AccountId: 011433970860
ContactId: 519a713e-8ca5-4677-abc8-87f76a7f6cf3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 603840 ms
Total Talk Time (AGENT): 179862 ms
Total Talk Time (CUSTOMER): 96872 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/519a713e-8ca5-4677-abc8-87f76a7f6cf3_20250305T19:25_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm calling from a provider's office um following up on a claim.
[AGENT][NEUTRAL] OK, I can take a look at that for you. Could I get your name and a callback number?
[CUSTOMER][NEUTRAL] My name is [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you. The policy number you're calling on today, [PII]?
[CUSTOMER][NEUTRAL] It is 02410980.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, it is [PII], and her date of birth is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] OK, and you did say you were calling uh to check status today?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is the data service you're checking?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I do show the claim received let's see.
[AGENT][NEUTRAL] The claim was processed on [PII], paying $110 to the provider.
[CUSTOMER][NEGATIVE] OK, so there was a problem with the claim, I think I was told by someone, uh, APL it was entered incorrectly, the fees, so I've called on this 1233 times, um.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And I've been told that it's gonna get fixed and I just wanted to.
[CUSTOMER][NEUTRAL] Follow up on if it got fixed or not.
[AGENT][NEUTRAL] OK, let me see what's going on here.
[AGENT][NEUTRAL] Schedule
[AGENT][NEUTRAL] So the procedures that did pay, you're saying the incorrect amount was paid on those procedures according to the the schedule is.
[CUSTOMER][NEUTRAL] Well, on the, yeah, no, on the EOB, the fees that we submitted are not the fees that are showing on the EOB for the adult pro fee and the bylines.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK, do.
[AGENT][NEUTRAL] like
[AGENT][NEUTRAL] OK, let me pull the.
[AGENT][NEUTRAL] OK. And you said you've called several times?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] The last time I called was [PII] and they told me it was gonna be fixed in 10 days.
[AGENT][NEUTRAL] That's so like OK, I do show that several times. Let's see what.
[AGENT][NEUTRAL] Go.
[AGENT][NEUTRAL] Information a dollar
[AGENT][NEUTRAL] OK, and this is for code 0274 and.
[AGENT][NEUTRAL] 1110.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and claim back to examiner for additional payment.
[AGENT][NEUTRAL] OK, let me, do you mind holding one moment?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh I'm not.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] Nobody wants to fucking work, man.
[AGENT][NEUTRAL] This is
[AGENT][NEGATIVE] I'm no point in talking to her. Shit.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I'm gonna get out for her.
[AGENT][POSITIVE] OK, thank you for calling. I'm sorry, thank you for holding, [PII]. I apologize for the wait. Um, I read the notes also I show I actually spoke with you also. I do remember this one. I'm not sure why it hasn't been reprocessed. Uh, I do see where you are told that every time you call, I do apologize for that, um.
[CUSTOMER][NEUTRAL] Oh wait.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This would need to be escalated to a team lead or supervisor um and so right now, uh, everyone's in a meeting but I can um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Make sure that this is handled by a supervisor team lead and um.
[CUSTOMER][POSITIVE] You're good you'll be just a few, OK, alright.
[AGENT][POSITIVE] Get it handled. I'll call you if anything's different, you'll get a call back, but um I do believe with it being escalated, it'll be taken care of uh within 24 hours.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. I do apologize for that. Um, but like I said, it should be, um, I will call back in 24 hours just to make sure unless you get a call stating something different than what you've been told, uh, there is no reason the claim would not be reprocessed once escalated.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] OK, you have a wonderful day. Thank you for calling APO.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.