AccountId: 011433970860
ContactId: 51ba558b-881a-4357-9739-2e5a2dc0bb4d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1231300 ms
Total Talk Time (AGENT): 313895 ms
Total Talk Time (CUSTOMER): 492544 ms
Interruptions: 5
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/51ba558b-881a-4357-9739-2e5a2dc0bb4d_20250320T18:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hey, good day, [PII] how you doing?
[AGENT][POSITIVE] I'm doing good how about you?
[CUSTOMER][NEUTRAL] I'm doing OK. I'll, I'll feel much better if you can tell me whether or not my claims have been uploading to your portal. I'm not sure if it was you that taught me how to do it, you know, you walked me through one day. I'm not sure I'm looking for on one of the claims, uh, the representative's name, but I've been uploading them to the portal.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and I don't see them. I'm going back to like follow up on them and I don't see them.
[AGENT][NEUTRAL] OK. What is your, um, policy number? Do you have that available?
[CUSTOMER][NEUTRAL] Well, I am a provider.
[AGENT][POSITIVE] Oh, provider, OK, perfect. Sorry about that.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Do you have the policy number for your patient?
[CUSTOMER][NEUTRAL] The um uh member ID?
[AGENT][POSITIVE] Yeah, that should hopefully work.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 02265945.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what was your name and callback number?
[CUSTOMER][NEUTRAL] My name is [PII]. Last name initial [PII]
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] And a good call back number just in case we get dropped.
[CUSTOMER][NEUTRAL] [PII] and that's direct. It almost, I, I keep thinking that the call is gonna drop and I hear that you have me on speaker phone, but it seemed like you keep clicking out every once in a while, but at least you got my number just in case the call drops the call.
[AGENT][NEUTRAL] I know I I keep.
[AGENT][NEUTRAL] Keep getting that.
[AGENT][NEUTRAL] OK,
[CUSTOMER][NEUTRAL] Just give me a holler back.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I'm looking at, um, it looks like she has a
[AGENT][NEUTRAL] What dates of service are you checking on?
[CUSTOMER][NEUTRAL] Um, [PII] for this particular claim.
[CUSTOMER][NEUTRAL] Um, it, we, I resubmitted it.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Just EDI, you know, electronically back in December then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I uploaded it.
[CUSTOMER][NEUTRAL] To the portal that I'm gonna try to find.
[CUSTOMER][NEUTRAL] OK, you know what, we're gonna, if you ever get ready for a member ID again, can I try a different member ID because I know this for sure. OK, 023.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 893-82.
[CUSTOMER][NEUTRAL] The first member was the one I was looking at at the time, but I remember reloaded Virginia's claims.
[AGENT][NEUTRAL] Let's see
[CUSTOMER][POSITIVE] And it was so simple. It would seem so simple. Oh, I love it.
[AGENT][POSITIVE] Oh great.
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][POSITIVE] That's good to hear.
[CUSTOMER][NEUTRAL] Uh huh, I, I, and it gives you a confirmation number of the resubmission.
[CUSTOMER][NEUTRAL] OK, uh, while you're looking up.
[AGENT][NEUTRAL] OK, and that was March, you said, I'm sorry, [PII], or can you repeat that?
[CUSTOMER][NEUTRAL] For [PII]
[AGENT][NEUTRAL] Uh, this one's for [PII].
[CUSTOMER][NEUTRAL] For [PII] it was um.
[CUSTOMER][NEUTRAL] 1111 2024.
[CUSTOMER][NEUTRAL] Let me look at this one too.
[CUSTOMER][NEUTRAL] I have a
[CUSTOMER][NEUTRAL] I have a, a confirmation on the.
[CUSTOMER][NEUTRAL] But it's a different data service submission. I might have didn't get to that 1111.
[AGENT][NEUTRAL] What were the build charges?
[CUSTOMER][NEUTRAL] The bill charges were $79.
[CUSTOMER][NEUTRAL] Do you need the confirmation number, [PII]?
[AGENT][POSITIVE] No, I'm good.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see what we've got here.
[AGENT][NEUTRAL] OK, I show the $79 and let's see.
[AGENT][NEUTRAL] Uh, it looks like office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Um, do you have the claim number?
[AGENT][NEUTRAL] I do. It's 356-715-7.
[CUSTOMER][NEGATIVE] And it was non-covered, the $79 charge.
[AGENT][NEUTRAL] Non-covered.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, can you check her other dates of service while we're in in her chart?
[AGENT][NEUTRAL] Absolutely, and this is still for [PII], correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, mhm, yes, ma'am, she had 4, this one is 8-13-2024.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what were those bill charges?
