT][NEUTRAL] Oh no, there it is 23,140. So then that was voided so then it's this one.
[AGENT][NEUTRAL] Looks like
[AGENT][NEUTRAL] Just to make sure.
[AGENT][NEUTRAL] 038140 pay ratio.
[AGENT][NEUTRAL] What's the check number.
[AGENT][NEUTRAL] So 38,510.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. There were a few that came in for that day. Um, so it was the one in March was voided. Are you wanting to know about the reissued one or the voided check?
[CUSTOMER][NEUTRAL] Um, hold on, let me go back there. Um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I didn't know, I didn't know there was a.
[CUSTOMER][NEUTRAL] Voided check.
[AGENT][NEUTRAL] Yeah, let me see if it was sent to the wrong address or something what caused the void.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Well, because I called, I called on [PII] and I was told that there was no claim on file.
[AGENT][NEUTRAL] Well, it might not have been because we received it on the [PII], so depending on when you called, it may not have been visible.
[CUSTOMER][NEUTRAL] OK, so that's, uh, I don't know, like I said, I don't know anything about a reissued of tax.
[AGENT][POSITIVE] OK, I can give you both if you want. I just want to know what, you know, make sure I give you what you need.
[AGENT][NEUTRAL] You want to do both?
[CUSTOMER][NEUTRAL] Sure, I, yeah.
[CUSTOMER][NEUTRAL] Um, yeah, because when
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess when was the one issued, the voided one issued.
[AGENT][NEUTRAL] It was issued on [PII] of this year.
[CUSTOMER][NEUTRAL] Was that reissued because it was sent to the wrong address or something?
[AGENT][NEUTRAL] That's what I was trying to look in the notes, but I didn't see anything in the notes. Hold on one second, delete.
[AGENT][NEUTRAL] What's the difference between the two? Hold on one moment.
[AGENT][NEUTRAL] OK, so the provider submitted both.
[CUSTOMER][NEUTRAL] Oh, you're fine.
[AGENT][NEUTRAL] I was thinking maybe the insured submitted one or something, but I don't, I see it's all from the provider. Let me look at this original check and compare the addresses. Hold on one second.
[CUSTOMER][NEUTRAL] OK, no, that's fine because I, we did have a change of address. Um, I was just confused when you said the void and I'm like, uh.
[AGENT][NEUTRAL] It wasn't expecting that. OK.
[AGENT][NEUTRAL] Yeah, I don't know. Let me see. 2034072.
[AGENT][NEUTRAL] OK, hold on one moment, so this is the voided one.
[AGENT][NEUTRAL] Deer of
[AGENT][NEUTRAL] I see
[AGENT][NEUTRAL] And then let me do the one that was just submitted, I mean reissued.
[AGENT][NEUTRAL] No, they were sent to the same address.
[CUSTOMER][NEUTRAL] What's the address?
[AGENT][NEUTRAL] I'm not
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEGATIVE] Yeah, that's the wrong address.
[AGENT][NEUTRAL] That's wrong?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So, let me go back to the original then.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] OK, yeah. So they both were sent to the incorrect address. So, um, what is the correct address?
[CUSTOMER][NEUTRAL] Um, the correct address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, yeah, yeah, just, yes, [PII], yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so for that, let me do this. Do you mind if I place you on just a brief hold? Let me pull up these documents. Um, hold on one moment, OK?
[CUSTOMER][NEUTRAL] No, that's fine.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Let's do this.
[AGENT][NEUTRAL] Cause that's gonna solve it all. What did you send in?
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Why it was [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] NPL
[AGENT][NEUTRAL] And it was sent to [PII], it was sent to [PII].
[AGENT][NEUTRAL] Where's their billing box?
[AGENT][NEUTRAL] Oh, wait, come back.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] OK, hello, [PII].
[AGENT][NEUTRAL] Hello, [PII].
[AGENT][NEUTRAL] Uh oh, hello?
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Yes, can you hear me?
[CUSTOMER][NEUTRAL] OK, I did. I, yeah, I had to get up real quick. I was hoping you wouldn't come back.
[AGENT][NEUTRAL] OK, so there's a few.
