AccountId: 011433970860
ContactId: 96bc46d8-795d-4368-a5c1-33fe38f978dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1479979 ms
Total Talk Time (AGENT): 283440 ms
Total Talk Time (CUSTOMER): 299114 ms
Interruptions: 6
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/96bc46d8-795d-4368-a5c1-33fe38f978dc_20250129T15:31_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII]. I'm calling from Doctor [PII]'s office, and I have a question on
[CUSTOMER][NEUTRAL] A couple claims for a patient.
[AGENT][NEUTRAL] OK, I can help you with claims Ms. [PII]. um, can I get your callback number please just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Um, patient's name is [PII]. It's [PII]
[AGENT][NEUTRAL] OK, and then what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And her policy number, please?
[CUSTOMER][NEUTRAL] 02440284
[AGENT][NEUTRAL] OK, let me pull that policy in real quick.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] OK, and then what is [PII]'s date of service?
[CUSTOMER][NEUTRAL] OK, so the first one is [PII].
[AGENT][NEUTRAL] OK, and the charge amount?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, where is that?
[CUSTOMER][NEUTRAL] Um, 9.
[CUSTOMER][NEUTRAL] 64.
[AGENT][NEUTRAL] OK, $964 even?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then what is the uh charge amount after the primary paid their part?
[CUSTOMER][NEUTRAL] OK, so the primary paid, OK, so the primary paid on the office visit.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] They paid 3849. Um, it left a responsibility of $100 to the patient.
[AGENT][NEUTRAL] OK thank you and I know you told me when you first called, yes ma'am, I know you told me when you first called what the name of your facility is, but can I ask you again because I didn't catch it.
[CUSTOMER][NEUTRAL] Is that what you need? OK.
[CUSTOMER][NEUTRAL] It's Doctor [PII], but our facility name is the Orthopedic Center of Saint Louis.
[AGENT][NEUTRAL] OK, or the whole.
[CUSTOMER][NEUTRAL] Or it could be it's probably under Midwest Spine and Orthopedic Midwest orthopedic and Spine because he was.
[AGENT][NEUTRAL] I'm saying
[CUSTOMER][NEUTRAL] It's confusing. He was there until March, the end of March, and.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It's just a mess.
[AGENT][NEUTRAL] OK, well, I'll look for all of them. I thank you so much for letting me know that it's OK. It's gonna be a brief hold while I know that you're fine. It's gonna be a hold while I look up this claim for you, and then I will right back, Miss [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I'm sorry.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Miss [PII], this is [PII] back with you again.
[AGENT][NEGATIVE] So I did find 2 claims for that date of service for your provider, but they weren't for the amount that you gave me.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so when I was looking at this.
[AGENT][NEUTRAL] I can give them to you and give you the remark. Uh-huh.
[CUSTOMER][NEUTRAL] Yes, that's fine. Why don't you do that because I think they broke them up separate, um, is how it looks here. They paid for the X-ray 6610 it looks like.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But the office visit portion which um they didn't pay so I'm just confused on that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Right, let me look and see what the remarks say for it.
[AGENT][NEUTRAL] Office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] That's what I understood too, OK? So the patient called me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] The other day and she said I just got off the phone with the insurance and they said they never got the the claims and they said that you're billing you're billing this wrong they don't do office visits by time and I said it's not by time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It was billed out as an office visit and she said well you need to rebuild it because they're not paying it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And I was like, OK, I don't know what you're talking about, but anyway, um.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Yeah, for the patient's policy contract.
[CUSTOMER][NEGATIVE] So they don't even they don't pay for office visits.
[AGENT][NEUTRAL] Right, office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so can you send me something um that states that on the explanation of benefits because I've got two other dates of service as well and I have it in here that office visits not covered, but um I just need something in writing for her so when I send it back to her so she knows she still owes this.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, yes ma'am. I can send you the EOB for, for this one with the office visits on it. Um, can I get your fax number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] And then I just have 2 other dates of service for the same reason.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] Let me get this one to you first because I have to send them one at a time. It won't let me send multiple, but if you hold for just a second, let me get this one to you. We'll look at the next one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Perfect thanks [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Miss [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I just wanted to get back with you and let you know that I forgot about you, but my computer is being extremely slow right now but I'm getting it done.
[CUSTOMER][POSITIVE] All right, no worries, thank you.
[AGENT][POSITIVE] OK, you're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] My gosh.
[AGENT][NEUTRAL] Come on computer.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I've got it on its way to you I guess it was just being contrary this morning.
[CUSTOMER][NEUTRAL] That's fine, it's Wednesday. It's not ready to get started today, I guess.
[AGENT][NEUTRAL] Yes, uh.
[AGENT][NEGATIVE] It just was like take forever to load for me to send it to you um what is the next uh data service for for this insured?
[CUSTOMER][NEUTRAL] Oh, that's OK.
[CUSTOMER][NEUTRAL] OK, the next one is 5324 for $370. Um, we were asking them to pay 9939.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] 9
[AGENT][NEUTRAL] $9.39.
[CUSTOMER][NEUTRAL] No, $999.39.
[AGENT][NEUTRAL] Oh, OK, 99. OK, alright, let me pull this one up and I'll be right.
[CUSTOMER][NEUTRAL] All righty. You are on hold.
[AGENT][POSITIVE] Thank you, ma'am.
[AGENT][NEUTRAL] So.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi Ms. [PII], this is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm I'm sorry you were on hold long uh my computer, I think I've got it fixed so I I it's always when I've got somebody on the phone, um, so on this one it was the same reason the claim number is 347-0936 and the office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][POSITIVE] OK, no worries.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect um yeah so if I can get a copy of that EOB for that one, yeah, I just mainly have to have something from you guys to send her, so I'm sure that's the case on this other data service too, but I, I know how she is she's gonna want something proof in writing that they're not gonna pay it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right. I understand. Um, what, no, no, I'm sorry, you're having to wait so much. Usually, I've had this already completed and to you by now, so, um, that's, that's up that upsets me that you had to wait so long. Um, what is the, um,
[CUSTOMER][POSITIVE] I'm sorry to make you go through that.
[CUSTOMER][POSITIVE] No, no worries.
[CUSTOMER][NEUTRAL] Oh, that's OK.
[AGENT][NEUTRAL] What is the other date of service did you have another one?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and what was the charge amount for that data service?
[CUSTOMER][NEUTRAL] Um, 256 and we were asking $68.54.
[AGENT][NEUTRAL] 54. OK, alright, I'm sending this fax over to you right now with this EOB for you and I'm gonna look up the other one and send the fax to you and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome thanks [PII].
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] OK, Ms. [PII] for the um data service of [PII], I, I do not find the claim on file for that date of service.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK. So you don't, OK, so I can, can I fax this to you?
[AGENT][NEUTRAL] Yes I am.
[AGENT][NEUTRAL] Let me give you the fax number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, and that's 5:21. OK, perfect. I'll just go ahead just so I can get the denial that'll work so thank you so much I really appreciate it.
[AGENT][POSITIVE] Yes ma'am, you're welcome you're very welcome I hope you have a good your week miss.
[AGENT][POSITIVE] [PII], I enjoyed talking with you.
[CUSTOMER][POSITIVE] Thank you. You too.
[CUSTOMER][POSITIVE] You too. Have a great day. Mhm.
[AGENT][POSITIVE] Alright, thanks for calling APL you too bye bye ma'am.
[CUSTOMER][NEUTRAL] Mhm