AccountId: 011433970860
ContactId: 7d2a2ac6-9b6c-419b-9153-ee64616cb687
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323940 ms
Total Talk Time (AGENT): 108592 ms
Total Talk Time (CUSTOMER): 131190 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/7d2a2ac6-9b6c-419b-9153-ee64616cb687_20250325T17:12_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, you said your name was [PII]?
[AGENT][NEUTRAL] [PII], yes.
[CUSTOMER][NEUTRAL] Uh, hi [PII], my name is [PII] and I'm with Great Plains Regional Medical Center, and I'm needing to have you look back on a very old claim, um.
[CUSTOMER][NEUTRAL] And I'm talking oh like 2020.
[AGENT][NEUTRAL] OK, [PII], I can look at that. Um, do you have the policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, 01893462. I'm sorry, there's quite a bit of an echo.
[AGENT][NEUTRAL] Oh OK um let me see.
[AGENT][NEUTRAL] Does that sound any better?
[CUSTOMER][NEUTRAL] Um, it's what it sounds like kind of it's like I'm on speakerphone.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Well, I am having speaker issues.
[CUSTOMER][NEUTRAL] I mean, I can hear you but it's just yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] That, um, so, uh, OK, we're checking claim status. Let me get that pulled up.
[AGENT][NEUTRAL] Do you have a good call back
[CUSTOMER][NEUTRAL] Yeah, old, old like.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Do you have a good call back number?
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][NEUTRAL] And do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you were wanting status on the claim?
[CUSTOMER][NEUTRAL] Well, according to my notes, the claim got sent to you guys back [PII], but I don't show any processing, any denials, anything, so I am going to assume that you never got them.
[AGENT][NEUTRAL] What were the total bill charges?
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, do you have the total bill charges for the, uh, claim?
[CUSTOMER][NEUTRAL] Um, yes, um, on the UB claim it's for $2,174.68.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then there is an ER physician for 45,160.
[AGENT][NEUTRAL] OK, I don't show the physician charge on file. I do have the facility claim and it looks like we denied that. Uh, it said benefits are payable only if major medical insurance provides benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If the claim is later paid by major medical, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] OK, so you never received the this is for an ER visit, so you never received the primary insurance carrier EOB?
[AGENT][NEUTRAL] So did the primary carrier pay for the claim or consider it?
[CUSTOMER][NEUTRAL] They did and they applied they didn't make a payment but they applied to patient liability.
[AGENT][NEUTRAL] OK, then we must not have received that piece because based on that denial it doesn't sound like we got a viable EOB so that can be remitted.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] OK, with it being as old as it is, it can be resubmitted?
[AGENT][POSITIVE] Yes, we actually don't have timely filing, so you can absolutely submit that along, yeah, I know.
[CUSTOMER][POSITIVE] Oh gosh, that's awesome. OK, so you need the.
[CUSTOMER][NEUTRAL] Primary EOB and you did not ever receive the emergency room physician as far as you know.
[AGENT][NEUTRAL] No, don't have that on file, so be sure to submit that too along with the primary EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can these be faxed or do they have to be mailed or do they have to be red copy?
[AGENT][NEUTRAL] Uh, you can fax them.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] What is that number?
[AGENT][NEUTRAL] Number is [PII].
[CUSTOMER][NEUTRAL] OK, and there is no timely and is there a reference number for this call?
[AGENT][NEUTRAL] Uh, reference number will just be my first name, [PII], last initial [PII] as [PII], and today's date. Is there anything else I can help with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I will get those put together and get them um all faxed, uh, in one fax and how long after you received those for processing?
[AGENT][NEUTRAL] Uh, typically takes 7 to 10 business days.
[CUSTOMER][POSITIVE] 7 to 10. OK, alright, thank you very much have a great day.
[AGENT][POSITIVE] Thank you for calling APL have a great day.
[CUSTOMER][NEUTRAL] Bye bye.