AccountId: 011433970860
ContactId: 68fdda95-8db0-4da1-aa25-37ad0451ddf4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 616989 ms
Total Talk Time (AGENT): 150261 ms
Total Talk Time (CUSTOMER): 116517 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/68fdda95-8db0-4da1-aa25-37ad0451ddf4_20250212T17:15_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling from provider's office to check up on a claim that is. Also this call is been recorded for quality and training purposes. Are you OK with that?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Uh, sure, it would be [PII]. Also, can you help me with your name?
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Yes, you spell it [PII]
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're very welcome. And then may I have the patient's name?
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The date of birth would be [PII].
[AGENT][NEUTRAL] And then what is the policy number please?
[CUSTOMER][NEUTRAL] It would be 02.
[CUSTOMER][NEUTRAL] 266017 M. Mike Lima number 8.
[AGENT][NEUTRAL] OK, let me look that policy.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then what is the date of service?
[CUSTOMER][NEUTRAL] Yeah, the date of service would be [PII] and the total charge was $850 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEGATIVE] Uh, no.
[CUSTOMER][NEUTRAL] $850 is the original billed amount of the claim.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's diagnostic Center for Womeny.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Ms. [PII]. I'm gonna be right back. I'm gonna check this claim for you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, Ms. [PII], I found it. It's on a different policy number. Um, the policy number that it was filed on is 241-9335.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied and the reason for the denial is.
[AGENT][NEUTRAL] And this is what the remarks say Benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing the benefits were paid.
[CUSTOMER][POSITIVE] Yeah, actually we have already submitted that multiple times actually.
[AGENT][NEUTRAL] Right, I do see that but it's not, it's not the explanation of benefits for the services that are being filed where the primary paid first.
[CUSTOMER][NEUTRAL] It was, yeah.
[CUSTOMER][NEUTRAL] Yeah, actually primary process the claim towards patients responsibility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we're the secondary insurance, yeah, we're the secondary insurance and we only pay if primary pays.
[CUSTOMER][NEUTRAL] That's why
[CUSTOMER][NEUTRAL] I just need to know, uh, did you receive the EOB primary EOB?
[AGENT][NEUTRAL] Yes, we received the ELB.
[AGENT][NEUTRAL] And the remark is that we need, we need, we need to, OK, let me look at that.
[CUSTOMER][NEUTRAL] Uh, when was it received?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We received the EOB on [PII].
[AGENT][NEUTRAL] And process it on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And again it's [PII]?
[AGENT][NEUTRAL] We need
[AGENT][NEUTRAL] The EOB where the primary paid first.
[AGENT][NEUTRAL] We need the EOB with the primary payment what they paid.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Can you help me with the claim number?
[AGENT][NEUTRAL] Yes, ma'am. It's 341.
[AGENT][NEUTRAL] 465 7.
[CUSTOMER][NEUTRAL] 344-657
[AGENT][NEUTRAL] No, 341.
[AGENT][NEUTRAL] 465 7.
[CUSTOMER][NEUTRAL] 341-465-7
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][POSITIVE] OK, thank you so much. Can you help me with the call reference number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name. It's [PII]
[AGENT][NEUTRAL] In today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for your help.
[AGENT][POSITIVE] You too, you too, Ms. [PII]. I hope you have a great day and thanks for calling APL.
[CUSTOMER][POSITIVE] Bye bye take care.
[AGENT][NEUTRAL] Bye bye.