AccountId: 011433970860
ContactId: 8127ae4f-567e-4b11-8cdc-a66ac882b134
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437369 ms
Total Talk Time (AGENT): 100997 ms
Total Talk Time (CUSTOMER): 193301 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/8127ae4f-567e-4b11-8cdc-a66ac882b134_20250416T15:10_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling in regards to a claim that looks like you, they may be wanting the op report and some information. I just wanna get some follow up please.
[AGENT][NEUTRAL] OK, [PII], I can help you with that claim status. Um, do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And are you with the provider's office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] It's a professional claim.
[CUSTOMER][NEUTRAL] Yes, it's D as in David 43302148.
[AGENT][NEUTRAL] OK, and the last name of the patient?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And first name?
[CUSTOMER][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] OK, and is this for, um, do you have the claim number?
[CUSTOMER][NEUTRAL] Um, well, I can give you what's on the information that was sent back that is under 202408-230045.
[AGENT][NEUTRAL] What was the date of service?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] And the bill charges?
[CUSTOMER][NEUTRAL] $793.
[AGENT][NEUTRAL] And who is the provider on that?
[CUSTOMER][NEUTRAL] It is a professional claim.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Uh, what type of service?
[CUSTOMER][NEGATIVE] I tried to find it online but it wasn't pulling.
[CUSTOMER][NEUTRAL] Uh, professional.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] What like what services were rendered?
[CUSTOMER][NEUTRAL] Is that what you
[CUSTOMER][NEUTRAL] Uh, it looks like there was a, um, colonoscopy.
[CUSTOMER][NEUTRAL] the CPT is 453-85.
[AGENT][NEUTRAL] I'm not sure. Let's see.
[AGENT][NEUTRAL] I've got a
[CUSTOMER][NEUTRAL] And it was sent with the, the diagnosis on there the screening.
[AGENT][NEUTRAL] I'm trying to figure out which policy this is under. She's got several different policies and I don't have, I've got a data service for that, but it looks like it's for anesthesia. Um.
[AGENT][NEUTRAL] Yeah let's see.
[CUSTOMER][NEUTRAL] Yeah, that would be probably been on the facility side.
[AGENT][NEUTRAL] And I don't have anything for that um bill amount so I'm trying to figure out where this claim is because that claim number you gave me is not one of our.
[AGENT][NEUTRAL] Not one of our claim numbers.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Well, it came back with uh the scanned images under the 90 degree.
[CUSTOMER][NEUTRAL] And it had this telephone number on there.
[AGENT][NEUTRAL] Yeah, we do claim status for them.
[CUSTOMER][NEUTRAL] For customer service.
[AGENT][NEUTRAL] Um, but I don't have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] See that claim on file.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 24
[AGENT][NEUTRAL] So you do have an EOB is that is denied or?
[CUSTOMER][NEUTRAL] Yeah, I couldn't
[CUSTOMER][NEGATIVE] Well, this was a scanned image and um it was a letter or I assume a letter, but it's broke down like a um EOB.
[CUSTOMER][NEUTRAL] And then about a note of it is it's wanting an op report with history and physical is required for review.
[CUSTOMER][NEUTRAL] It says your claim is being closed due to the information that was requested was not received.
[CUSTOMER][NEUTRAL] So I don't know if that affected how we're seeing it because I did try to pull it up on your website too and I couldn't.
[CUSTOMER][NEUTRAL] Get it to pop either.
[AGENT][NEUTRAL] And let me see what, let me see what pol um benefits are under this. Hold on one moment.
[AGENT][NEUTRAL] So it's a routine colonoscopy, not diagnostic.
[CUSTOMER][NEUTRAL] Well, it turned, well, there was some diagnostic um.
[CUSTOMER][NEUTRAL] Um, diagnosis attached to it, but the main reason she had it was for screening.
[CUSTOMER][NEUTRAL] And then they found diverticulitis too, so that could be why they're wanting.
[CUSTOMER][NEUTRAL] But the primary diagnosis on there is for an encounter for screening for mag malignant neoplasm.
[AGENT][NEUTRAL] Um, well, if you don't mind, will you go ahead and resubmit the claim to us, um, and then we can process it according to this policy, um, because they do have a wellness, uh, rider on the policy.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now I show that went to a [PII]. Is that the correct location for that to go, or should it? let me see what the other one?
[CUSTOMER][NEUTRAL] They've done some revamping.
[CUSTOMER][NEUTRAL] I do have an [PII] City address so with the [PII].
[AGENT][NEUTRAL] Yes, that's our address. Yeah, if you can send it there.
[CUSTOMER][POSITIVE] I can do that. OK, we're still within timely on this claim.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, we actually don't apply any timely filing, so you're totally fine.
[CUSTOMER][POSITIVE] Oh perfect, that's unusual.
[AGENT][NEUTRAL] I know, I know.
[CUSTOMER][NEUTRAL] So, all right, I will send it to that, yeah, [PII] under the American Public Life which will go to you with that address, correct?
[AGENT][NEUTRAL] Yes, that will. I'll go to our claims department.
[CUSTOMER][POSITIVE] Alright, perfect, and [PII] at the end?
[AGENT][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] OK, that's why I always ask. [PII] instead of the [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And do you have a reference number then for our call, please?
[AGENT][NEUTRAL] A reference number is just my name and then today's date.
[CUSTOMER][POSITIVE] All right, thank you so much, [PII]. I hope you have a good rest of your week.
[AGENT][POSITIVE] Thank you. Thanks for calling APLU as well.
[CUSTOMER][POSITIVE] Thank you bye now.