AccountId: 011433970860
ContactId: 3877d59c-8d0d-413e-bc83-bd746fa89722
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515770 ms
Total Talk Time (AGENT): 154639 ms
Total Talk Time (CUSTOMER): 141116 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/3877d59c-8d0d-413e-bc83-bd746fa89722_20250127T15:24_UTC.wav
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[AGENT][NEUTRAL] For calling APL. This is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling um for a patient from Blanchard Valley Hospital on, on, um, denial for for duplication.
[AGENT][NEUTRAL] All right. So you received the claim and it was denied and you just wanted to know the explanation of that denial. Is that correct?
[CUSTOMER][NEUTRAL] Well it yeah it denied duplicate because the original claim submitted they wanted an itemized statement to be sent along with that and then when the biller at the time sent the itemized statement along with the claim, it denied duplicate stating that they've already received the claim. So when the item, uh, so yeah, I'm just checking to see if it can be processed or one of these claims be processed after the itemized had been received.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is this for um a gap policy or this cancer?
[CUSTOMER][NEUTRAL] Well, it's, it's for radiation oncology so a patient with cancer, um, it's an outpatient um facility claim that I'm calling for.
[AGENT][NEUTRAL] OK, let me just um double check if this is a cancer or you need to go to gap. Um, so, can I get your callback number?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Sure it's [PII] [PII].
[AGENT][NEUTRAL] All right. And uh can you please provide me with the policy number?
[CUSTOMER][NEUTRAL] Sure that would be.
[CUSTOMER][NEUTRAL] Um, it's D as in David, 404-07979.
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] That is not a policy number um with APL.
[AGENT][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] OK, I just called the number that was on the explanation of benefits.
[AGENT][NEUTRAL] Yeah, yeah, that's fine. I can look them up, um.
[AGENT][NEUTRAL] Do you happen to have their social?
[CUSTOMER][NEUTRAL] Um, let me see if we have that on file here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yes, it's [PII].
[AGENT][NEUTRAL] Their name and date of birth, please?
[CUSTOMER][NEUTRAL] It's for [PII], [PII].
[AGENT][NEUTRAL] Alright.
[AGENT][POSITIVE] OK. [PII], thank you so much for verifying the information. So, um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So you're calling on the hospital indemnity plan and um
[AGENT][NEUTRAL] Do you know when this claim was sent? because I don't have any recent claims from um.
[AGENT][NEUTRAL] Last year.
[CUSTOMER][NEUTRAL] So the original claim was [PII] and then when she resubmitted the claim with the itemized, it was sent on [PII].
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And we received the denied on [PII].
[CUSTOMER][NEUTRAL] And it looks like the check date was [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, [PII] is what it says on the EOB.
[AGENT][NEUTRAL] OK. I think I found it. This is Blanchard Valley Regional Health.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so let me take a look at what was submitted.
[AGENT][NEUTRAL] I'm gonna try to help you as much as I can. If not, then I'll have to send you to the, the correct department, so just one moment.
[CUSTOMER][POSITIVE] Oh, I appreciate that.
[CUSTOMER][POSITIVE] No, no problem, thank you.
[AGENT][NEUTRAL] All right. So yeah, I'm gonna have to get you over to the hospital indemnity plan because I'm not too sure, um.
[AGENT][NEUTRAL] What their requirements are, so just um give me one moment, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] in the cancer queue.
[CUSTOMER][NEUTRAL] Hey how are you?
[AGENT][NEUTRAL] Yeah, I have a provider on the line.
[AGENT][NEUTRAL] And it's for policy 02427279.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And um I'm reviewing claim 347777777.
[CUSTOMER][NEUTRAL] OK, let's see, give me just a second, let me get everything pulled up here.
[CUSTOMER][NEUTRAL] OK, what's going on with it?
[AGENT][NEUTRAL] OK, so the this denied as a duplicate, um, the prior claim, which is 346-5976 denied because they're asking for the itemized billing, they submitted the UB um and it denied as a duplicate, so I'm sending her over so um you all can let her know what, what is missing.
[CUSTOMER][NEUTRAL] OK, uh, what is the provider's name?
[AGENT][NEUTRAL] Her name is [PII]. The callback number is [PII]. Her extension is [PII].
[CUSTOMER][NEUTRAL] OK, you can send her through.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Uh-huh.