[CUSTOMER][NEUTRAL] The bill amount was $96.
[AGENT][NEUTRAL] Uh, that one.
[AGENT][NEUTRAL] Looks like we need um.
[AGENT][NEUTRAL] The primary explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah and.
[CUSTOMER][NEUTRAL] When did you receive that one?
[AGENT][NEUTRAL] That one was.
[CUSTOMER][NEUTRAL] I'm trying to see if I uploaded the records with uh with the primary ELB with that one.
[AGENT][NEUTRAL] Uh, we received that on 221-25.
[CUSTOMER][NEUTRAL] Yeah, that's when I uploaded.
[CUSTOMER][NEUTRAL] That's exactly when I uploaded it and you said.
[CUSTOMER][NEUTRAL] Uh, after then is when you need the primary EOB, so it must not have been on the, on the, um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Portal.
[CUSTOMER][NEUTRAL] OK, cause you don't have it. OK. OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] We don't have it, no.
[CUSTOMER][NEUTRAL] Primary it'll be, can I have that claim number?
[AGENT][NEUTRAL] Yes, it is 356-714-7.
[CUSTOMER][NEUTRAL] 357147
[AGENT][NEUTRAL] 356-714-7.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and her, um she also has for that same data service $113.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Was that what I'm sorry, what data service was that again? Sorry about that.
[CUSTOMER][NEUTRAL] OK, 8:13 2024.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Uh huh thank you.
[AGENT][NEUTRAL] 113 let's see.
[AGENT][NEUTRAL] Uh, it looks like the same thing on that one. We need the primary.
[AGENT][NEUTRAL] of benefits.
[CUSTOMER][NEUTRAL] OK, and you received that on the [PII] as well?
[CUSTOMER][NEUTRAL] Because it looks like I probably uploaded all of these the same day. OK, can I, um, have that claim number?
[AGENT][NEUTRAL] Yep.
[AGENT][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] It is 356-692-5.
[CUSTOMER][NEGATIVE] Um, I missed the number again. It keeps blinking off.
[AGENT][NEUTRAL] 0356-6925
[CUSTOMER][NEUTRAL] OK, 2695. OK and her last date of service is, oh no, the same date, $356.
[AGENT][NEUTRAL] That was [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, yes, [PII], yes, ma'am.
[AGENT][NEUTRAL] OK, sorry, I'll just search.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][POSITIVE] This is great. I'm glad to know that the portal works.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yep, same thing on that we need the primary explanation of benefits.
[AGENT][NEUTRAL] And then um also office visits are not covered so the office visit charge is a non-covered service and then you still need that primary EOB for the other charge, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For the other OK, office visit not covered.
[CUSTOMER][NEUTRAL] And is that the $79 charge that was denied on the first one?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got you, and may I have that claim number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That one is 356-6906.
[CUSTOMER][NEUTRAL] 906 good now you said [PII], can you try [PII] again or or I'm sorry.
[AGENT][NEUTRAL] I can, yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Yeah, sorry about that.
[CUSTOMER][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] Let's see, what was [PII]'s uh policy again, sorry.
[CUSTOMER][NEUTRAL] OK, it's 022.
[CUSTOMER][NEUTRAL] 65945.
[AGENT][NEUTRAL] And what was [PII]'s day?
[AGENT][NEUTRAL] Your birth
[CUSTOMER][NEUTRAL] Um, [PII] for $259.
[AGENT][NEUTRAL] Oh no, um, [PII]'s date of birth, uh, when she was born, yeah, yeah.
[CUSTOMER][NEUTRAL] Oh, date of birth [PII].
[AGENT][POSITIVE] OK, perfect. Thank you so much. Let's see.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It looks like we have a more recent policy number, the one you gave me.
[AGENT][NEUTRAL] Is one that's a prior policy number.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK, may I have the new one?
[AGENT][NEUTRAL] It's 255.
[CUSTOMER][NEUTRAL] 255.
[AGENT][NEUTRAL] 6230.
[CUSTOMER][NEUTRAL] 623-0 did they keep the claim from processing?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see if it processed under.
[AGENT][POSITIVE] one. Hopefully it'll.
[AGENT][NEUTRAL] And what was the bill?
[AGENT][NEUTRAL] Charges and date of service.
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] You said what was the date of service is [PII].
[CUSTOMER][NEUTRAL] And the bill amount was 259.
[AGENT][NEUTRAL] 259. OK, let's see.
[CUSTOMER][NEUTRAL] That one and I didn't have this number.
[CUSTOMER][NEUTRAL] When I uploaded to the portal so it may have processed under the other.
