AccountId: 011433970860
ContactId: 8ed56e94-b77d-431d-bbc8-2b228bdde299
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 996409 ms
Total Talk Time (AGENT): 240109 ms
Total Talk Time (CUSTOMER): 262360 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/8ed56e94-b77d-431d-bbc8-2b228bdde299_20250117T14:31_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] My name is [PII] and I'm calling from the provider's office to check on the denied claim status. Can you please spell out your name?
[AGENT][NEUTRAL] Sure, my name is [PII]. That's [PII]. Last initial is [PII]. And may I have a callback number, Mr. [PII]? You're welcome.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02475818
[AGENT][POSITIVE] Mm thank you.
[AGENT][NEUTRAL] And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, that is uh [PII] with the date of birth, [PII].
[AGENT][NEUTRAL] Thank you. And may I have the date of service and the amount of the claims?
[CUSTOMER][NEUTRAL] It's [PII] and the bill amount is $15,235 even.
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this claim, and for the future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And let me see if I can find this claim for you.
[CUSTOMER][NEUTRAL] Actually, it was denied for the primary UB and we have recently submitted that primary UB as well.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Give me one moment. I'm searching to see if we, we have that. One moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Gonna be one more minute. I'm going through the paperwork, OK?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, we received the explanation of benefits on the [PII] on yesterday, so it is in line to be processed.
[CUSTOMER][NEUTRAL] OK. So, how many days it will take to get processed?
[AGENT][NEUTRAL] 7 to 10 business days is the normal processing, processing time.
[CUSTOMER][NEUTRAL] OK. Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And can you give me the claim number?
[AGENT][NEUTRAL] There's no claim number it's not been processed.
[CUSTOMER][NEUTRAL] Mm, give me just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And may I know the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will, Mr. [PII].
[CUSTOMER][NEUTRAL] OK. Just a moment. There are 2 more accounts. Can you help me with those?
[AGENT][NEUTRAL] Yeah, I just need to make a note on each one of them before I move forward to the next one. And do you need any other information on this one?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for the next account, shall I give you the information?
[AGENT][NEUTRAL] Bear with me.
[AGENT][NEUTRAL] Give me just a minute. I need to finish a note.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, go ahead with the policy number.
[CUSTOMER][NEUTRAL] Yes. So the policy number is 01861397.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, that is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes. That is [PII] with the bill amount of $228.54 dollars, $28,584.50.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, looks like we recently processed the claim on [PII], but we need the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK. Uh, just a moment. Do you have the claim number?
[AGENT][NEUTRAL] Yes, the claim number is 355-0771.
[CUSTOMER][NEUTRAL] OK, just give me a moment. Uh let me just first check if our team has sent any reports of primary EUB.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And no, I don't think so. So, may I know the fax number to which we can send the primary EOB?
[AGENT][NEUTRAL] OK, sure. Fax number is [PII].
[CUSTOMER][NEUTRAL] Uh, I think I took the wrong, uh, is it [PII]?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] So it's 11 digits, I think.
[AGENT][NEUTRAL] No. [PII].
[CUSTOMER][NEUTRAL] I'm really sorry. It is [PII].
[AGENT][POSITIVE] Yes, that is the correct number.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, can you please check once again because it is 11 digits.
[AGENT][NEUTRAL] Yes, yes, you're supposed to have a 1 in front of it, yes.
[CUSTOMER][NEUTRAL] OK, OK, OK, uh, that's what I was, uh, confused about, and I just wanted to know whether you need the, uh, uh, claim form along with that primary EOB.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you can send it. It's really up to, um, the provider if they want to send a copy of the claim or not, but we need the copy of the explanation of benefits. We already got the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. And whether the primary insurance is United Healthcare?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I'm just confirming whether it is the same insurance or do you have any other primary insurance.
[AGENT][NEUTRAL] OK, let me check on that. I'll have to pull it up. One moment.
[CUSTOMER][NEUTRAL] It should be UHC but still uh confirm once.
[AGENT][NEUTRAL] Yes, it's United Healthcare.
[CUSTOMER][NEUTRAL] OK, got it. Now for the last account?
[AGENT][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] Give me just a moment. Y[PII].
[AGENT][POSITIVE] I'm ready whenever you are.
[AGENT][POSITIVE] Uh, Mr. [PII], I'm ready whenever you are.
[CUSTOMER][NEUTRAL] Hello? Hello?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm really sorry. Um, my call was on mute. I'm just, uh, my apologies for that. The name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Oh, I didn't get the policy number.
[CUSTOMER][NEGATIVE] Oh sorry.
[CUSTOMER][NEUTRAL] It is 01869443 Mike Lima 8.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] And my apologies for that. I kept you on hold for a long time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] All right. And let me have the name and date of birth one more time, OK?
[CUSTOMER][NEUTRAL] Uh yes, it is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK. So the date of service is [PII] and the bill amount is $10,415 even.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, looks like we're still missing the explanation of benefits from the primary insurance.
[AGENT][NEUTRAL] Um, let me check.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] What's the claim number?
[AGENT][NEUTRAL] And for the most recent one, which is the um denied of the duplicate, the claim number is 352-6130.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh no, not the duplicate, uh, which is denied, uh, for the primary UB. I'll need that.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] The original, OK. The original is 349-8602.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And when was this claim denied?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] is the original one, and the duplicate one was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, and you need the primary UVs via fax, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And OK, I don't, I don't think I'll need anything more. I just wanted to confirm whether the primary insurance is BCBS.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] Florida Bloom, mhm.
[CUSTOMER][POSITIVE] Yes. So, thank you so much, [PII], for your kind assistance throughout the call. I really appreciate your efforts. Is there any way that I can rate your service?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, only by sending an email to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome, Ms. [PII], and thank you for calling APL. Have a good day, Mr. [PII].
[CUSTOMER][NEUTRAL] So it was
[CUSTOMER][NEUTRAL] So it was AM public?
[AGENT][NEUTRAL] Care [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Have a good day, Mr. [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Yes bye bye.