AccountId: 011433970860
ContactId: 687eaf65-3faa-4428-9991-090dca56eb7c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 626799 ms
Total Talk Time (AGENT): 133962 ms
Total Talk Time (CUSTOMER): 204406 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/687eaf65-3faa-4428-9991-090dca56eb7c_20250123T16:01_UTC.wav
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[AGENT][NEGATIVE] Calling American Public Life, this is [PII]. Who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Hi [PII] and how can I help you?
[CUSTOMER][NEUTRAL] Yes, I'm sorry if I'm pressed the wrong button, but I'm actually trying to get or more information about the claim denial to one of our patients, please.
[AGENT][NEUTRAL] Oh absolutely I can help you with that. uh, but first we're having phone issues. Can I get a callback number in case I lose you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yes, let me just get my phone number. Phone number is [PII] [PII].
[AGENT][POSITIVE] Perfect and the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number is 02792137.
[AGENT][NEUTRAL] OK, I apologize. Something must have have. Can I have it one more time?
[CUSTOMER][NEUTRAL] Um, yes, numbers 02792137.
[AGENT][NEGATIVE] Yeah it's saying it's invalid.
[AGENT][NEUTRAL] Uh, do you have their social by any chance?
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Oh sorry, I only have the last four digits.
[AGENT][NEUTRAL] OK, no problem. What's the uh last name?
[CUSTOMER][NEUTRAL] Um, last name?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK, and the first name?
[CUSTOMER][NEUTRAL] Um [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, there's a lot of those [PII], uh, what city and state does he live in?
[CUSTOMER][NEUTRAL] See, uh sorry, let me.
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] And his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, found them.
[AGENT][NEUTRAL] Oh it's [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK and the date of service?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And how much was the claim for?
[CUSTOMER][NEUTRAL] This is for $3,649 even.
[AGENT][NEUTRAL] Do you happen to have the claim number by any chance?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, I, I have it.
[CUSTOMER][NEUTRAL] Um, the claim ID.
[CUSTOMER][NEUTRAL] 349-445-9.
[AGENT][NEUTRAL] OK, what he has is an indemnity policy, so it's not a major medical, it's very limited.
[AGENT][NEUTRAL] So, uh, for the, uh,
[AGENT][NEUTRAL] Procedure code for the office visit 99284.
[AGENT][NEUTRAL] Or the ER, excuse me, it's only gonna pay 350.
[AGENT][NEUTRAL] And then for the X-ray it's only gonna pay 100.
[AGENT][NEUTRAL] That's why the payment of 450 was made.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um, ma'am, I do have a quick question about the, the EUB. Um, I reviewed the EOB and I noticed that the, the claim was processed for only 2,088 cents versus the total charge of $33,000 649 cents.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, uh, let me pull the claim real quick. Let me look at it. Give me one second.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, it's because.
[AGENT][NEUTRAL] The adjuster only put in the ER amount, the 1740.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because that was the only thing that was payable like she didn't uh.
[AGENT][NEUTRAL] Put the total charges.
[AGENT][NEUTRAL] She just put because we're only gonna pay for the ER room.
[AGENT][NEUTRAL] So she put that in
[AGENT][NEUTRAL] And then the uh for the CT or the uh.
[AGENT][NEUTRAL] Uh, X-ray, there it is, X-ray. She just put the 348, so that's why it totaled up to that.
[CUSTOMER][NEUTRAL] OK, just a moment. Let me just add it on my notes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sorry about that.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Thank you. Is it OK if I ask for an updated EOB?
[CUSTOMER][NEUTRAL] Um, showing, showing how it was processed or the 1740.
[CUSTOMER][NEUTRAL] Or at least
[CUSTOMER][NEUTRAL] The, the, the total bill amount showing the 3,0649 because that's the one that I need to attach in the claim.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So you need one with the total charges, right? Like if she put the ER visit and then put the total charges there.
[AGENT][NEUTRAL] I mean, she's gonna deny it as as a duplicate.
[CUSTOMER][NEUTRAL] Uh, yes, yes.
[AGENT][NEUTRAL] But that way you could get the EOB, right?
[CUSTOMER][NEUTRAL] Yeah, yes, yes, I just need to attach it and see the total charge.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, um, yeah, I'll go ahead and and send her an email and see if she could do that for you.
[CUSTOMER][NEUTRAL] Uh-huh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is it OK if I'll give my email address?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Or fax number or how do I receive it.
[AGENT][NEUTRAL] Yes, what is your fax number?
[CUSTOMER][NEUTRAL] Uh, fax number is [PII]. Attention to Rose.
[CUSTOMER][NEUTRAL] And Tanner, Tanner Medical Center.
[CUSTOMER][NEUTRAL] And uh I would like also to request for a reference number, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the reference number?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, what is it?
[CUSTOMER][NEUTRAL] Oh, for this one, the reference number is gonna be 747534012.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for our call, may I ask for call reference number, please?
[AGENT][NEUTRAL] It's just my name.
[CUSTOMER][NEUTRAL] [PII], is that correct?
[AGENT][NEUTRAL] Yes, uh huh, last initial [PII].
[CUSTOMER][NEUTRAL] And today
[CUSTOMER][POSITIVE] [PII], OK. Thank you. You are a great help. Have a great day to you. Bye-bye.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] No problem at all. You have a great rest of your day. Thank you for calling APL.
[CUSTOMER][POSITIVE] Mhm thank you bye bye.
[AGENT][NEUTRAL] Um bye bye