AccountId: 011433970860
ContactId: 358aeb22-4dfc-40a9-87a4-62fd479471f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 617210 ms
Total Talk Time (AGENT): 196498 ms
Total Talk Time (CUSTOMER): 243452 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/358aeb22-4dfc-40a9-87a4-62fd479471f2_20250127T16:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from a provider and I have a question about a claim.
[AGENT][NEUTRAL] OK. And you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah, I'm sorry I didn't have.
[AGENT][POSITIVE] OK, I can help.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Your name once again?
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] And what's the policy number, [PII]?
[CUSTOMER][POSITIVE] OK, yes, I do.
[CUSTOMER][NEUTRAL] Uh, let me get that.
[CUSTOMER][NEUTRAL] It is 0244.
[CUSTOMER][NEUTRAL] 497556.
[AGENT][NEUTRAL] 497.
[CUSTOMER][NEUTRAL] 56
[AGENT][NEUTRAL] Is there 2 4s or 3?
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] that's the direct number.
[AGENT][NEUTRAL] OK, thank you. And you said that you were calling um about a claim. Did you receive the ELB and you had a question about the claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, we actually haven't received the EOB and so I have previous notes that it was sent again.
[AGENT][NEUTRAL] OK. So
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Let me see if I can give you um.
[CUSTOMER][NEUTRAL] I have a check number, a check amount.
[CUSTOMER][NEUTRAL] When it was processed.
[AGENT][NEUTRAL] So did you receive payment?
[CUSTOMER][NEUTRAL] It's from the previous notes, it shows that we did.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But for whatever reason we don't have, we don't have an EOB and of course that doesn't make no sense cause it was.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the one that you're reading from, does it, what's the remark code on it?
[CUSTOMER][NEUTRAL] For the EOB or something.
[AGENT][NEUTRAL] You said that you have the check number or are you looking in your system?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, I have it in my
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] The check number?
[AGENT][NEUTRAL] Yeah, never mind. Give me, give me just a second.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what's the date of service and the bill amount on the claim?
[CUSTOMER][NEUTRAL] 221 of 24.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then let me get the the amount is.
[CUSTOMER][NEUTRAL] 31,900.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, so I show that the claim was processed on the on [PII]. Is this the.
[AGENT][NEUTRAL] Orthopedic Surgery Center?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so I do show that a payment.
[AGENT][NEUTRAL] Of, um
[AGENT][NEUTRAL] $481.01 was made payable to the provider.
[AGENT][NEUTRAL] And on that explanation of benefits, it cites that.
[AGENT][NEUTRAL] With the payment of this check, the policy maximum for this benefit has been met, so that was the remaining benefit available. So that was all that was paid.
[AGENT][NEGATIVE] And then we received the claim again and denied it as a duplicate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because the information of the note is that we haven't actually received the EOB, the EOB even though we might have received.
[CUSTOMER][NEUTRAL] Um, well, I'm not even too sure of the, um, the payment.
[CUSTOMER][NEUTRAL] But in, and then the notes indicate that it was, it was faxed over. Can it be faxed again?
[AGENT][NEUTRAL] So the EOB is attached to the check. So did you receive a check for 4101?
[CUSTOMER][NEUTRAL] Is it a is it a, it's a check, it's not an EFT.
[AGENT][NEUTRAL] Individual
[AGENT][NEUTRAL] It's an individual paper check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you show receipt of the check?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That is something we need to do it, it's according to these notes and that's what I'm going by, and I don't see that we haven't posted yet.
[CUSTOMER][NEUTRAL] But then I know that there's no that it cleared on [PII].
[AGENT][POSITIVE] Right, so I do show that it cleared.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] But in regards to
[CUSTOMER][NEUTRAL] I don't know how it might have happened, how it got posted or not, but is it possible that you could fax it from because there was, there was notes on here on [PII].
[CUSTOMER][NEUTRAL] That it was going to be yeah.
[AGENT][NEUTRAL] Yeah, but I'm saying it was also attached to the check as well that has already cleared, so the EOB is there somewhere, but we can re fax it and you can also download it from the online service center since it's been generated. I can give you that address and assist you with creating the account if you would like as well.
[CUSTOMER][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, well, can we just have it requested to be faxed again to the same previous number?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Do you have that in your notes from uh [PII]?
[AGENT][NEUTRAL] I'm trying to confirm it. So what is the fax number?
[CUSTOMER][NEUTRAL] That I do not have. I have our billing department, but we have another group that actually posts the the information and that.
[AGENT][NEUTRAL] OK, where does it, where should it be faxed?
[CUSTOMER][NEUTRAL] To the previous number that it was.
[AGENT][NEUTRAL] OK, but you didn't receive it, so I'm just trying to confirm.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] So if I send it again and you didn't receive the first one, I think we should confirm the correct fax number.
[CUSTOMER][NEGATIVE] No, it, it is correct from the first one. It's just that they're, they're indicating that they want more time to be waiting and I don't think we should be waiting. I think it needs to be faxed again.
[CUSTOMER][NEUTRAL] Because the way I understood it, it, it only should, you should, we should receive it within the day.
[AGENT][NEUTRAL] Yeah, I mean, it, it could be anywhere from 5 to 7 days. So, to receive a, a fax.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that we would actually receive the EOB?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK, no, they said the notes indicate that we would receive it the same day.
[AGENT][NEUTRAL] Yeah, it could take anywhere from 5 to 7 business days.
[CUSTOMER][NEUTRAL] Oh no, then it hasn't been really enough time. 1234567. Today's day number 8. OK, well then I'll update the notes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And, and then we will wait another, another, who knows, another week or so.
[AGENT][MIXED] OK, but it would be nice to verify the fax number though as well.
[AGENT][NEUTRAL] Because then it's gonna be kind of a vicious cycle if we, I mean I have an [PII], but you said you don't know the fax number.
[CUSTOMER][NEUTRAL] Uh, let me see if I
[AGENT][NEUTRAL] So it would be wise to verify it.
[CUSTOMER][NEUTRAL] No, that could, that could possibly be right, because my, my.
[CUSTOMER][NEUTRAL] The fact that I would give you.
[CUSTOMER][NEUTRAL] Doesn't handle that that information. So even though you would fax it directly to us, then it still needs to know so we need to wait but no the the notes indicate that it should have come the same day.
[CUSTOMER][NEUTRAL] So, and it's only day number [PII]. So, that is fine. But um
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Alright, can you, I was gonna say, can you give me that fax number again so I can write it down.
[AGENT][NEUTRAL] What, what office are you calling from, ma'am?
[CUSTOMER][NEUTRAL] Orthopedic surgery center, do you want my tax ID or NTI?
[AGENT][NEUTRAL] Verify the tax ID number for me please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And can you verify the patient account number that's on the claim that was submitted to us?
[CUSTOMER][NEUTRAL] Oh yeah sure.
[CUSTOMER][NEUTRAL] Patient account number would be [PII].
[AGENT][NEUTRAL] OK, so I'm showing that the fax number provided was [PII] was made to the attention of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said 866
[AGENT][NEUTRAL] 822.
[AGENT][NEUTRAL] 9770.
[CUSTOMER][POSITIVE] Alright then thank you so much. uh, is there a reference for our call?
[AGENT][NEUTRAL] You'll use my name in today's date is your reference T O N Y A, first initial last name is [PII]. Any other questions?
[CUSTOMER][POSITIVE] No, thank you so much for all your help and your and your information.
[AGENT][POSITIVE] You're welcome. Thanks for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] You too.