AccountId: 011433970860
ContactId: 60e2d249-72ff-4e3b-b4b7-0995c34301de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376019 ms
Total Talk Time (AGENT): 120981 ms
Total Talk Time (CUSTOMER): 150735 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/60e2d249-72ff-4e3b-b4b7-0995c34301de_20250623T15:13_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], I need you to help me. This is [PII]. I need you to help me, um, see if some claims have been filed for one of our group members.
[AGENT][POSITIVE] I'd be happy to assist [PII]. I have that policy number please?
[CUSTOMER][NEUTRAL] Yes, it's 218-030-8.
[CUSTOMER][NEUTRAL] And it's [PII], the wife, the spouse.
[AGENT][NEUTRAL] And, OK.
[AGENT][NEUTRAL] And the date of service for the claim?
[CUSTOMER][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] OK, we did get some claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For that now one claim in particular.
[CUSTOMER][NEUTRAL] I have a an amount, uh-huh.
[AGENT][NEGATIVE] Uh, for one provider it was the facility claim we asked, they found, we, um, denied it because we need the EOB and they never sent it back in.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And do you have the amount on that one?
[AGENT][NEUTRAL] Um, the charge amount is $12,181.05 but I'm not sure. Let me, I have to pull up the claim to see what her patient responsibility for that was. One moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then also do you have the facility because I think the one that I'm looking at my oh no I see OK yeah that's another one I was actually gonna ask about the 12,181.
[CUSTOMER][NEUTRAL] See if I have the EOB.
[AGENT][NEUTRAL] Uh, this is, uh
[AGENT][NEUTRAL] The Box Regional Health System.
[CUSTOMER][NEUTRAL] Mhm, OK, yeah, I think I actually have the EOB so I can just submit it through y'all, right? Yeah, I have it in front of me. OK, perfect. So let me just write that down.
[AGENT][POSITIVE] OK, great.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How about did you get a claim for the charge amount 6,127?
[AGENT][NEGATIVE] Yes, that was denied because it showed that it wasn't covered. Let me pull up the EOB.
[AGENT][POSITIVE] And make sure that we didn't do nothing wrong.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim.
[AGENT][NEGATIVE] They sent in an EOB that was denied as a duplicate.
[AGENT][NEUTRAL] So if they can send us the original EOB where um there was uh the patient responsibility applied then we can process it but they sent in an EOB and it was there was no patient responsibility on it because it was denied as the charge was previously processed.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Got you. OK, I think I also have the EOB on that one, so I can submit that one as well. This one does have a patient responsibility on it. Oh, I see which one you have. I see which one you got. I have both of them actually, OK.
[AGENT][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] OK, yeah, I can send that one as well.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][POSITIVE] OK, perfect. Let me see what I have a couple here. Give me one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is a different, oh wait, here's another one actually, OK, same date [PII] claim amount 1,598.
[AGENT][NEGATIVE] Now I only have 2 other claims for that data service and we paid the.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 1598 you said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that was for the anesthesia and the patient responsibility was $444.44 and we paid that.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Y'all paid that OK perfect OK.
[CUSTOMER][NEUTRAL] Sorry, one second, I'm just taking my notes.
[CUSTOMER][POSITIVE] Perfect, OK.
[CUSTOMER][NEUTRAL] And then,
[CUSTOMER][NEUTRAL] A different date. This is [PII].
[CUSTOMER][NEUTRAL] And the amount was $199.
[AGENT][NEUTRAL] OK, that originally denied because we needed the EOB. They sent the EOB in and we processed and paid the patient responsibility of $98.67 and we paid that on [PII] where is it at?
[CUSTOMER][NEUTRAL] OK, so this one was all.
[AGENT][NEUTRAL] We paid that [PII].
[CUSTOMER][POSITIVE] [PII]. OK, perfect.
[CUSTOMER][POSITIVE] Awesome, OK.
[CUSTOMER][NEUTRAL] OK, and then.
[CUSTOMER][NEUTRAL] I've got one more. This is for a this is for uh um one of the children, [PII] back now, same policy.
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[CUSTOMER][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] We don't have that on file.
[CUSTOMER][NEUTRAL] OK, and then how about [PII] for [PII]?
[AGENT][NEUTRAL] We don't have that either.
[CUSTOMER][NEUTRAL] OK, so I'll submit those.
[AGENT][POSITIVE] OK great.
[CUSTOMER][POSITIVE] Alrighty, well I really appreciate your help, [PII] that cleared up a bunch of stuff for me.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] My pleasure. Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] That's it. That's all I had.
[AGENT][POSITIVE] Alright well thank you for calling APL you have a good day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.