AccountId: 011433970860
ContactId: 5fa17b70-16b8-493c-860e-7de4126adae5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 431059 ms
Total Talk Time (AGENT): 96140 ms
Total Talk Time (CUSTOMER): 138782 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/5fa17b70-16b8-493c-860e-7de4126adae5_20250327T18:32_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi [PII], my name is [PII], um, and I'm calling from Tulsa Pain Consultants, and I just need help, um, with claim status, please.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] I do. It's [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Do you have a policy number for the patient?
[CUSTOMER][NEUTRAL] Um, yes, I do. It is um 02503347.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Um, the patient's name is [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] And what was that date of service?
[CUSTOMER][NEUTRAL] Um, date of service is [PII].
[AGENT][NEUTRAL] And what were the bill charges?
[CUSTOMER][NEUTRAL] Um, the bill charges were $2,727.50.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me get that pulled up. Give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh, it looks like benefits are only payable if the major medical insurance provider provides benefits.
[AGENT][NEUTRAL] Have they since processed this claim?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, so yes, his primary hasn't it's left a $60 copay, so, um, do I need to send a primary EOB?
[AGENT][NEUTRAL] Yeah it looks like let's see what we have here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] What is the $60 co-pay?
[CUSTOMER][NEUTRAL] I know typically
[AGENT][NEUTRAL] Is that for the office visit?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, it's actually, um, it's an injection that he had done in his primary community care, so they paid everything but left the $60 copay to him and I've noticed on other dates of services that, um, APL has picked that up so I wasn't quite sure if something was held up on this or if we need to send something to you guys.
[AGENT][NEUTRAL] Yeah, let me see, cause I've got a couple, I have two different denial codes. Let me pull up the actual what we received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] OK, let's see, 3.
[AGENT][NEUTRAL] Is this, OK, so the $60 left, there, there was no uh offices charge though. This is strictly an injection. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, that's correct, yeah, no office visit is just a straight injection.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, do you mind if I put you on a brief hold?
[CUSTOMER][POSITIVE] Oh, no problem at all thank you I appreciate your help.
[AGENT][NEUTRAL] OK, thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so let's see.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding. It shows, so based on the explanation of benefits we received from the primary that was attached to the claim, because it shows patient responsibility 0.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] That's why it didn't pay anything.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] All right let me um.
[CUSTOMER][NEUTRAL] Let me see what happened there um so I know there was a corrected claim, um, done, but that's still the same thing um so I have an EOB here that actually shows the $60 copay. um, can I, is there a fax number or somewhere where I can send this to actually show that there is a $60 copay? I'm not sure why that didn't show up on that EOB.
[AGENT][NEUTRAL] And that didn't show up on it. Yeah, absolutely, uh, fax number is 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 9423.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, perfect. Do I need to attention that to anybody?
[AGENT][NEUTRAL] Uh, no, that'll come directly to our claims department.
[CUSTOMER][POSITIVE] OK perfect [PII] um thank you so much for your help with this. I appreciate it and is there a call reference number for our call today?
[AGENT][NEUTRAL] Uh, call reference is just my first name, last initial, and is there anything else I can help with today besides that?
[CUSTOMER][NEUTRAL] Um, that'll be it, and what was the last, um, initial for you?
[AGENT][NEUTRAL] Oh, sorry. [PII].
[CUSTOMER][POSITIVE] Your last name initial, that's OK. All right, perfect. [PII], thank you again for you, OK, perfect. Thank you again for your time with this and I hope you have a good rest of your day.
[AGENT][POSITIVE] Definitely.
[AGENT][POSITIVE] All right, thank you for calling APL [PII]. Have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye.