AccountId: 011433970860
ContactId: 88b8459d-f55a-4fbc-8fd3-1aabc0b98026
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 619859 ms
Total Talk Time (AGENT): 156656 ms
Total Talk Time (CUSTOMER): 180951 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/88b8459d-f55a-4fbc-8fd3-1aabc0b98026_20250528T12:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII] and I'm calling from Wake Med Hospital. I'm calling on behalf of one of your members who was a patient of ours. I'm trying to find out the status of a couple of claims we submitted on his behalf.
[AGENT][POSITIVE] OK, great. I'm happy to check on claims. Do we have a policy number?
[CUSTOMER][NEUTRAL] Yes, it's 2586425.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] So if I'm pronouncing it correctly, it's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And then what is the data of service?
[CUSTOMER][NEUTRAL] So on the first one is for [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and then what was the bill amount?
[CUSTOMER][NEUTRAL] Uh, it is $28,632.64.
[AGENT][NEUTRAL] All right. I'm not seeing.
[AGENT][NEUTRAL] Any me please let me check this 11 moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not seeing any claims on file for that date range or that billed amount.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let me see, so we filed the claim back on [PII]. Can I confirm the your, your guys' um claim address?
[AGENT][POSITIVE] Yeah, absolutely. Let me, um, give me just one second. There are.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, you said back in April, correct?
[CUSTOMER][NEUTRAL] [PII], let me go back, yeah, [PII].
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, because I was gonna say there are a few that are like pending, but those are obviously new, um, yeah, absolutely you can verify where the claims were sent and the address. What what do you have there?
[CUSTOMER][NEUTRAL] So I got it as [PII] is that the one?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. And the payer ID is 645, correct, and payer ID is 64556.
[CUSTOMER][NEUTRAL] That's, that's it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, let me do this. Can I double check on the second claim, uh, is, is for.
[CUSTOMER][NEUTRAL] Data service of is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the amount is for $2,336.13.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that claim it looks like we did receive.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] to go back and see.
[AGENT][NEGATIVE] I think this was received.
[AGENT][NEUTRAL] This claim was received on [PII]. Uh, looks like denied [PII]. Policy doesn't provide a host or ambulance benefits, excuse me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And that denial day you say [PII]?
[AGENT][NEUTRAL] Oh, no, [PII].
[CUSTOMER][NEUTRAL] Oh, [PII], [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, so being that that's the case on, well, let, let, can I have the claim number on that one, by the way?
[AGENT][NEUTRAL] Mhm. It's 359.
[AGENT][NEUTRAL] 7084.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and being that it was denied, um, do you know how much was applied to member responsibility?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We don't advise on patient responsibility that's up to the provider facility, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just, just the fact that that is the 9, OK.
[CUSTOMER][NEUTRAL] OK, uh, let me make a note here.
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] A little bit um I was scratching my head that one claim was received but not the first one that we that we saw um you're absolutely sure that that one was not received that that the first one that we were talking about?
[AGENT][NEUTRAL] I'll double check, um.
[CUSTOMER][NEUTRAL] And if you need the amount on the first one just let me know.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] English
[AGENT][NEUTRAL] Um, let's see here.
[AGENT][NEUTRAL] It was for.
[AGENT][NEUTRAL] The 26,000 or 28,000, correct?
[CUSTOMER][NEUTRAL] 28, 28,63264.
[AGENT][NEUTRAL] Yeah, I mean, I even pulled what was submitted um because sometimes in the system like the billed amount will show a different so I pulled the claim that I gave you, um, that one shows received on [PII] and then processed [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Patient had 2 claims before that. Um, I pulled both of those and neither of those on the claims that were submitted show that amount. So, we definitely don't have that larger one.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, OK, alright, so we'll, we'll go ahead and resubmit it. In fact, we'll, we'll go ahead and send it via certified mail this time, and then we'll go from there. So I think that basically covers it all. So aside from that, [PII], is there a call reference number?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is my name with today's date. Again, my name is [PII], which is [PII] Last initial to my name is [PII], and then today's date.
[CUSTOMER][POSITIVE] All right. Well, thank you for checking on that information today and you have a good day.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] OK. Bye-bye.