AccountId: 011433970860
ContactId: 3dc08d13-0a92-43a4-a657-a26c8e82194d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335799 ms
Total Talk Time (AGENT): 159754 ms
Total Talk Time (CUSTOMER): 81882 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/3dc08d13-0a92-43a4-a657-a26c8e82194d_20250218T21:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm a provider. I'm calling on a claim please.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. Uh, can I get a good call back number from me first, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Um 01897871.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, do you have that bill amount?
[CUSTOMER][NEUTRAL] $41,082.20.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], do you happen to have the amount after major medical paid?
[CUSTOMER][NEUTRAL] Um, 627,440.
[AGENT][NEUTRAL] That was 6,274 and 40 cents.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Got it. OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, what was the name of the provider's office this was with?
[CUSTOMER][NEUTRAL] Barnes Jewish Hospital.
[AGENT][NEUTRAL] Um, do you happen to have that tax ID?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like she has quite a few claims from that data service. I just wanna make sure I find the right one.
[CUSTOMER][NEUTRAL] Yeah, that's OK.
[AGENT][NEUTRAL] OK, I believe I found it. Um, you did see the Barnes Jewish Hospital, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so from this what we see is, uh, we did receive it, um, it states that the insured's primary insurance provided full benefits so that there are no benefits payable.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] What are you showing that the primary insurance paid?
[AGENT][NEUTRAL] Honestly for this claim that's what I was looking at. I do see one that's that full amount, the $41,082.20 and that is the one that I see, so I don't show us. I there's several that are smaller, um, but they're all from different providers.
[AGENT][NEUTRAL] So it's possible, do you think maybe we didn't receive the primary EOB or at least the correct primary EOB?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's what I'm thinking. Um, so it
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, well, it shows on my end that primary only paid 156,860.
[AGENT][NEUTRAL] Ah, OK, so I'm wondering if typically we're pretty good about catching that like it would just simply deny us stating that we were missing the primary EOB, but it is odd that that's saying that it paid in full. So if you don't mind, I think what we should do is, um, I could put you on a brief hold and reach out to our claims specialist that actually goes through and do the processing of the claims, uh, just to make sure that that information is accurate.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me just a moment, [PII] I'll be right back with you OK?
[CUSTOMER][POSITIVE] Alrighty thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEUTRAL] Doing well thank you. I have got a provider on the line who's calling regarding a claim um it's stating that uh the primary insurance paid the full benefits so there wasn't anything payable and she's saying that from what she has that there was a remaining balance so she wants to review, make sure that what was submitted was accurate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, are you ready for the policy number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it is 01897871.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it is for part 2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, do you have that claim number?
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] OK, it's 3,549,630.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then her name is?
[AGENT][NEUTRAL] Uh, the provider is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And a good callback.
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][POSITIVE] Thank you. I'm ready.
[AGENT][POSITIVE] Alright appreciate it thank you bye bye.
[CUSTOMER][POSITIVE] You're welcome bye bye.