AccountId: 011433970860
ContactId: 8239d72a-c739-48e7-b261-89723d810a82
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 624510 ms
Total Talk Time (AGENT): 118464 ms
Total Talk Time (CUSTOMER): 342334 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/8239d72a-c739-48e7-b261-89723d810a82_20250416T21:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling in regards to a claim that was sent. Oh, I have the
[CUSTOMER][NEUTRAL] Certificate number or certification number I don't know.
[AGENT][NEUTRAL] OK. Uh, can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] If you need it.
[CUSTOMER][NEUTRAL] Yes, [PII], our office callback number [PII].
[AGENT][NEUTRAL] OK, and what's that certificate number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It's um 0230.
[CUSTOMER][NEUTRAL] 8028 M as in Mary, L as in Lima number 8.
[AGENT][NEUTRAL] OK, thank you, and you want to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, and the patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient. His name is [PII] and last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And what was that date of service?
[CUSTOMER][NEUTRAL] OK, let me, I have the facts.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Oh, you're fine.
[CUSTOMER][NEUTRAL] Um, so I don't wanna log to the, I know I sent the fax and I, I did, I think I don't know what was the problem, but.
[CUSTOMER][NEUTRAL] OK, let me just look for it. I have it here. I have it here on here.
[CUSTOMER][NEUTRAL] But it was not it.
[CUSTOMER][NEGATIVE] I know it's 2 days of service, but I received the fax for that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see if I can find it because I had it here some somewhere on here.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, I have it here.
[CUSTOMER][NEUTRAL] OK, it's um.
[CUSTOMER][NEUTRAL] For date of service, let me go back.
[CUSTOMER][NEUTRAL] Da of service.
[CUSTOMER][NEUTRAL] Uh, uh, [PII].
[CUSTOMER][NEUTRAL] Huh, [PII].
[CUSTOMER][NEGATIVE] And I'll tell you what's the total bill amount on that one. I don't know why I can't find the fax I sent.
[CUSTOMER][NEUTRAL] And the other date of service is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I think so.
[AGENT][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] Oh, [PII], [PII], [PII].
[AGENT][NEUTRAL] OK, for [PII], what was the billed amount?
[CUSTOMER][POSITIVE] I'm looking at it right now. It's popping up bom bom.
[CUSTOMER][NEUTRAL] $150
[AGENT][NEUTRAL] Um, do you know if that was for what type of service was that for? I've got a couple different.
[AGENT][NEUTRAL] Um, services with that dollar amount.
[CUSTOMER][NEUTRAL] OK, what do you mean what do you want the code?
[AGENT][NEUTRAL] It was in an office visit or what?
[CUSTOMER][NEUTRAL] Yeah, it was uh the procedure code is 11102.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, code 111, the, the place of service code 11.
[CUSTOMER][NEUTRAL] And I'll tell you right now, let me look at it because I'm, I'm, I can't remember at the top of my head.
[CUSTOMER][NEUTRAL] Um, I mean she did perform a biopsy.
[AGENT][NEUTRAL] OK, it looks like, yes.
[CUSTOMER][NEUTRAL] Tangential biopsy.
[CUSTOMER][NEUTRAL] Yeah, a biopsy was done for that, for that date of service.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] That's the procedure code.
[AGENT][NEUTRAL] Uh, looks like we've received the primary explanation of benefits, but the explanation of benefits received did not list the amounts applied to deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, what do you, OK, let me, OK, that's, I don't think that's quite right. I don't think so. Let me check.
[CUSTOMER][NEUTRAL] It has to be here. Let me, let me give me just a sec. Let me see if I can.
[CUSTOMER][NEUTRAL] Credit, um.
[CUSTOMER][NEUTRAL] It has to be here because I know.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] this here
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] is something I'll have to check tomorrow.
[CUSTOMER][NEUTRAL] OK and this is uh.
[CUSTOMER][POSITIVE] This is awesome though.
[CUSTOMER][NEUTRAL] To keep going on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me see if I can find what I'm trying to find is uh.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] I'm just trying to find the facts that I sent just so I know what I included.
[CUSTOMER][NEUTRAL] The yeah.
[CUSTOMER][NEUTRAL] It's time we see APL. OK, I have it here.
