AccountId: 011433970860
ContactId: 522cceef-13ac-41e1-8882-55faff2dfa80
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451820 ms
Total Talk Time (AGENT): 174457 ms
Total Talk Time (CUSTOMER): 133296 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/522cceef-13ac-41e1-8882-55faff2dfa80_20250226T21:27_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] My name is [PII] I'm calling from a provider's office about a claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 2550107
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] 117 of 25 5 93.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, let's see, this one is for [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] What's the tax ID?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. Um, so the reason I'm asking is because I'm showing 484, could that
[AGENT][NEUTRAL] Is this total bill the only total bill that can be because this is the only claim and it is from you all, but it just has a different total bill.
[CUSTOMER][NEUTRAL] Let me see if we have any more.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, OK, so, yeah, we have 3 for her but they're all.
[CUSTOMER][NEUTRAL] Different. Uh, what was the, the amount?
[AGENT][NEUTRAL] The bill amount on this claim is $484.
[CUSTOMER][NEUTRAL] 84.
[CUSTOMER][NEUTRAL] Um, no, I'm not seeing that.
[AGENT][NEUTRAL] Hold on, let me pull up the documents. Hold on one second.
[CUSTOMER][NEUTRAL] See what
[AGENT][NEUTRAL] Let me see if there's a way.
[AGENT][NEUTRAL] Yeah, this one is for 484. So I'm, this is the only one from you all for the data service. So if it is 593, we don't have that one on file. I just pulled up the documents to see like if it was a different amount on there, but this one says total charge is 484.
[CUSTOMER][NEUTRAL] And that one's for 117?
[AGENT][NEUTRAL] Mhm. 117 25 and it had the same, I was thinking maybe like, you know, how you, if it's a big facility, it has different branches, that's why I asked for the tax ID, but it was the one you gave.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, um, we don't have that bill amount. OK.
[CUSTOMER][NEUTRAL] I guess I'll just resubmit. If we resubmit this and it denounces for a duplicate, will it process the original?
[AGENT][NEUTRAL] Well, the
[CUSTOMER][NEUTRAL] Or do we need to call?
[AGENT][NEGATIVE] So this one was actually denied um because it's not.
[AGENT][NEGATIVE] So this one is for code 99204. I don't know if that's different than the code you're looking for, but it was denied um because it's not a covered charge.
[CUSTOMER][NEUTRAL] OK. Can you send me that AOB?
[AGENT][NEUTRAL] Mhm. What's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the phone kind of broke up a little bit. Did you say [PII]? OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Um, it'll come directly to me.
[AGENT][POSITIVE] OK, so I'm gonna go ahead and send this over to you now. And was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, how many can you help me with?
[AGENT][NEUTRAL] Um, as many as you need, let me send this one to you though. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See what's going on with this one.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold? I'm just sending this fax and noting this policy. It, well, are the other claims for the same member?
[CUSTOMER][NEUTRAL] No, I don't know.
[CUSTOMER][NEUTRAL] Yes, they are.
[AGENT][NEUTRAL] Oh, OK, well then I'll just, I'll just go ahead and we can move on to the next data service, um, since it's the same person, I'll just note it all at once.
[CUSTOMER][NEUTRAL] OK. Um, it's 1/6 of 25 and it's for 456.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Is there any other amount?
[CUSTOMER][NEUTRAL] Uh, see.
[CUSTOMER][NEGATIVE] Not for that data service.
[AGENT][NEUTRAL] OK, because we have one, but it's the 291.
[CUSTOMER][NEUTRAL] What is going on?
[AGENT][NEGATIVE] But they're being denied for the same reason. I don't know if that helps.
[CUSTOMER][NEUTRAL] OK, can you send me that as well?
[AGENT][NEUTRAL] You want me to send this one? Sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I'll just, I'll send out because this one just popped up. So I'll send them all at the end of the call too. Is that OK?
[CUSTOMER][NEUTRAL] OK, one more, um, it's probably different, but it's 11725.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And let me make sure it's for the same.
[CUSTOMER][NEUTRAL] Facility because we cover so many um it is and it's for 593.
[AGENT][NEUTRAL] Oh, that's the same as the first one, or it's a different?
[CUSTOMER][NEUTRAL] That's the same. Wait, hang on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, wait, that's so weird. It says.
[CUSTOMER][NEUTRAL] 616 but when I'm pulling up is 593.
[CUSTOMER][NEUTRAL] Yeah, that's an issue on our end. Um, yeah, if you can just send those.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, maybe we'll reference somehow. Um, and what is the reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date and again that's [PII], the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And mine's [PII]. Thank you so much.
[AGENT][POSITIVE] You're very welcome and I'm sending this over to you now, so you should be receiving it shortly, OK?
[CUSTOMER][POSITIVE] OK, sounds good. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks, you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mm