AccountId: 011433970860
ContactId: a3a60f7c-b629-4052-96dc-f8e52a649b84
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 508179 ms
Total Talk Time (AGENT): 133927 ms
Total Talk Time (CUSTOMER): 343163 ms
Interruptions: 13
Overall Sentiment: AGENT=1.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/a3a60f7c-b629-4052-96dc-f8e52a649b84_20250409T15:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII]. I need to go over a claim that's processed and um was paid for some reason they input all the information our cash cash posting department, but I cannot find a scan of the original ELB so they didn't put many details on it, and I just need to go over it to get some of those details.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Absolutely. Happy to help [PII]. What is the patient's policy number or if you have the claim number, whatever works.
[CUSTOMER][NEUTRAL] or if you have to
[CUSTOMER][NEUTRAL] Um, I, I think I got the claim number that, that they did.
[CUSTOMER][NEUTRAL] Let me, no, not put the clear. OK, hang on, let me get their ID ID number of 01659284, and I'm sorry, what was your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Oh, OK, thank you.
[AGENT][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] And then, uh, can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] And can I get the patient's name.
[CUSTOMER][NEUTRAL] Um, [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then [PII], do you have a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Number is [PII].
[AGENT][POSITIVE] Thank you so much alright and then what's the data service?
[CUSTOMER][NEUTRAL] And then what's
[CUSTOMER][NEUTRAL] Data service is [PII] and then the total charges on that claim were $57,788.38.
[CUSTOMER][NEUTRAL] And then actually when you um pull it up if I could get the claim number because they did not document that on the posting of it.
[AGENT][POSITIVE] Yeah, absolutely.
[AGENT][NEUTRAL] It was 32 to 33, correct?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, let me actually pull up the claim image file to make sure that that's what they have it listed as the accounts created like that, but.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, it's 32-20233233 of 2023.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I do have the check EFT trace number they input that, but yeah, they, they didn't put the claim number on there. They didn't go. It just says C paper remit, but it looks like nobody actually scanned it in.
[AGENT][NEUTRAL] OK, does the check number end in 4999?
[CUSTOMER][NEUTRAL] Um, yes, 39, so it's 4999 correct.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Alright, so the claim number on that was gonna be 327.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] That which gonna be 32.
[AGENT][NEUTRAL] 563 0.
[CUSTOMER][NEUTRAL] 8630.
[AGENT][NEUTRAL] And then what other information did you need from the claim on the term?
[CUSTOMER][NEUTRAL] OK, so I'm pretty sure I know how it was processed because it did pay to the penny of what primary left as a deductible, but I just need to confirm that. So it paid for $3,968.80 and um it was processed as secondary correct by American public.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, we are the member secondary, correct.
[CUSTOMER][NEUTRAL] Yes, OK, OK. Does it the details on there that it was just the the um primary deductible that was paid, is there anything like that on the EOB?
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I mean it is really to the penny what primary applied as a deductible so I'm.
[CUSTOMER][NEUTRAL] Like 99.9% sure it's, you know why it paid um the amount that it paid.
[AGENT][NEUTRAL] Yeah, no, yeah, it, yeah, it's meant to cover like the deductible co-pay or co-insurance that the primary doesn't, so.
[CUSTOMER][NEUTRAL] Yeah, I tend to cover like the deductible copay or coin insurance.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] OK, um, and then.
[CUSTOMER][NEUTRAL] It's I know um.
[CUSTOMER][NEUTRAL] When we still a change I would just get the EOBs from there. Are you able to resend the EOB, the actual paper copy of it so I can see it line by line?
[AGENT][POSITIVE] Yeah, absolutely. I can fax it or do you want it, is that OK?
[CUSTOMER][POSITIVE] Yeah, um, faxing is quicker and you can remail it too, but faxing is quicker.
[AGENT][POSITIVE] No, no, no, prefer to fax. Yeah, absolutely. It's a good fax number.
[CUSTOMER][NEUTRAL] Yeah, yeah, so it will be [PII], and are you sorry, are you able to put an attention on it?
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] OK, so I need to have it um the attention read as F as in Foxtrot, A as in Alpha, C as in Charlie, S as in Sierra 973791-79 and then I'll go uh the account's mine, but that'll go directly they'll scan it right in.
[AGENT][NEUTRAL] OK. OK, gotcha. All right, so I can absolutely do that and just to confirm, I had F as in Frank, A as in apple, C as in cat, S as in Sam, 973-791-779.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Right, so I can absolutely do that. And just to confirm, I have F as in Frank, A as in apple, C as in cat.
[CUSTOMER][NEUTRAL] S as in Sam, 973-791-779. Yes, correct.
[AGENT][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then uh do you directly fax or do you have to forward it to another department like how long usually?
[AGENT][NEUTRAL] Um, no, no, we do it through an EFA, so it usually takes about.
[CUSTOMER][NEUTRAL] Oh, so it's pretty quick, OK.
[AGENT][NEUTRAL] Yeah, takes just about 5 minutes maybe to come through.
[CUSTOMER][NEUTRAL] Takes just about 5 minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, trying to think, was there, I don't think there's any other questions because I, I, uh, I figured that it paid because of what the primary left, um, when was the claim received because it looked like, I don't know why they rebuild this claim a couple of times, so we also got duplicate denials from you guys, um, understandably, yeah, yeah, I, I, I are reviewing the account. I got it handed back to me after something.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I'm like, oh I gotta hand it to me because it's just a mess, um, so for the actual payment EOB, not the duplicate EOBs, but the actual payment one, what prompted that? What, um, when was the claim received for this EOB?
[AGENT][POSITIVE] That's funny.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So claim was originally received on [PII].
[CUSTOMER][NEUTRAL] So play was originally received on [PII].
[AGENT][NEUTRAL] And then processed on [PII] if you need that.
[CUSTOMER][NEUTRAL] OK, and then processed on [PII] if you need that.
[CUSTOMER][NEUTRAL] Yeah, I'll, I'll take it down, um.
[CUSTOMER][NEUTRAL] OK, uh, I don't remember. Do you do call reference numbers because it's not that often I have to call.
[AGENT][NEUTRAL] Yeah, so call references our name with our last initial and then today's date. So my last initial is [PII].
[CUSTOMER][NEUTRAL] Yes, the phone references our name with our last initial and then today's name, so my last.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty, OK, I am all set thank you [PII].
[AGENT][POSITIVE] You're welcome, [PII]. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Uh-huh, bye bye.