[AGENT][NEUTRAL] It's OK. So there's a few things that I see. So, for one, we're going to need to receive a corrected claim.
[AGENT][NEUTRAL] In your billing box on the claim form, it lists the [PII] City address. That's why it's being sent there. So we need to correct the claim with the correct address.
[CUSTOMER][NEUTRAL] For what?
[CUSTOMER][NEUTRAL] Can I just fax the W-9 to you?
[AGENT][POSITIVE] Yeah, you can do that as well.
[CUSTOMER][NEUTRAL] But do you need both of them or can I just do the the W-9?
[AGENT][NEUTRAL] Well, we request to correct the claim, but if you'd like to send the W-9, you can.
[CUSTOMER][NEUTRAL] OK, I just didn't know what was because most providers just want the W-9 that's why I didn't know.
[AGENT][NEUTRAL] Yeah, it's fine, whichever one you send, uh, we can use both or either or, but also I wanted to point out the address that it was sent to was [PII]. We have a new claims mailing address. I didn't know if you knew that or not. I will give you the new one if you need it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can change it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because, uh, well, let me see, let me, oh, I'm on a different account, hold on, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because the address that I have is the [PII], so yeah, I can take the new one.
[AGENT][NEUTRAL] Alright, so it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and what's your fax number for the W-9?
[AGENT][NEUTRAL] So it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And um it needs to be to the attention [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we receive that,
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][POSITIVE] Oh go ahead I'm sorry.
[AGENT][NEUTRAL] No, you're fine. So once you receive that, we'll go ahead and correct the um
[AGENT][NEUTRAL] I was gonna say the mailing address [PII], it's Friday. I'm sorry. We will go ahead and.
[CUSTOMER][NEUTRAL] It, it sure is.
[AGENT][NEUTRAL] And correct the um claims mailing address on file here to the um [PII] address and then um we'll go ahead and reissue the check to you.
[CUSTOMER][NEUTRAL] OK, so, um, you automatically, uh, like follow up on this one or do I need to call back at a certain time to say hey can you send that back?
[AGENT][NEUTRAL] Say that one more time. What do you mean by that?
[CUSTOMER][NEUTRAL] Once you get the W-9, do you automatically go through, go through the go through the claims to have them sent back to be reprocessed to the correct address?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, because how would, how I guess my question is how do you know that, um, this, this claim goes with the.
[AGENT][NEUTRAL] Right, so, so that's why we request.
[AGENT][NEUTRAL] Right, so that's why we request the corrected claim. So we'll know which claim it goes to, but I can give you, um, if you want to put like the claim number or the policy number on there, you can. If you want to write a little note on the W9, you can, um, but yeah, that's why we asked for the corrected claim because it will be on the claim with the claim information.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, I'll just send them both together.
[AGENT][POSITIVE] Oh yeah, I can do that.
[CUSTOMER][NEUTRAL] I'll just send the W-9 and the
[AGENT][NEUTRAL] correct the claim.
[CUSTOMER][NEUTRAL] Uh, I'll just send the W-9 and I'll send the UB, yeah.
[AGENT][NEUTRAL] OK. And I'll put that on the um the policy as well just so that, you know, the notes are there and it'll be no confusion when it gets here because they'll look up your group.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, and can I, can I have one of the, OK, can I have one of the claim numbers just so.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I can put that on the, on the um backs as well.
[AGENT][NEUTRAL] Mhm. So the voided claim is 357-857-3.
[AGENT][NEUTRAL] And then I can give you the paid one also if you need, you want to put both?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I'll just go ahead and put both that way.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the um paid one is 3586672.
[CUSTOMER][NEUTRAL] OK, and uh how much is being paid, do you know?
[AGENT][NEUTRAL] Um, hold on one second.
[AGENT][NEUTRAL] $1,965.23.
[CUSTOMER][NEUTRAL] And then you're leaving the remaining balance for the patient?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility. So the, the remaining balance would be, um, whatever your procedures are and an outstanding balance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do you do reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. And again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Alright, I'll go ahead and get this sent over to you then thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, that'll be it.
[AGENT][POSITIVE] Alright, well thanks for calling APL. Have a great weekend. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you.