AccountId: 011433970860
ContactId: 8c28414b-661d-4393-be7f-95d3efc2ef06
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364730 ms
Total Talk Time (AGENT): 151305 ms
Total Talk Time (CUSTOMER): 132729 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/8c28414b-661d-4393-be7f-95d3efc2ef06_20250116T16:12_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling to check to see if you have any claims on file for the patient. And if not, where can I send it and if you accept um fax.
[AGENT][NEUTRAL] OK, yes, absolutely. So let's take a look and see if we have that claim on file, Miss [PII], do you mind if I really quickly snag a good call back number from you?
[CUSTOMER][NEUTRAL] Yes. Uh, my direct line is [PII].
[AGENT][NEUTRAL] Thank you and what's the member's policy number, Miss [PII]?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And just give me a moment.
[CUSTOMER][NEUTRAL] OK, it's 749161873.
[AGENT][POSITIVE] Perfect, and give me a moment to check on that. And I have 749161873?
[AGENT][NEUTRAL] Was that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] All right. Unfortunately, that's not a policy number with us at APL. Um, I can try searching for them a different way.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Wait a minute. I gave you the wrong one. I was looking at the primary. 02369707 M as in Larry, um M as in Mary, L as in Larry, 8.
[AGENT][POSITIVE] No worries.
[AGENT][POSITIVE] Thank you, thank you, and one sec.
[CUSTOMER][NEUTRAL] I'm sorry, I'm trying to multitask here.
[AGENT][POSITIVE] No, you're OK. Um, let me get them pulled up for you.
[AGENT][NEUTRAL] And what is the date of service on the claim we're going to be looking at today?
[CUSTOMER][NEUTRAL] So I have two data services. Um, this one is for 6 18 2024 and the total charges of 3,759 and 12 cents.
[AGENT][NEUTRAL] OK, and then what's that second data service?
[CUSTOMER][NEUTRAL] Um, it's give me a moment.
[CUSTOMER][NEUTRAL] 610, 2024 for 3,408 60 cents.
[AGENT][POSITIVE] OK, perfect. Thank you, thank you. I appreciate that.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And can you verify for me, pretty please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII], [PII].
[AGENT][POSITIVE] Perfect, thank you, and.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Give me a moment to look in on those for you real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And could you verify for me the name of the facility on file?
[CUSTOMER][NEUTRAL] Um, you may have it under Wame PLLC or United Va Vascular Cents.
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So I'm seeing the one on here for the [PII], um, but I'm not showing one for the [PII]. On the [PII], I have that we received your claim on [PII]. We processed it on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show that your
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is 351-477-1 and I do show the claim ended up being denied. I have the reason stating is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, benefits are only payable if your major medical insurance provides benefits. Um, if this claim is later paid by your major medical, please, um, send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] OK, that's what I figured. Um, the one we actually, um, the way it was posted wasn't reflecting that the amount was actually applied to the patient's deductible. So I'm just gonna go ahead and send the, the correct EOB um in order for you to process it.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, is there a way to fax it over?
[AGENT][NEUTRAL] And then you needed some remittance for the claims? I'm sorry.
[CUSTOMER][NEUTRAL] Is there a way where I can fax it for you to get it faster or only by mail?
[AGENT][NEUTRAL] Oh, no, we do have a fax number and an online payer ID.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, our fax number here is, oh, and I'm sorry, let me know if you're ready. I should have asked that first.
[CUSTOMER][NEUTRAL] Um, right.
[CUSTOMER][POSITIVE] No, no, no, it's fine. I'm ready.
[AGENT][POSITIVE] Perfect. Our fax number is 877.
[AGENT][NEUTRAL] 3659423
[AGENT][NEUTRAL] And then if you would like our online payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, give me a moment's 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] 801. OK, I'll try to find it in our system and if we don't have it on file, then I'll just go ahead and submit it via fax.
[AGENT][POSITIVE] Perfect. And then is there anything else I can do to help you out today, Ms. [PII]?
[CUSTOMER][POSITIVE] Uh, no, actually, if you can provide me just with a call reference number, that will be great.
[AGENT][NEUTRAL] Yeah, I'd love to. The call reference number is my name, [PII] First initial last name, B like [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much for your time and you have a great day.
[AGENT][POSITIVE] My pleasure. Thanks for calling the APL and you take care, Miss [PII].
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] OK.