AccountId: 011433970860
ContactId: 4be15998-e586-4c01-af65-0978fbe44a39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 697869 ms
Total Talk Time (AGENT): 276906 ms
Total Talk Time (CUSTOMER): 231823 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/4be15998-e586-4c01-af65-0978fbe44a39_20250210T19:03_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII], and I'm trying to find out if a claim in a primary EIB has been received.
[AGENT][NEUTRAL] OK, [PII], you're wanting to verify if we've received a claim, you said along with the primary insurance's explanation of benefits, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] 02137731
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bear with me just one moment, [PII], my system is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] It has a lag in it a little bit.
[CUSTOMER][NEUTRAL] I tried to look on, yeah, I was trying to get on the website and it was saying that there was a problem it timed out. I don't know if it was.
[AGENT][NEUTRAL] Huh, OK. I don't.
[CUSTOMER][NEUTRAL] I, I just somewhere if it's the internet or what.
[AGENT][NEUTRAL] OK, so let's see here. I can check that for you, but you do have our portal website already?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, good. All right. So first off.
[AGENT][NEUTRAL] of any information, [PII] that I provide, is it [PII] or [PII]? How do you say it again?
[AGENT][NEUTRAL] How do you pronounce your name?
[CUSTOMER][NEUTRAL] Either way.
[CUSTOMER][NEUTRAL] Either way, I answered it either way.
[AGENT][NEUTRAL] Oh, OK. All right.
[AGENT][NEUTRAL] OK, so first off, any information that I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him please?
[CUSTOMER][NEUTRAL] He's got two dates of service. The first one is [PII]. Total bill amount is $168.02.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] So on this one, we did receive a claim.
[AGENT][NEUTRAL] Um, have you all, OK, so on claim number it was initially received with 352-728-1. That's the claim number.
[AGENT][NEUTRAL] That was denied needing the primary EOB?
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] OK. I think what had happened with that one.
[AGENT][NEUTRAL] Has that been sent?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] They build
[CUSTOMER][NEUTRAL] The APL before they build.
[CUSTOMER][NEUTRAL] Um, Cigna.
[AGENT][NEUTRAL] Their primary insurance? OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] So we just need to have the primary insurance EOB sent for that one.
[CUSTOMER][NEUTRAL] Cigna
[AGENT][NEUTRAL] For that data service that's all that would need to be submitted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And we're gonna use that claim number 352-7281 for that one.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me, give me just a moment.
[AGENT][NEUTRAL] Yeah, OK, that's, that is correct. Would you just need to send us the primary EOB for the 9/11 data service, and you said you had another data service for him also.
[CUSTOMER][NEUTRAL] Yes, it is 9324.
[CUSTOMER][NEUTRAL] And the total charge on that one was $679.02.
[AGENT][NEUTRAL] OK, let's check that.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Uh, just one moment.
[AGENT][NEUTRAL] OK, and how much again was that total bill amount?
[CUSTOMER][NEUTRAL] $679.02.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It looks like they did the same thing with this one like they build it.
[CUSTOMER][NEUTRAL] Before they build the primary insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I don't have a claim on file for that bill amount.
[AGENT][NEUTRAL] For him
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For that data service, not for 679.02. What is the um facility?
[CUSTOMER][NEUTRAL] All right. And
[AGENT][NEUTRAL] Billing?
[CUSTOMER][NEUTRAL] Prima Health Urgent Care South Carolina.
[AGENT][NEUTRAL] What's the tax ID number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so we do have a claim on file for him for that data service.
[AGENT][NEUTRAL] That matches, but the bill amount doesn't match and it was denied needing a primary EOB but it's for 701.02.
[AGENT][NEUTRAL] Not 679.02.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Let me see if I can.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, OK, no.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] OK. I found that one. I don't know why they, they must have changed something on there.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] 9921
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] They.
[CUSTOMER][NEUTRAL] I don't, I don't know what they changed. They've changed something because it's less.
[AGENT][NEUTRAL] I mean, I don't know, I just, I saw, yeah, I.
[AGENT][NEUTRAL] Yeah, I saw, I mean, what your facility and the um data service matches and the tax ID number matches for the claim that we do have on file needing the primary EOB, but the bill amount like I said, you know, that is different of course filed it initially with us instead of the, you know, so there is something different but.
[CUSTOMER][NEUTRAL] But I don't I think.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't, so technically we do not have a claim on file at all for 679.02.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Um,
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I don't know why. Yeah, because I see where in my notes back in November.
[CUSTOMER][NEUTRAL] There was a claim that denied for.
[CUSTOMER][NEUTRAL] Um, primary EIB was needed, but I don't know what they, what they changed unless
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The only other thing I can think of is that for some reason, once they, we got it flipped around and billed the primary insurance that left the balance being what it is, 67902, which I'm not even sure if that looks right at this point. So, um.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I'm going to have to figure out what they did what they changed here before I send this primary EOB, um, do you need the, well y'all would need.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Because it's a $22 it's a, it's a $22 difference. Either way, we need.
[AGENT][NEUTRAL] We need the claim and the prime, yes, because on these supplemental policies, [PII], um, we always will have to have the primary EOB since it's a supplement that helps with their co-pays, deductibles and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] You still need the primary ear
[AGENT][NEUTRAL] We have to have that EOB to see what their primary insurance, you know, applied to the covered services under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Right, and I don't know why there's not a way that when we bill these out, it doesn't bill with the primary EOB attached to it. I have no idea because 9 times out of 10 I know when I see a claim that has is for you guys that it's gonna deny it will have probably denied for primary EOB is needed and I usually end up faxing all of the information in, but I, I just don't understand what they did on this one. They got it kind of all messed up, messed up a little bit, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Oh. Happy Monday. Well, happy Monday, [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yes, somebody gonna fix this. All right, um, Ms. [PII], is there a reference number I can notate for our call today?
[AGENT][POSITIVE] Happy Monday.
[AGENT][NEUTRAL] You would use my name along with today's date, and when you can access the portal now that you have the claim numbers you know you could see.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] The remarks and everything associated.
[AGENT][NEGATIVE] Well, no, I mean, there's no point me even giving you this claim number because it doesn't match what you have anyway.
[AGENT][NEUTRAL] Again, this is for a different bill amount. So for your claim for the 67902, there is not. So we would need the claim and an EOB for that amount. We would need both.
[CUSTOMER][NEUTRAL] OK. So if I get the information from them?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Because we don't have one for 67902.
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] All right, I will get it moving on down the road.
[AGENT][POSITIVE] All righty. OK, then. Well, if that's all I can help you with, it was my pleasure in speaking with you today, [PII], and I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. You as well. Bye-bye.
[AGENT][POSITIVE] Alright, thank you so much. Bye bye.
[CUSTOMER][NEUTRAL] Mhm.