AccountId: 011433970860
ContactId: 393e342f-611c-42bb-82fb-12c0eec22ee6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 880580 ms
Total Talk Time (AGENT): 175019 ms
Total Talk Time (CUSTOMER): 171490 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/393e342f-611c-42bb-82fb-12c0eec22ee6_20250424T15:23_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from provider's office to check on a claim.
[AGENT][NEUTRAL] Sure, I can assist you with claims Mr. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh yes, my callback number is [PII].
[AGENT][NEUTRAL] May I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes, I'm calling from facility Doctors Hospital of [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number 02564245.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] What's the name?
[CUSTOMER][NEUTRAL] Um, patient name is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Your date of birth?
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh date of service is [PII].
[CUSTOMER][NEUTRAL] And bill amount is $83,407.96.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service that you provided to me was [PII].
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, let me look at this claim, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] I don't wanna hear. It's gonna be one more minute. It looks like um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, there's a lot of claims for that date. So let me just pull this other 11 moment.
[CUSTOMER][NEUTRAL] That's my point.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] All right, so it looks like we processed this claim on [PII].
[AGENT][NEUTRAL] And based on the explanation of benefits that we received, it looks like it was fully paid by the major medicals. So if that has changed, we need a copy of the explanation of benefits showing the amount applied towards the deductible co-payment or co-insurance.
[CUSTOMER][NEUTRAL] Uh, could you please provide this information? Uh, I have to update the same information in my system.
[CUSTOMER][NEUTRAL] So this claim was processed on [PII], right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK. And this claim was received on?
[AGENT][NEUTRAL] Uh, let me see when it was received. That's not on the EOB. One moment.
[AGENT][NEUTRAL] Received on [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And what is the claim number?
[AGENT][NEUTRAL] It is 354-043-8.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 38, OK. And this claim is denied or paid?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] is denied because based on the explanation of benefits from the primary insurance, uh, the insured's primary insurance provided full benefits.
[CUSTOMER][NEUTRAL] to generate.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Primary provide full benefits. So secondary will not gonna pay.
[AGENT][NEUTRAL] Yes, if it was fully paid by the major medical, then there's nothing for us to pay. Now, if that has changed in any way, and you have an explanation of benefit that's showing an amount applied towards the deductible co-payment or co-insurance, you can submit the updated EOB the one we have indicates that it's fully paid.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So do you need the primary to process this claim further?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] we want that.
[CUSTOMER][NEUTRAL] OK. Could you please tell me how we can submit this primary OB? Can we submit through fax?
[AGENT][NEUTRAL] You can fax it or mail it, yes. Uh-huh. The fax number is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], correct?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Attention to
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, could you please, uh, fax that you to me?
[AGENT][NEUTRAL] Yes, what is the fax number?
[CUSTOMER][NEUTRAL] Um, it is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you mind holding for me while I send this out to you while I got you on the line, Mr. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Mr. [PII]. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm. OK. Uh, could you please spell your name?
[AGENT][NEUTRAL] Sure. My name is [PII]. That's initial [PII].
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. OK, so, uh, uh, can I get call reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's name.
[CUSTOMER][POSITIVE] Mm, OK, fine. Thank you so much, uh, so for assisting me. Have a good day.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling APO. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.