AccountId: 011433970860
ContactId: 649eca23-ac21-4691-ac7f-b15f62254161
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 998630 ms
Total Talk Time (AGENT): 132653 ms
Total Talk Time (CUSTOMER): 274264 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/649eca23-ac21-4691-ac7f-b15f62254161_20250212T14:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from provider office and this call may be recorded for quality and training purposes. Uh, I have a question on a claim. Could you please help me with that?
[AGENT][NEUTRAL] OK, I can help you. What's the policy number and the claim number?
[CUSTOMER][NEUTRAL] Yeah, the policy number it is 02039877 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh the claim number is 351-374-3.
[AGENT][NEUTRAL] What's a good number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Repeat the extension again, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] Just a few more minutes.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] Thank you for holding, [PII]. Can you verify the patient's name and date of birth for me?
[CUSTOMER][NEUTRAL] Yeah, the patient name, it is uh
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and the date of birth it is um [PII].
[AGENT][NEUTRAL] OK, you said you need a clarification of this claim. How can I help you with that?
[CUSTOMER][NEUTRAL] Yeah, actually, in this one, this claim, yeah, actually, uh, it was paid as an incorrectly as the primary allowed $398.07 but you guys only paid $250 so we send an appeal on this one on [PII]. So my question is that did you receive that and uh did the claim was reprocessed?
[AGENT][NEUTRAL] OK, what was the amount that was paid?
[CUSTOMER][NEGATIVE] Uh, actually, the primary insurance was not paid anything. Uh, they only process deductible for $398.07 but you guys paid only $250 so remaining $140.
[AGENT][NEUTRAL] What's the
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] It is uh [PII] build amount $500.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And what is the provider's name?
[CUSTOMER][NEUTRAL] It is diagnostic Center for Women LLC.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] Still looking.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] On the EOB that you have, what date did the primary insurance, what is the the process the claim?
[CUSTOMER][NEGATIVE] Sorry, it means I'm not getting.
[AGENT][NEUTRAL] The primary ELB there should be a a date that they process the claim. Can you verify that date?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure, just a minute, let me check one more time on this one.
[CUSTOMER][NEUTRAL] me to that.
[CUSTOMER][NEUTRAL] Uh, just a second, I'm just pulling up that EOB.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The process it is 19 2024.
[AGENT][NEUTRAL] Yeah, I'm showing 250 applied towards deductible.
[CUSTOMER][NEUTRAL] Actually, if you see on that you.
[AGENT][NEUTRAL] So if, if you have, if you have a corrected explanation of benefits, did you send that with the reconsideration?
[CUSTOMER][NEUTRAL] Yeah, actually after that we submitted an appeal and what happened in this one is that uh whenever that uh insurance primary insurance, the process, uh, that's a claim as in uh.
[CUSTOMER][NEUTRAL] In the two line items, the one line item, they, they will show $250 and other one line item they will show uh $148.07. The total amount, it shows that uh $398.07 which is applied to a deductible.
[AGENT][NEUTRAL] How much applied towards deductible?
[CUSTOMER][NEUTRAL] $398.07.
[AGENT][NEUTRAL] 39807.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] If you see the allowed amount, uh, the total amount, uh, of the allowed amount column, you will find out that $398.07.
[AGENT][NEUTRAL] Yeah, I see where it says the total patient responsibility is that amount, but when you look at the claim detail under the copay deductible co-insurance column, what does it say on under that?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Under that, uh, they, they just, uh, split the amount because, uh, on this, uh, CPT there is a, uh, modify use 50 which it shows represent bilateral modifier for that reason they, uh, process the claim into two parts for 250.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] and $250 because the old amount is $500. They split that amount in it in two sections. Uh, the one line item is for one line is for $250 and another line is for $250 and that one, the one line 11 line item is totally showing of $250 as a deductible and other line item shows $148.07 as in uh deductible.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In this column, uh, the first line item shows $110 as deductible, $40 as co-pay, and on the next line item it was showing $148.07 as a deductible PR1.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. OK. Give me just a second, OK? I see that.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Good morning. Thank you for calling APL. This is [PII] speaking. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII]. How are you?
[CUSTOMER][POSITIVE] Doing well, [PII] thank you how are you?
[AGENT][NEUTRAL] Good. Can you look at a claim with me?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, the policy number is 2039877.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For part two.
[CUSTOMER][NEUTRAL] Just give me one
[CUSTOMER][NEUTRAL] Part 2.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I have the provider on the line. They submitted. They say a reconsideration, but we did not it as a duplicate under claim 3544.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 209.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm gonna pull that claim image. Did you need me to speak with them or?
[AGENT][NEUTRAL] Yeah, it needs to be reprocessed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There were they split the $500 into two lines and so one they applied $250 deductible, the other they applied 14807 deductible on the ELB.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And was it, let me take a look at.
[CUSTOMER][NEUTRAL] Yeah, because it does show.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm looking at the document now from when it was processed the first time it looks like that's where.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Did you wanna go ahead and transfer them to me or how do you wanna do this?
[CUSTOMER][NEUTRAL] Are you still there [PII]?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] I need it. I was coughing. Yeah, so yes, I wanna go ahead and transfer the call so that it'll need to be reprocessed.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] All righty. His name is [PII].
[CUSTOMER][NEUTRAL] OK, and that's says call back that's listed?
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] 986.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Extension [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I'll take it from here and of course everything's been verified, right?
[AGENT][POSITIVE] All righty. All righty.
[AGENT][POSITIVE] Yes it has. Here it comes. Uh thanks.
[CUSTOMER][POSITIVE] Great. OK. Thank you so much. All right.