AccountId: 011433970860
ContactId: 92272c58-7a7c-48a6-bb7c-5fed19f6d33b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 533659 ms
Total Talk Time (AGENT): 254521 ms
Total Talk Time (CUSTOMER): 117513 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/92272c58-7a7c-48a6-bb7c-5fed19f6d33b_20250421T13:02_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm having, I'm struggling with a claim and I was wondering if you could help.
[AGENT][NEUTRAL] Yes, certainly, and this is for your policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is your policy number, please?
[CUSTOMER][NEUTRAL] My policy number is 2286572.
[AGENT][NEUTRAL] 572. Thank you. And if I could just verify your name, uh date of birth, and a phone number, please?
[CUSTOMER][NEUTRAL] Excuse me, [PII], date of birth [PII] and what was the other question?
[AGENT][NEUTRAL] Uh, just your, uh, phone number, please.
[CUSTOMER][NEUTRAL] Phone number 5 OK I'm sorry [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. And uh [PII], what data service are we looking for? What, what claim are we looking for that you, that you're having problems with?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] I'm looking at um 359-1004.
[AGENT][NEUTRAL] 04. OK, the claim. OK, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For uh Fairfield Medical Center, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, so let's just see, it looks like uh we had originally processed this.
[AGENT][NEUTRAL] And uh there's
[CUSTOMER][NEUTRAL] Well, I, I'm sorry, go ahead.
[AGENT][NEUTRAL] Oh, no, please go ahead. That's fine.
[CUSTOMER][NEUTRAL] Well, it's there's there's, there's 3 different bills listed in the um in the claim.
[CUSTOMER][NEGATIVE] And the outstanding charges and I'm getting $24.07 and they're saying that that was a duplicate actually I was charged 3 times the $24.07 but that's not my concern, um.
[CUSTOMER][NEUTRAL] My concern is the one for $1900 in [PII]. I don't know why it's not being.
[AGENT][NEUTRAL] Sure
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And there's another one in there for $113.13 and I'm not seeing any questions about that or any answers.
[AGENT][NEUTRAL] Of course, let's see what we have here.
[AGENT][NEUTRAL] OK, so the,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the original, uh, let's start, let's start at the very first one. so [PII], it looks like there's a facility bill for 8000.
[AGENT][NEUTRAL] $210.
[AGENT][NEUTRAL] And it looks like that's for Fairfield. OK. So what um what we uh needed on, on that, uh,
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] We have to have a diagnosis code from the from the provider. Um, we have to have some, no, sometimes there, there will be a facility bill, uh, or, or they will have the diagnosis code on there. Sometimes the physician's notes, uh, will have that. So that's, that's what we have for that. That's 3-19-2025. So let's look at the next 1, um, 306-2025.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Uh, this is a facility bill for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let's see this one.
[AGENT][NEUTRAL] So it looks like.
[AGENT][NEUTRAL] They're paying $24.07 on that one.
[AGENT][NEUTRAL] Um, this is for Fairfield Medical Center.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so it looks like when this was first processed, they were at, they were listing this as, as uh as being a duplicate or something. It's uh and so that's what that is. Now, let's look at the next one.
[AGENT][NEUTRAL] The 319 again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For $125.
[AGENT][NEUTRAL] OK, this is the same.
[AGENT][NEUTRAL] thing, it looks like it had been submitted before, but we were looking for the diagnosis code from the provider.
[CUSTOMER][NEUTRAL] Right and I OK.
[AGENT][NEUTRAL] So
[CUSTOMER][POSITIVE] And I understood that so and oh go ahead I'm sorry.
[AGENT][NEUTRAL] It looks like
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, please, uh, um, so what, uh, so which one in, in particular are we looking at that there's a problem?
[CUSTOMER][NEUTRAL] Pretty much all of them. I've been paid $24.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And my total amount owed was $2,223.34 so I understand that the in the um.
[AGENT][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Uh, claim number 3589276, I didn't send enough information.
[CUSTOMER][NEUTRAL] So in claim number 3591004 it was the same bill but I also attached doctor's notes inpatient summary I attached everything that I had in hopes that you had your codes and everything on there and all I got was $24.
[AGENT][POSITIVE] Awesome.
[AGENT][NEUTRAL] With this, yeah, I see. OK, so let's just see what we have here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So what I'm gonna do, I'm just pulling up your submission here and I'll go through them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I apologize my computer is just a little bit slow coming up, but we'll see what we've got here.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][POSITIVE] OK, got that. We got the EOB that's good.
[AGENT][NEUTRAL] OK. Fairfield Medical Center.
[AGENT][NEUTRAL] Clinical summary.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, that's page 11. I'm sorry, I'm just making notes while I, I go through this because what, what's gonna um
[CUSTOMER][POSITIVE] It's OK, it's OK. Let's take your time. I'm.
[AGENT][NEUTRAL] Yeah, we're gonna, I'm gonna send this back to the examiner and have them look at it, but let's, I just wanna make sure that I've got some notes here. So on page 11, we do have a diagnosis code and this is for the date of service, uh.
[AGENT][NEUTRAL] [PII] from uh.
[CUSTOMER][NEUTRAL] Yes, yes, it's all for [PII].
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Oh, OK, so that's.
[AGENT][NEUTRAL] I think my computer is still on.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Weekend mode
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I am too.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So I do see this, um, and thank you for calling and letting us know. So what I'm gonna do is I'd like to return this to uh the examiner so that we can have this, uh, looked at and see what we can do about getting uh this um uh reevaluated. Um.
[AGENT][NEUTRAL] Now, is there, is this, um, so we have this this one claim that needs to be readdressed. Uh, is there anything else that I need to look at any other claims that we have a question about that we need to, to look at that um.
[AGENT][NEUTRAL] You know, that, that, uh, so everything that you've got here from 36 to 319, OK.
[CUSTOMER][NEUTRAL] Now my
[AGENT][NEUTRAL] OK, so, um,
[AGENT][POSITIVE] Again, uh, thank you for contacting us and letting us know this. I will have this sent back to the examiner so that we can have this, um, uh, we can get this paid and, and get it, uh, get it back to you.
[CUSTOMER][POSITIVE] I appreciate it thank you so much.
[AGENT][POSITIVE] OK, well thank you very much for contacting us. Uh, have a very good day. Now once you do get this, uh, I would keep looking at in the, um, in our uh online service center to see when this is reprocessed, but if you do have any other questions, please let us know and, and we will try and help with anything that we possibly can.
[CUSTOMER][POSITIVE] Thank you so much you're great I appreciate it.
[AGENT][POSITIVE] OK, thank you for contacting AP have.