[CUSTOMER][NEGATIVE] That's so weird. Now that I want to find it, I can't find it.
[CUSTOMER][NEUTRAL] I'm sorry, uh, maybe it was not clear, but I'm pretty sure it was listed because.
[CUSTOMER][NEUTRAL] I don't, the EOB does say here it is. I have it. I found it, found it, found it, found it.
[CUSTOMER][NEUTRAL] So I sent it.
[CUSTOMER][NEGATIVE] On [PII] and then I resent it again.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I just sent it once.
[CUSTOMER][NEGATIVE] I have to send it a second time.
[CUSTOMER][NEUTRAL] Yeah, it does say.
[CUSTOMER][NEUTRAL] And I, and I resend it again. That's the thing. That's weird.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Should I resend them again?
[AGENT][NEUTRAL] Um, let me see what we received.
[CUSTOMER][NEUTRAL] Because this time, maybe the first time around, it, it was not clear. What I did the second time around is like, like screenshot like what the insurance process, but it does say plan a lot amount $80.49 dollars plan paid 49 cents, patient responsibility $80 right?
[CUSTOMER][NEUTRAL] And that's for the date of service [PII].
[CUSTOMER][NEUTRAL] And that's the UOB that they provide, they don't provide any other.
[CUSTOMER][NEUTRAL] Kind of you'll be
[AGENT][NEUTRAL] OK. And you said
[CUSTOMER][NEUTRAL] Like I mean if you're saying that do the service code then I don't know.
[AGENT][NEUTRAL] Let me see what we received. Hold on one moment.
[CUSTOMER][NEUTRAL] If you received something recently, let me know because I just have, oh yes, I did. I sent it on [PII], so I did resend it like I sent it again to send it like more clearly and I, I included another date of service that's for [PII], so I did resend it. I have proof here.
[AGENT][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] It's just you know like they paid something or for the second one that does the patient have to pay? I don't know.
[AGENT][NEUTRAL] Um, I know that the office visit it's not covered, because that's not covered under the policy, but let me, um,
[AGENT][NEUTRAL] I do see the EOB attached so I'm not sure why that wasn't processed um.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And and I've, and I've done this for other patients that have AMI. I don't know what's the problem. Like that's the OB that AMI provides and we filled out uh the insurance claim form, complete, like it's complete.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me, uh, let me get you, uh, um, can I get you over to our claims department and they can get this sent back through. I'll give them all the information that you've given me.
[CUSTOMER][NEUTRAL] OK, um, yeah, sure, go ahead.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Currently no agent staffed. Goodbye.
[AGENT][NEUTRAL] Oh, well, OK.
[AGENT][NEUTRAL] OK, I guess the claims closes at [PII]. I didn't realize that. OK, um, I'm gonna send this back through and and see if we can get this processed because I see what you're talking about we, we processed. I see the amount billed 150, the allowed amount, um.
[AGENT][NEUTRAL] $8049 plan or patient responsibility $80 so um let me send this back through if there's any issues at all, um they can give you a call back at that number you provided me.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, question. How about, do you have the one for [PII]?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And the, the, the total bill amount for [PII] is.
[CUSTOMER][NEUTRAL] Uh, $100.
[CUSTOMER][NEUTRAL] Because the, the fax I sent it on the, the second time around, right? I sent it on [PII].
[AGENT][NEUTRAL] Um, yes, we did receive that one and that one was for an office visit, which is not covered under the policy.
[CUSTOMER][NEGATIVE] So that it's denied.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so the other one will be resent and and processed.
[AGENT][NEUTRAL] Yes, I'll send it back through for processing.
[CUSTOMER][NEUTRAL] OK, can you like send, like if there's a denial on [PII], can you fax it to me just to have proof just in case the patient has, oh, but do you have proof of the
[CUSTOMER][NEUTRAL] I don't know, they get picky
[AGENT][NEUTRAL] Um, looks like we actually just sent it today, so you should be receiving that.
[CUSTOMER][POSITIVE] OK, OK, so I'll wait for that one and just wait for from um [PII]. OK, thank you so much. Thank you so much.
[AGENT][POSITIVE] OK, thanks for calling.
[CUSTOMER][POSITIVE] Thank you.