AccountId: 011433970860
ContactId: 34128f33-9a34-4e4f-ac01-7a3d12ed3e11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424619 ms
Total Talk Time (AGENT): 112042 ms
Total Talk Time (CUSTOMER): 226517 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/34128f33-9a34-4e4f-ac01-7a3d12ed3e11_20250414T17:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, sir. This is [PII] calling from the provider's office. I required a claim status. Actually, uh, I had a word, uh, around 10 to 15 minutes ago with the Cara, and I just had a confusion, so I need to talk about more about that claim. So shall we go quickly to the claim detail what you required?
[AGENT][POSITIVE] Yeah, I'm happy to check on a claim, [PII]. Do you have the claim number or the policy number?
[CUSTOMER][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yes, the claim number is 354-0438.
[CUSTOMER][NEUTRAL] Total charge amount is 212.
[AGENT][NEUTRAL] One moment. And do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And if I could please verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII] and the last name is [PII] and the date of birth is [PII]. The date of services.
[CUSTOMER][NEUTRAL] [PII]. And the total bill amount is $83,407. 96 cents.
[AGENT][NEUTRAL] OK. So, claim was denied because the insured's primary insurance covered full benefits. There was nothing for us to pay.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I understand, but what I just need to confirm is that do you guys have received any EOB from the uh primary insurance?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK, just, just, yes, just bear with me.
[CUSTOMER][NEUTRAL] 23281.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what is the address?
[CUSTOMER][NEUTRAL] OK, can we move further for the 2nd class?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Let me check and see what was submitted with the claim here give me just one moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I'll repeat the number. It is PO Box 2997.
[CUSTOMER][NEUTRAL] PO box 2997.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] OK. Pittsburgh, I got that.
[CUSTOMER][NEUTRAL] So we'll do one thing, we will resubmit the claim.
[CUSTOMER][NEUTRAL] Uh, through electronics.
[CUSTOMER][NEUTRAL] And what is, what will be the time for?
[AGENT][NEUTRAL] OK, so it looks like we did receive an EOB with the original claim, yes.
[CUSTOMER][NEUTRAL] OK, but, uh, as we have received the EOB from the primary where uh it is a PTR of 7,311 dollars.55 cents. So I just want to know that uh this will go for secondary adjustment or directly for the patient responsibility.
[CUSTOMER][NEUTRAL] Bye
[AGENT][NEUTRAL] So we don't show that the patient had any outstanding balance on this. That's why there was nothing paid additionally. So if the claim needs to be resubmitted, it can be. There is no timely filing limit, but I don't show that there was anything for us to pay on this because their primary did cover it.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, thank you for calling have a great day.
[CUSTOMER][NEUTRAL] But we have, we do have an EOB where it is showing that 7,311 amount is
[CUSTOMER][NEUTRAL] Uh, patient responsibility, so I just wanna confirm that it is for directly patient responsibility or it is secondary adjustment.
[AGENT][NEUTRAL] I can't advise on the patient responsibility. The EOB that we have does not show that that balance is due, so it would need to be resubmitted.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So, who is the right person who can give me the information related to this? So can you just out the call to the correct person for this?
[AGENT][NEUTRAL] I'm sorry, [PII], I don't understand. What's your question?
[CUSTOMER][NEUTRAL] I just want to say that, that there is a patient responsibility of $7,311.
[CUSTOMER][NEUTRAL] Which I want to confirm that it is directly for patient responsibility that is billed to the patient or it will be paid by the secondary, that is you guys. So I just wanna confirm that because in our system, we have received an EOB from the primary career where it is shown that 7,311 amount is pending. That is the patient's responsibility.
[AGENT][NEUTRAL] We're not able to advise on patient responsibility that's up to the facility or the provider to build the patient.
[AGENT][NEUTRAL] We can't advise you on that.
[CUSTOMER][NEUTRAL] So can you just tell me what is the allowed amount from your end?
[AGENT][NEUTRAL] The outpatient benefit amount on this plan per calendar day is 1500.
[CUSTOMER][NEUTRAL] 1500, that is the allowed amount from your end.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, if you want, we can just send it for reprocess.
[AGENT][NEUTRAL] That's fine, you can do that.
[CUSTOMER][NEUTRAL] So can you just go, go further and do the reprocess it?
[AGENT][NEUTRAL] It would need to be resubmitted to be, it would need to be resubmitted to be reprocessed.
[CUSTOMER][NEUTRAL] Send it for the repurchase.
[CUSTOMER][NEUTRAL] OK, you need it from our end.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Not an issue, help me with the call reference number.
[AGENT][NEUTRAL] Call references my name with my last initial, then today's date. My name is [PII], that is spelled [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] OK, [PII], thank you so much. Take care. Bye-bye.
[AGENT][NEUTRAL] Bye bye.