AccountId: 011433970860
ContactId: a4104af6-71ec-4026-a6da-c50cdef3bc2f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1130020 ms
Total Talk Time (AGENT): 359662 ms
Total Talk Time (CUSTOMER): 236116 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/a4104af6-71ec-4026-a6da-c50cdef3bc2f_20250326T15:37_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling from provider's office to check up on a claim status. Also, this call has been recorded for quality and training purpose. Are you OK with that?
[AGENT][POSITIVE] Yeah, sure, I can assist you with claim status, and can you spell your name for me?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's [PII] spelled as [PII]. Initial to my last name would be [PII]. Also, can you spell out your name for me?
[AGENT][NEUTRAL] Sure. That's [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. And Miss, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it would be [PII].
[AGENT][NEUTRAL] OK. And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yeah, it's Pembroke Pink Imaging LLC.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 02035266.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Name of the member is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you. Alright, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It's [PII] total charge $500 even.
[CUSTOMER][NEUTRAL] And I do have concern with the claim.
[AGENT][NEUTRAL] OK, bear with me, let me find the claim first, OK?
[CUSTOMER][NEUTRAL] Uh, that's
[AGENT][NEUTRAL] And for future you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] One moment, I'm waiting on the EOB and the details.
[AGENT][NEUTRAL] OK, so it looks like we received the claim [PII], processed [PII], and we're waiting on the primary explanation of benefits to continue the processing of this claim. It looks like United Healthcare is the primary.
[CUSTOMER][NEUTRAL] We have already submitted that on [PII].
[AGENT][NEGATIVE] We have not received that.
[AGENT][NEUTRAL] Where did you send it to?
[CUSTOMER][NEUTRAL] It was through fax.
[AGENT][NEUTRAL] What's the fax number that you send it to?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEGATIVE] That is the correct fax, but we have not received that.
[AGENT][NEUTRAL] As of today.
[CUSTOMER][POSITIVE] OK, sure, no problem.
[CUSTOMER][NEUTRAL] I can resubmit that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Uh, yeah, can you help me with the call reference number for this one?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We don't have references.
[CUSTOMER][POSITIVE] And I do have some more clients with me. Can you help me with?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Do you have a
[CUSTOMER][NEUTRAL] Can you help me with those claims as well?
[AGENT][NEUTRAL] Yes, and it's different members.
[CUSTOMER][NEUTRAL] Actually it's for the same number.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] It's [PII] and I do have 22 claims for the same date of service.
[AGENT][NEUTRAL] OK, what's the amount?
[CUSTOMER][NEUTRAL] The first charge amount.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Would be $450 even 450.
[AGENT][NEUTRAL] And what's the next one just in case I find the next, the other one before.
[CUSTOMER][NEUTRAL] It's $670 even.
[AGENT][NEUTRAL] OK, so they're both for [PII], correct?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Also we have submitted primary ZOB for uh these claims as well.
[AGENT][NEUTRAL] Mm, OK. And it doesn't look like we have, we're getting them.
[CUSTOMER][NEUTRAL] just in the
[AGENT][NEUTRAL] Um, I do see the one for 670 and the one for 450. They're both pending for primary ALB.
[CUSTOMER][NEUTRAL] Yeah, we have submitted that on [PII].
[AGENT][NEGATIVE] We have not received those.
[CUSTOMER][NEUTRAL] So the same fax number.
[AGENT][NEGATIVE] We have not received those.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again the fax number is [PII]. Just make sure to put that one in front if you don't have that access already put in the system it's [PII].
[CUSTOMER][POSITIVE] OK, sure, no problem.
[CUSTOMER][POSITIVE] Sure, no problem. Thank you so much. Also, I do have one more claim with me. Can you help me with that claim as well?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Is it the same same member or different member?
[CUSTOMER][NEUTRAL] It's for the different member actually.
[AGENT][NEUTRAL] OK, so I need to make a note on this one. I need to notate all the claims that I gave you information on. So bear with me just a second, and you don't have no other questions on this 11 moment.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and you call for balance.
[AGENT][NEUTRAL] And that was the data service.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] 15
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 670.
[AGENT][NEUTRAL] 9.
[AGENT][NEUTRAL] 352-4559.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] 30803.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It would be 018.
[CUSTOMER][NEUTRAL] 261
[CUSTOMER][NEUTRAL] 70
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima. 8.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, part two, and what is the day of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It's [PII] total charge $3500 even.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] And it and here is also the same scenario like previous one.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, bear with me because this one has been submitted 3 times. So let me check.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEGATIVE] OK, so it looks like we're still waiting for that ELB again on this one we're sending 3 times. The 3 times it didn't have the primary EOB attached to it.
[CUSTOMER][NEUTRAL] Again through fax.
[AGENT][NEUTRAL] We have not received that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The fax number is uh the same.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, and the claim number is 3553405?
[AGENT][NEUTRAL] That is um the, the one prior we received this again on [PII], processed [PII], denied for the same reason on [PII] on claim number 3564[PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, because we haven't submitted a claim again.
[CUSTOMER][NEUTRAL] On [PII] we just submitted primary explanation of benefit to you.
[CUSTOMER][NEUTRAL] On the same date, [PII].
[AGENT][NEUTRAL] Let me look at those documents, but based on this, we still needing, need the EOB so it's probably the wrong EOB or something like that. Let me go ahead and see what I have there.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, here's the claim.
[AGENT][NEUTRAL] One moment, I'm waiting on the document.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Can I put you on a brief hold?
[CUSTOMER][POSITIVE] Sure, no problem. Take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for me, Ms. [PII]. OK, I'm looking at the document that was sent in, but that document only says patients responsibility. It doesn't say where to apply that if it's gonna be the, the, the deductibles, co-payment or co-insurance. We need a detailed explanation of benefits indicating if it's applied towards the deductible, co-payment or co-insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I mean, yeah.
[CUSTOMER][NEUTRAL] Uh, just give me a moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We have submitted this correctly because they're showing PR 3.
[CUSTOMER][NEUTRAL] Also, uh,
[CUSTOMER][NEUTRAL] If you, if you can see on the next page, there is also an explanation of 3 which is co-payment amount.
[AGENT][NEUTRAL] Well
[AGENT][NEGATIVE] Where is it at? Because I didn't find it. I was looking for it. I think it's cut off.
[AGENT][NEUTRAL] I don't see that information.
[AGENT][NEGATIVE] I think that information is cut off out of the facts because I don't see that anywhere and I looked into it and I didn't see it either.
[AGENT][NEUTRAL] Yeah, that information is cut off. I see where it says something like there's a line and it says uh co-payment amount, but there's no remarks code in that after the
[AGENT][NEUTRAL] The information. So the remarks codes are um or the recent codes claim adjustment reason the C of claim is cut off, so anything is that is under the C is cut off. So we just need that to be sent out to us again.
[CUSTOMER][NEUTRAL] Claim adjustment reasons you mean you can see their claim adjustment reasons, right?
[AGENT][NEUTRAL] Showing that information.
[AGENT][NEGATIVE] I see lame adjustment reason. I don't see the C. So anything under the sea after, you know, after claim is, is cut off. So none of that information is there.
[CUSTOMER][POSITIVE] OK, sure, no problem, I can resubmit that thank you.
[AGENT][POSITIVE] OK. You're welcome.
[CUSTOMER][POSITIVE] Uh yeah, thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today? Any other claims or any other questions or concerns?
[CUSTOMER][POSITIVE] No, thank you so much. That's it that's it for the day. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] Thank you. You too. Bye-bye.