AccountId: 011433970860
ContactId: 5983b808-d7f2-47bc-85f7-e6953e114ce1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1001679 ms
Total Talk Time (AGENT): 227473 ms
Total Talk Time (CUSTOMER): 248519 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/5983b808-d7f2-47bc-85f7-e6953e114ce1_20250512T18:15_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello. This is [PII] calling from APA Healthcare on a recorded line. Can you please help me with the claim status information?
[AGENT][NEUTRAL] Yes, I can help you with claim status, um, and can you please spell your first name for me?
[CUSTOMER][NEUTRAL] Sure. My name is [PII]. It is [PII] my [PII] name [PII] [PII].
[AGENT][NEUTRAL] OK, thank you, and you said you were calling from Advent Healthcare?
[CUSTOMER][NEUTRAL] It's Apria Healthcare. It's A [PII] Alpha, P for Papa, R for Romeo, as in India, A as in Alpha.
[AGENT][NEUTRAL] Apria. OK. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The policy number for this person is going to be 02422301.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the member's first name is going to be [PII] as in Mike, [PII].
[CUSTOMER][NEUTRAL] Last name is going to be [PII]. Date of birth is going to be [PII].
[AGENT][NEUTRAL] OK, thank you, and then may I please get the data service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service for the claim is going to be [PII] with the total charge amount on the claim, $941 with 20 cents.
[AGENT][NEUTRAL] OK, and then what is the uh balance after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Oh, you're asking how much the primary paid for this claim?
[AGENT][NEUTRAL] No, I'm asking for the balance after the primary paid.
[CUSTOMER][NEUTRAL] OK. It is $90 with 60 cents.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Miss uh [PII], I'm going to put you on a quick hold while I look up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me. So looking on data service of [PII], I do not see a claim on file for that data service.
[CUSTOMER][POSITIVE] OK. Thank you so much for the confirmation.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Can you please help me with the ECS payer ID to resubmit? Can we resubmit the claim?
[AGENT][NEUTRAL] Yes, you may, um, the payer ID number is 60801.
[CUSTOMER][NEUTRAL] Uh, can you please verify the address also?
[AGENT][NEUTRAL] It's APL claims PO Box 248,950 that's in [PII].
[CUSTOMER][NEUTRAL] OK. It is, the pay ID is going to be 60801 PO Box 248,950, Oklahoma City, [PII] State. And the ZIP code is going to be [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you. Thank you so much for the confirmation. Uh, can you please check for the the date of service for the same number?
[AGENT][NEUTRAL] Yes, what's the next day of service?
[CUSTOMER][NEUTRAL] It is [PII]. Uh, the primary paid after the leftover balance is going to be $93.43.
[AGENT][NEUTRAL] OK, and what was the amount before the primary paid?
[CUSTOMER][NEUTRAL] Uh, before primary pay, you're asking me the bill amount on the claim?
[AGENT][NEUTRAL] Yes, before the primary pay.
[CUSTOMER][NEUTRAL] It is $941 with 20 cents the bill amount.
[AGENT][NEUTRAL] OK, and it's for the same facility?
[CUSTOMER][NEUTRAL] Yeah, it's with the same facility.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a quick hold while I look up this one and I'll be right back with you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9414567, that's it right there.
[AGENT][NEUTRAL] 3493715.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me. I have this claim ready for you. The claim number is 3493715.
[AGENT][NEUTRAL] And the claim has been denied because durable medical equipment is not covered under the patient's policy.
[CUSTOMER][NEGATIVE] OK, DMA is not covering under the patient policy. Then the primary paid the money, right? How can it it's not covered?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's not covered because this policy only helps with deductible copay and co-insurance and under the patient's plan, durable medical equipment is not covered.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] The plan covers coinsurance and deductible, right?
[AGENT][NEUTRAL] Yes, the plan does.
[CUSTOMER][NEUTRAL] Then the primary gave you the coinsurance for this claim.
[AGENT][NEUTRAL] The claim has been denied because durable medical equipment is not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK. Just give me a moment. Let me check on that.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] He
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, I can hear a voicemail message.
[AGENT][NEUTRAL] I didn't leave a message for you, ma'am.
[CUSTOMER][NEUTRAL] Hello, can you hear me?
[AGENT][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Yes, I can hear you.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] I can hear the only voice message till now. That's the reason.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Uh, can you
[CUSTOMER][NEUTRAL] Yeah, can you please help me with the next date of service for this another member?
[AGENT][NEUTRAL] Of a different member, is that correct?
[CUSTOMER][NEUTRAL] Yeah. Uh-huh. No, it's the same number and the date of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] If you can give me the date of service and the charge amount before and after primary.
[CUSTOMER][NEUTRAL] Date of
[CUSTOMER][NEUTRAL] OK. The date of service is going to be [PII].
[CUSTOMER][NEUTRAL] With the total charge amount is $512.20.
[CUSTOMER][NEUTRAL] After the primary, the balance is going to be $78 with 0.5 cents.
[AGENT][NEUTRAL] OK and then can you give me that first.
[AGENT][NEUTRAL] Um, before the, the, the first bill amount?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $512 512 dollars with 20 cents.
[AGENT][NEUTRAL] Again,
[AGENT][POSITIVE] OK. All right. I'm gonna put you on a quick hold and I'll be right back with you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me. I have this claim ready for you.
[AGENT][NEUTRAL] The claim number is 3,458,840 and the claim was denied for the same reason. durable medical equipment is not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Can you please repeat the claim number once again?
[AGENT][NEUTRAL] Yes, ma'am. It's 345-8840.
[CUSTOMER][NEUTRAL] 345-8840. The plan does not come.
[CUSTOMER][NEUTRAL] How about DMA, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you so much for the information.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Can you please, can you please help me with the call reference number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], in today's date.
[AGENT][NEUTRAL] Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No, thank you so much. Thank you so much for the confirmation and have a good day. Bye for now.
[AGENT][POSITIVE] You have a good day too and thank you for calling APL bye bye ma'am.