AccountId: 011433970860
ContactId: 5fe892a1-3d0d-4a7d-a05f-178dd7200eff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 630190 ms
Total Talk Time (AGENT): 183440 ms
Total Talk Time (CUSTOMER): 146086 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/5fe892a1-3d0d-4a7d-a05f-178dd7200eff_20250623T15:48_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Um, I'm just calling to see if I can status a claim for a patient, please.
[AGENT][NEUTRAL] OK, yeah, I can verify claim status for you. Give me one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK. And Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Uh, policy number I have is.
[CUSTOMER][NEUTRAL] 02283356
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[AGENT][POSITIVE] OK, thank you, ma'am. Give me one moment.
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] OK, and you say you're calling for claim status, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Um, so it looks like it's let me.
[CUSTOMER][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] And the total bill charges is for $8,593.45.
[AGENT][NEUTRAL] OK, and do you have a call back or not callback number, the balance after primary has processed the claim?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You said the balance after primary process?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, 7, I think it was $7,118.69.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Actually maybe that might be wrong because that was the.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And the name of the provider's office?
[CUSTOMER][NEUTRAL] Uh, Duncan Regional Hospital.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And so.
[AGENT][NEUTRAL] Uh, looks like the claim process is, um.
[AGENT][NEUTRAL] Receipt of the reference claim is acknowledged, however, in order for us to process this claim, we need the ELB or exclamation benefits that matches the claim information.
[CUSTOMER][NEUTRAL] Um, OK, give me just a second here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so it looks like we mailed the EOB out.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so it looks like we received the claim a second time and it was processed as a duplicate.
[CUSTOMER][NEUTRAL] On [PII] in well in July.
[AGENT][NEUTRAL] Well, it looks like the claim was received a 2nd time.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] And I'm showing a different charge amount on the claim as well, but um.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is the is the primary EOB attached to that claim?
[AGENT][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] Because maybe they just sent out um.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] What did showing see.
[AGENT][NEUTRAL] I do show an EOB it's been received, however, um, just looking at the claim.
[AGENT][NEUTRAL] Previously, the total charge on the claim does not match the amount that's on the EOB. It's showing the total charge of the claim as being $2,196.45.
[AGENT][NEUTRAL] As opposed to the $8,593.45 that is on the EOB.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] Um, is there any way to take the EOB that you have and pair it to the claim that's denied for the EOB?
[AGENT][NEUTRAL] Well, they reprocessed it using the EOB, but the claim information we show on the UBO4 is showing a different charge amount than what's on the EOB that we received. That's why it was initially processed as needing the correct EOB.
[CUSTOMER][NEUTRAL] Oh, so the original claim is also denying, uh, like, uh, you said it shows the amount for $2000 the original claim?
[AGENT][NEUTRAL] Right, on the UBO4 that we received along with the EOB, it shows a total charge amount of $2,196.45 as opposed to that $8,593.45.
[CUSTOMER][NEGATIVE] That's that makes no sense, um.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] So on 3-11-25 it looks like we sent something else via mail. I, I think so already filed secondary claim USPS.
[CUSTOMER][NEUTRAL] Claim never made it resent to American Public Life. OK, so they resent the claim again on 3-11-25 just a couple of months ago. Do you have anything from them?
[AGENT][NEUTRAL] Uh, no, ma'am. I'm not sure we received anything for this year.
[CUSTOMER][NEUTRAL] Because it was delivered.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] I don't show we've received it. If you like, I can give you a fax number or if you like to fax the claim to us, but I don't show it's been received for this year.
[CUSTOMER][NEUTRAL] Yeah, I'll just may I please just have the fax number and I'll just resend the information right now.
[AGENT][NEUTRAL] Yes, ma'am. Our fax number is [PII].
[CUSTOMER][NEUTRAL] [PII] OK and do I need to attention that to anyone?
[AGENT][NEUTRAL] Uh, just claims department.
[CUSTOMER][NEGATIVE] OK perfect I will go ahead and get the information resent over to you guys um.
[CUSTOMER][NEUTRAL] Right now.
[AGENT][NEUTRAL] All right. And is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, may I please just have a reference number please?
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK, uh, can I get your name again?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII], last initial [PII]
[CUSTOMER][NEUTRAL] And you said and today's date?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK perfect thank you so much for your help I appreciate it.
[AGENT][POSITIVE] Oh, you're welcome. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.