AccountId: 011433970860
ContactId: 7c496a3b-fe5a-4eb8-a630-29f7c549cb76
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 294410 ms
Total Talk Time (AGENT): 106070 ms
Total Talk Time (CUSTOMER): 99858 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/7c496a3b-fe5a-4eb8-a630-29f7c549cb76_20250325T14:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. um I am just calling in regards to a claim for a patient.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, yes, it is policy number 00652964.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, member is [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Uh, date of birth for [PII] in.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh yes, data service is 12-19-24.
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Uh, total bill amount was for $412.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Uh, yeah, we did get a partial payment of $89.
[CUSTOMER][NEUTRAL] Um, my question to you is, um, so I sent in the claim and the claim that I have on my computer matches the total amount of $4412 but on the actual EOB there's only 3 of the 4 codes we sent in.
[CUSTOMER][NEUTRAL] And if you add those add add those up individually they don't equal that 412 so I'm missing code 0330.
[AGENT][NEUTRAL] OK, so code 0330 and 00277 are both on this claim, those were the two denied claims. 00 00330 was the it was denied, but the benefits were applied to the deductible, to the $50 calendar year deductible for that code and then for
[CUSTOMER][NEUTRAL] Yeah, the
[CUSTOMER][NEGATIVE] The EOB that I got doesn't have code 0330 on it like at all on it.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah, I can get them to print out a new EOB. I don't know why it's not on here. It is within the claim. Oh, it's on the 3rd page. How many pages do you have?
[CUSTOMER][NEUTRAL] I just have the one page.
[CUSTOMER][NEUTRAL] I mean I have like the cover one and then I have the other one and that's it.
[AGENT][NEUTRAL] Why are there 2, like it's almost like 2 copies. OK, I'm just gonna send you this copy. I don't know, it's like 2 copies under one, I'm not sure, but I'll go ahead and send this to you. So I apologize that that wasn't on your copy, but I see what you're saying.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Um, either way, that code.
[CUSTOMER][NEUTRAL] Is there any way to fax them over?
[AGENT][NEUTRAL] Yes. What's your fax number?
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] OK, do I need to put attention?
[CUSTOMER][NEUTRAL] But yeah, no, it's OK that it denied. I just, sorry, go ahead.
[AGENT][NEUTRAL] No, you're fine. Go ahead.
[CUSTOMER][NEGATIVE] I was just gonna say I just need to send it to secondary. It's OK that it denied. I just need it sent over to them and they're not uh accepting it because it doesn't match the claim I'm trying to send.
[AGENT][NEUTRAL] OK. So I'll go ahead and fax this um this copy of the explanation of benefits over, um, which shows the 0330 also. I'm sending that to you now. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, well thank you so much for calling APL [PII]. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.