AccountId: 011433970860
ContactId: a49e0b15-ae8a-4288-b756-230b16f891a1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1102560 ms
Total Talk Time (AGENT): 381278 ms
Total Talk Time (CUSTOMER): 499611 ms
Interruptions: 10
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/a49e0b15-ae8a-4288-b756-230b16f891a1_20250303T20:00_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello. Hi, this is [PII] calling from Porter's office.
[AGENT][POSITIVE] OK, and [PII], how may I assist you today?
[CUSTOMER][NEUTRAL] Yes, I need a claim status for a patient.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And what is that policy number, please?
[CUSTOMER][NEUTRAL] 140.
[CUSTOMER][NEUTRAL] 720
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] M as in [PII], and 8.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Could you please wait for a minute, I'll provide it. It's [PII].
[AGENT][POSITIVE] OK, thank you so much. And [PII], verify the patient's name, date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII] and his last name is [PII].
[CUSTOMER][NEUTRAL] Patient's date of birth is like.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you say you're calling for claim status?
[CUSTOMER][NEUTRAL] Just.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] The date of service is uh [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $1,124 even.
[AGENT][NEUTRAL] OK, thank you. And you said the date of service was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is the balance after primary?
[CUSTOMER][NEUTRAL] As the balances, so.
[CUSTOMER][NEUTRAL] Could you please wait for a second?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I was.
[CUSTOMER][NEUTRAL] As the the balance is $44 441 cents.
[AGENT][NEUTRAL] OK, bear with me one moment.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah it it.
[CUSTOMER][NEUTRAL] Alright uh.
[AGENT][NEUTRAL] OK, and what's the name of the provider's office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it's Gastro Health LLC.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] because the yeah yeah.
[AGENT][NEUTRAL] Uh, do you have that procedure code?
[CUSTOMER][NEUTRAL] Uh, it's 43239.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] order.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] yeah.
[CUSTOMER][NEUTRAL] It's yeah, so the LLC.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] 92.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] And what's the name of the provider?
[AGENT][NEUTRAL] No, the actual provider on the claim or physician?
[CUSTOMER][NEUTRAL] Oh, OK. OK, OK. It's Cavell Lean.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh
[CUSTOMER][NEUTRAL] Like.
[AGENT][NEUTRAL] OK, I'm showing that claim, it looks like it processed, uh, give me a moment.
[AGENT][NEUTRAL] And while I'm looking at claim information, just to let you know, we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think that address.
[AGENT][NEUTRAL] And I show on this claim, we paid 19797. No, we didn't. I'm sorry, I'm looking at the wrong one. Give me one moment.
[CUSTOMER][NEUTRAL] you know it is a time you and I think with and you have to check.
[AGENT][NEUTRAL] 336-477-6. Um, this claim looks like we paid 130 99.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] As the game was initially paid and later it was recalled.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][POSITIVE] Yes, initially the claim was paid and the later the payment of 130.99 cents was recouped.
[CUSTOMER][NEUTRAL] Is that
[AGENT][NEUTRAL] That's how much we paid and that was for the EOB received.
[AGENT][NEUTRAL] Like that is the amount they applied towards the deductible and that's what we pick up, uh, picked up and paid.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] OK. Could you please send me, uh, let me record all the details.
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Could you please provide me the details? I'll record all the details.
[AGENT][NEUTRAL] OK, uh, what information are you needing?
[CUSTOMER][NEUTRAL] What was, what was, OK, what was the payment amount?
[AGENT][NEUTRAL] $130.99.
[CUSTOMER][NEUTRAL] $1030 is it right?
[AGENT][NEUTRAL] $100 130 dollars, 130.99.
[CUSTOMER][NEUTRAL] OK, may I know the patient responsibility? Is there any patient responsibility?
[AGENT][NEUTRAL] Uh, we don't show, we can't give patient responsibility. We can only verify how the claim was processed and where we paid $130.99. And with that payment, it matched their benefit for the calendar year.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] Oh, no, I'm sorry. So, it looks like that's the max we paid.
[CUSTOMER][NEUTRAL] Could you please provide me the check number? Did you, is it, as it provided by paid by check or throughFT?
[AGENT][NEUTRAL] Uh, check and the check number is 1813953.
[CUSTOMER][NEUTRAL] Mhm. What is the loan amount?
[AGENT][NEUTRAL] There's not a allowed amount. The total check amount was $130.99.
[CUSTOMER][NEUTRAL] OK. Could you please wait for a second?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Could you please wait for a minute on hold?
[CUSTOMER][NEUTRAL] Check
[AGENT][NEUTRAL] I'm sorry, say that one more time.
[CUSTOMER][NEUTRAL] Could you please provide me the check issue date?
[AGENT][NEUTRAL] Uh, issued on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. What is a clear date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] 3.
[CUSTOMER][NEUTRAL] Uh, may I know was the check paid or it was recouped?
[AGENT][NEUTRAL] So the check cleared on [PII].
[CUSTOMER][POSITIVE] As I had checked in my inquiry with our software we have came to know that this $130.99 of the payment was recouped.
[CUSTOMER][NEUTRAL] And later this claim was sent back for review and it was on.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Uh, looks like we've received his claim 2nd time or 2 times before. Uh, the 2nd time we received it processed as a duplicate. The 3rd time received it processed the outpatient benefits of max.
