AccountId: 011433970860
ContactId: 9f41821d-4838-4ff1-a8bc-41ec2db6bd3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 809929 ms
Total Talk Time (AGENT): 318076 ms
Total Talk Time (CUSTOMER): 117480 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/9f41821d-4838-4ff1-a8bc-41ec2db6bd3f_20250124T20:13_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] I'm looking for um status of payment for a patient. I'm calling from Ford Physical Therapy.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with the claim status today and do you mind if I get your name please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, [PII]. And what's a great callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's ID number?
[CUSTOMER][NEUTRAL] 1566022
[AGENT][POSITIVE] Perfect, and give me a moment to get that policy pulled up for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, I appreciate your patience. Would you be able to verify your member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Perfect and I do see her here and what is the date of service for the claim you wanna look at?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, that is $374.76.
[AGENT][NEUTRAL] I'm not showing anything for [PII] for um the service date of [PII].
[AGENT][NEUTRAL] Hold on, hold on one second. Let me just double check.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, because I, I sent to the fax number.
[AGENT][NEUTRAL] OK, I'm sorry. So the policy number I was looking at was actually um a old policy number and so it wasn't on that one, but let me
[AGENT][NEUTRAL] Search for it with this updated policy number. And would you like her updated policy number, ma'am?
[CUSTOMER][POSITIVE] Yes, that would be helpful.
[AGENT][NEUTRAL] OK, perfect. I have the updated policy number listed as 02440268.
[CUSTOMER][NEUTRAL] 02440268
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I have [PII]. Would you remind me again? I should have noted it, but what was that total bill amount?
[CUSTOMER][NEUTRAL] Um, let me go back.
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] 37476.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And the name of the, oh, you said it was for physical therapy. Did I hear that right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, OK.
[AGENT][POSITIVE] All right, thank you so much for your patience. So I believe this is your claim here. It looks like we received it.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] [PII]. It looks like the claim was processed [PII], and I show your claim number listed as 3509653.
[AGENT][NEGATIVE] And I do show that that claim denied. I have.
[AGENT][NEUTRAL] Just one denial code for both parts of the claim. let me read those to you.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Oh, it says that benefits have been applied to the 1000 calendar year deductible.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Um, how many days of service can you check?
[AGENT][NEUTRAL] As many as you want.
[CUSTOMER][NEUTRAL] OK, I've got 3 more.
[AGENT][NEUTRAL] OK perfect and what is the next data service we wanna look at?
[CUSTOMER][NEUTRAL] 91624
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Alright perfect so I have this claim here and I'm so sorry let me.
[AGENT][NEUTRAL] I have to like open it to verify the location and I have to like go back to get all the dates so I'm so sorry um.
[CUSTOMER][NEUTRAL] No, it's fine.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] There it is. OK, perfect. So we have that claim. It looks like we received it [PII] [PII]. I'm sorry, um, we process it [PII]. I show that the claim number listed is 353-9415.
[AGENT][NEUTRAL] And I do show that this one denied just stating a copy of the explanation of benefits or it says please provide a copy of the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said you had 2 more dates, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can I send the um EOB to the fax?
[AGENT][NEUTRAL] Yes, absolutely, and you don't need a new claim form but you might reference the claim number um it is being requested on.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That was for date [PII].
[CUSTOMER][NEUTRAL] No, 9:16.
[CUSTOMER][NEUTRAL] Um, what was the claim number?
[AGENT][NEUTRAL] Claim number is going to be 3539415.
[CUSTOMER][NEUTRAL] 353-9145
[AGENT][NEUTRAL] No, I'm so sorry, 9415.
[CUSTOMER][NEUTRAL] 9415. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the next one is 92024.
[AGENT][POSITIVE] 92,020 24, perfect.
[AGENT][NEUTRAL] Alright, perfect, um, I see your claim here it looks like we received it [PII]. We processed it [PII]. Your claim number is 3544971.
[AGENT][NEUTRAL] And this one denied the same reason as that first one, just stating that the benefits are being applied to the $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause we never got that EOB.
[AGENT][POSITIVE] OK, I can absolutely get a copy of it and.
[AGENT][NEUTRAL] I can get you a copy of it faxed out if you'd like.
[CUSTOMER][POSITIVE] OK, that'd be great.
[AGENT][NEUTRAL] Um, let me pull it up. It should be pretty quick.
[AGENT][NEUTRAL] And while I'm waiting for that EOB to load, do you want me to look at that 4th date you had?
[CUSTOMER][POSITIVE] Yeah, that'd be great.
[AGENT][POSITIVE] Perfect and what is that date of service we wanna look at, ma'am?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, Ms. [PII], do you want that uh EOB made attention to yourself on that fax?
[CUSTOMER][NEUTRAL] Sure, you can.
[AGENT][NEUTRAL] And what is a what is a good fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Awesome, I'm gonna read that back to you real quick. I have [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Perfect, I'm gonna send on that now so it should be your way soon and then for that last claim I did find it for you it looks like.
[AGENT][NEUTRAL] We received your claim on the [PII].
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Oh no, hold on, I'm so sorry.
[AGENT][NEUTRAL] OK, there it is, we received it on the [PII] and we processed it on the [PII]. It looks like the claim number on this one is 354-499-1.
[AGENT][NEUTRAL] And this claim also processed with uh the denial code uh that the benefits are being applied to the $1000 calendar year deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can you also send that EOB as well?
[AGENT][POSITIVE] Yeah, absolutely. Let me pull it up for you.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Alright, Ms. [PII], and I'm getting that 2nd EOB fax working for you. Is there anything else I can help you today with this patient?
[CUSTOMER][POSITIVE] No, uh, that'd be great.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Um, I appreciate all your help and I will send over that EOB for that one that we talked about.
[AGENT][POSITIVE] Absolutely, yes, I'm on our way and we'll be able to reprocess for you, OK?
[CUSTOMER][POSITIVE] Great. Thank you.
[AGENT][POSITIVE] My pleasure thank you you have a fabulous day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thanks bye bye.