AccountId: 011433970860
ContactId: 491bfb71-848c-4004-bb66-fefe1cf363f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293690 ms
Total Talk Time (AGENT): 55327 ms
Total Talk Time (CUSTOMER): 155916 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/491bfb71-848c-4004-bb66-fefe1cf363f9_20250527T19:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. My last initial is [PII] I'm calling from Driven Physical Therapy and I was going to see if you could take a look. I've got one secondary claim for a patient that's unpaid. All the other ones have been paid, um, and it was faxed over the same day as all the others. If I could get you to take a look.
[AGENT][NEUTRAL] OK, [PII], I can help you with that claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah, policy number is.
[CUSTOMER][NEUTRAL] And what was your name again? [PII]? It was on the tip of my tongue.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, 02456506.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And what were the date of service and bill charges?
[CUSTOMER][NEUTRAL] The only one that's unpaid is [PII].
[CUSTOMER][NEUTRAL] The bill amount was $200 and it was faxed with the primary EOB on [PII] to the [PII].
[AGENT][NEUTRAL] Uh, let's see. Do you know what amount was left over?
[CUSTOMER][NEUTRAL] Yes, 113 94.
[AGENT][NEUTRAL] Uh, it looks like we stated benefits are only payable if major medical provides benefits. Claims later paid by major medical, please provide explanation of benefits showing it it was paid.
[AGENT][NEUTRAL] Was it denied by the major medical?
[CUSTOMER][NEUTRAL] Um, let me pull it up, pull up the UOB, the primary, um.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Discount was 860611394 was patient responsibility and the reason they did not pay expenses incurred after coverage termed.
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][POSITIVE] That's funny because.
[CUSTOMER][NEUTRAL] The primary paid all claims prior to that data service and all the ones after.
[CUSTOMER][NEUTRAL] Hm, let's see.
[CUSTOMER][NEUTRAL] 57 payment includes the allowances for other services, but then it's also a coverage term denial.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Wonder if they've since reprocessed it.
[CUSTOMER][NEUTRAL] But like 11:27, 11:27.
[CUSTOMER][NEUTRAL] What it's 11:27, 11:25 now.
[CUSTOMER][NEUTRAL] 12 3.
[CUSTOMER][NEUTRAL] I'm just looking at another data service see here.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So 123.
[CUSTOMER][NEGATIVE] That one was denied by the primary.
[CUSTOMER][NEGATIVE] For no pre-cert and then you guys paid 40 bucks.
[CUSTOMER][NEUTRAL] Uh, I don't know about that. Let's see.
[CUSTOMER][NEUTRAL] Oh, they ended up paying it they reprocessed it and paid it let me um.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEGATIVE] So you guys didn't pay it because the primary denied it.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is that what you saw? OK, can you tell me when it was done, and then I'm gonna take a look at it. I'm gonna go into their portal and see if they reprocessed at any point. Um, if they did, can I send a corrected claim to you with an updated EOB?
[AGENT][NEUTRAL] Yes, yeah.
[AGENT][NEUTRAL] Yes, absolutely, um, let me give you the claim numbers, uh.
[CUSTOMER][NEUTRAL] Do you have the claim number? Yeah, sure.
[AGENT][NEUTRAL] 3579857 so if you'll reference that if they've reprocessed it.
[CUSTOMER][NEUTRAL] You got it and then when did you guys process it or deny it?
[AGENT][NEUTRAL] Uh, we denied it on.
[AGENT][NEUTRAL] I was on 324, 25.
[CUSTOMER][POSITIVE] You got it. OK, thank you, and I'll check into that and get you a corrected claim over if if I can.
[AGENT][NEUTRAL] OK, anything else I can help with today, [PII]?
[CUSTOMER][POSITIVE] All right, no, that's it I appreciate it.
[AGENT][POSITIVE] OK, thanks for calling [PII]. Have a great day.
[CUSTOMER][NEUTRAL] Uh huh bye bye.
[AGENT][NEUTRAL] Bye bye.