[CUSTOMER][NEUTRAL] Because I wouldn't have been before.
[AGENT][NEUTRAL] That's what I'm checking.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] You said 3 16 2024?
[CUSTOMER][NEUTRAL] Uh-huh, yes ma'am. Wait, 3636.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 36. OK, sorry about that.
[CUSTOMER][NEUTRAL] Yes, 36 2024 for $259.
[AGENT][NEUTRAL] OK, let's see what's going on here.
[AGENT][NEUTRAL] 69
[CUSTOMER][NEUTRAL] And I have mentioned in my notes that I'm I uploaded secondary claims so I'm almost sure which I should have been a little bit more detail, but I'm almost sure that I sent that EOB.
[CUSTOMER][NEUTRAL] The primary LB.
[AGENT][NEUTRAL] OK, that
[AGENT][NEUTRAL] It's a duplicate, so let's see where the original claim is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I see her primary ELBs right here.
[AGENT][NEUTRAL] OK, it looks like that one.
[AGENT][NEUTRAL] We paid $34.
[AGENT][NEGATIVE] Well, that's not OK, that's not it. You and what provider are you with? Is it Sweetgrass?
[CUSTOMER][NEUTRAL] Um, let me look at the claim address. Hold on, let me look at it.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, yeah, Sweetgrass family [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like on the $259.
[AGENT][NEGATIVE] Office visits are not covered.
[CUSTOMER][NEUTRAL] On the $259 claim.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEGATIVE] Office visits not covered.
[CUSTOMER][NEUTRAL] As the secondary yeah processed as the secondary.
[AGENT][NEUTRAL] Yes, this is a secondary policy.
[AGENT][NEUTRAL] Will based on their plan, we'll consider deductible copay, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, OK, so that wasn't. Oh yeah, right, got, right, got you. OK, office is now can I have that claim number?
[AGENT][NEUTRAL] Not covered, yeah.
[AGENT][NEUTRAL] That claim number is 3456568.
[CUSTOMER][NEUTRAL] And it was received 225.
[AGENT][NEUTRAL] That was
[AGENT][NEUTRAL] Yeah, let me just double check.
[AGENT][NEUTRAL] The original claim was received [PII] of.
[AGENT][NEUTRAL] 24 and processed [PII].
[CUSTOMER][NEUTRAL] Oh, the original claim, right, OK, I'm gonna put that down. original claim.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, received May.
[AGENT][NEUTRAL] [PII] and then process [PII].
[CUSTOMER][NEUTRAL] Uh, I wonder why I can't, why we didn't find that the last time. I'm almost sure was you because it can't be two people that's as kind as you at the same at the same, you know what I mean, at the same office, uh, uh, that's that man, that's a coincidence.
[AGENT][NEUTRAL] Oh no, we, we.
[AGENT][POSITIVE] This is, this is my first day, so it wasn't me, we just have a top notch team. We're all so friendly, that's.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Awesome, yeah, yeah, OK, so she has a.
[AGENT][POSITIVE] Because it's so important.
[CUSTOMER][POSITIVE] Yes it is and y'all to do it your training was awesome.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, can you check data service 9:18 for her?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I can 9:18.
[CUSTOMER][NEUTRAL] And it's $277 bill charge.
[AGENT][NEUTRAL] OK
[AGENT][NEGATIVE] Office visits are not covered.
[CUSTOMER][NEUTRAL] Wow, OK, may I have that, uh, claim number?
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Covered
[AGENT][NEUTRAL] Sorry, got out of that screen that is 356-6764.
[CUSTOMER][NEUTRAL] 74
[AGENT][NEUTRAL] 356-676-4.
[CUSTOMER][NEUTRAL] 764.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, can you check, uh, let me see this, this person here while I got you on the phone, no.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, do I, what am I gonna get a reference number for all just one call, right?
[AGENT][NEUTRAL] Yeah, yeah, it's just, it's just my 1st 1st name last initial today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK got you OK this member ID.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Is
[CUSTOMER][POSITIVE] But uh oh I think that's it. That that was the last one. That was the last one. Thank you, [PII]. You are the bomb, girl. You, you did it. No, ma'am, thank you so much.
[AGENT][NEUTRAL] That's the last one.
[AGENT][POSITIVE] OK [PII], thank you so much. Is there anything else I can do?
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I'll talk to you next week.
[AGENT][POSITIVE] Thank you for calling APL.
[CUSTOMER][POSITIVE] You're welcome bye bye.
[AGENT][POSITIVE] OK. Thank you for calling APL. Have a great day. Bye.
[CUSTOMER][POSITIVE] You're welcome bye bye.