[CUSTOMER][NEUTRAL] With the new
[CUSTOMER][NEUTRAL] OK, could you please, uh, check this? We have, uh, sent us a new claim. It's like 3,495,580.
[AGENT][NEUTRAL] And what was that? Never mind, hold on one moment.
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] It looks like that claim processed an error. Um, it says return to a rep, uh, but it was not able to reach the person and to say the wrong number outpatient max met, so there's no benefits payable. So it looks like um.
[AGENT][NEGATIVE] Looks like the claim was processed in error because we've already paid on this claim.
[CUSTOMER][NEUTRAL] OK. Let me provide you a claim number. Could you please provide the check me the claim status for the claim ID is 3,495,580. What was the status of the claim?
[AGENT][NEUTRAL] Uh, as I stated, that claim processed incorrectly because on that claim it looks like they
[AGENT][NEUTRAL] Paid $44.41 in error.
[CUSTOMER][NEUTRAL] Was that paid for 44.41 cents?
[AGENT][NEGATIVE] Yes, and that was processed incorrectly.
[CUSTOMER][NEUTRAL] B
[AGENT][NEGATIVE] And so, looks like that check has been void.
[CUSTOMER][NEGATIVE] It was processed as incorrectly.
[CUSTOMER][NEUTRAL] OK, was that payment record or?
[AGENT][NEGATIVE] Repayment was recouped, so the check was void because that was processed in error.
[CUSTOMER][NEUTRAL] OK, did this, uh, did you receive any fresh claim for for this payment again?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So family.
[CUSTOMER][NEUTRAL] Hello? Yeah, hi. This is [PII]. Yeah, hi.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, may I know your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK, so you have given me the uh claim status, uh.
[CUSTOMER][NEUTRAL] For the paid amount of $130.99 but uh we have uh reached an EOB stating that it has been recouped.
[CUSTOMER][NEUTRAL] The amount has been red.
[AGENT][NEGATIVE] OK, well, it looks like a representative tried to call um one of your representatives to verify the claim that was processed and it was processed in error. That's the claim number you gave us 3,495,580, that processed an error.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, a representative did try to call and like I said, we received this claim 2 other times before. The second time process has to do the 3rd time process as outpatient benefits of max.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm so we got the payment for the claim number.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] So there is no equipment has been made from APL, right?
[AGENT][NEGATIVE] No, I'm not understanding what you're asking. The check was issued and it looks like it processed an error, the check was void, so there was no other payments made.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm. OK. So, the check has been cleared on [PII]?
[AGENT][NEUTRAL] For, yes, where we paid 13099.
[CUSTOMER][NEUTRAL] OK. So it has been paid and cleared, right?
[AGENT][NEUTRAL] Correct, for the one check for 1:30 99. Yes, it cleared on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK. And uh
[CUSTOMER][NEUTRAL] Can you uh provide me the claim number for this one?
[AGENT][NEUTRAL] It is
[CUSTOMER][NEUTRAL] It's 336-477-6, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And it has been processed as primary, right?
[AGENT][NEUTRAL] No, this is a secondary policy only, so we, after primary, it was a balance of 13099 and that's how much we paid.
[CUSTOMER][NEUTRAL] APA
[CUSTOMER][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Mhm. Yeah. OK. And can you your call reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, OK, thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Yeah, yeah, one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So for the primary uh.
[CUSTOMER][NEUTRAL] We got $175.40 not $150.99. From primary $130.99 it has been paid. I mean it has been applied towards the deductible and then it has been recouped and then it has been payment made on [PII] for the for the deductible amount of $175.40.
[CUSTOMER][NEUTRAL] Not for the $130.99. Yes, primary uh
[AGENT][NEUTRAL] OK. So you're saying that the primary.
[AGENT][NEUTRAL] So you're saying the primary reprocess the claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, well, the claim was received again [PII] and processed on [PII] as the outpatient benefits have maxed.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bes has been matched, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So the last date of, I mean from the visits, right? Visits are in dollars it has been existed in.
[AGENT][NEUTRAL] It's a dollar value.
[CUSTOMER][POSITIVE] Dollar value.
[CUSTOMER][NEUTRAL] OK. So may I know the uh annual dollar amount for the patient?
[AGENT][NEUTRAL] I want to see.
[AGENT][NEUTRAL] Uh, it looks like the insured had an outpatient benefit max of up to 1500 per calendar year.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] May I know the last date of service it has been.
[AGENT][NEUTRAL] No, I can't give you any information in regards to uh claims from a different provider, so, no, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, OK, so it has been done with a different provider, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. And can you give me the uh claim number for the maximum benefits has been exhausted?
[AGENT][NEUTRAL] 353-3584.
[CUSTOMER][NEUTRAL] 353-3584, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm. Yeah, OK. And can you please fax the EOP? I will provide my fax number.
[AGENT][NEUTRAL] We do, we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, OK. Yeah, OK, thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Mhm. Yeah, that's it. Thank you. Thank you so much. Have a good day. Bye-bye.
[AGENT][POSITIVE] OK. Mhm. You're welcome. Thank you. You too. Thanks for calling APL.