AccountId: 011433970860
ContactId: b787df22-41d2-4457-9264-5a4ffe3495c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398730 ms
Total Talk Time (AGENT): 90655 ms
Total Talk Time (CUSTOMER): 255066 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/b787df22-41d2-4457-9264-5a4ffe3495c4_20250619T17:59_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. It's [PII]. How are you?
[AGENT][POSITIVE] I'm good and you?
[CUSTOMER][NEUTRAL] I'm fine, thank you so I have a provider's office on the line um that needs to go over what was submitted on a claim before they submit.
[CUSTOMER][NEUTRAL] Something that may be missing because she had broken the claim up to start with in two parts.
[CUSTOMER][NEUTRAL] It's on policy number 251.
[CUSTOMER][NEUTRAL] 9228.
[CUSTOMER][NEUTRAL] By [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Part one.
[CUSTOMER][NEUTRAL] And uh-huh, I think that's all there is. I don't think anybody else is covered and the data service in question is 42 of 2025.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I, the lady's name on the line is [PII]
[CUSTOMER][NEUTRAL] And her callback number, well, it's gonna be in my note, but it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So she had she gave me claim number 3593384.
[CUSTOMER][NEUTRAL] Because again, the total bill amount she initially gave [PII] was $800.
[CUSTOMER][NEUTRAL] So that claim number that she gave to me we paid on that that was for like the claim itself was 69. The other claim number that's on file for this is 3,609,710.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that shows for 7:31, so that's a total of 800.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I went over the remarks that she thinks that there's one of the codes missing and she's gonna resubmit it again but I we denied part of this is a duplicate.
[AGENT][NEUTRAL] 442?
[CUSTOMER][NEUTRAL] Which was
[CUSTOMER][NEUTRAL] For that, uh-huh.
[CUSTOMER][NEUTRAL] If you'll notice on Amtrak, the same claim numbers on 2 lines.
[AGENT][NEUTRAL] Uh 73,130.
[CUSTOMER][NEUTRAL] That's the $69 so before she submits, she just wanted to verify what's missing on her line items that she's looking at versus.
[AGENT][NEUTRAL] OK, it, it shouldn't have been, it shouldn't have been denied it's a left and right.
[CUSTOMER][NEUTRAL] Cause she thinks there's some MRI's missing.
[AGENT][NEUTRAL] You just send to run over though.
[CUSTOMER][NEUTRAL] That's what she's saying, OK, and I didn't, I mean, obviously we don't get that deep into that, so, OK, all right, well are you ready for her?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Um.
[CUSTOMER][POSITIVE] Thank you so much. Have a good afternoon, [PII].
[AGENT][POSITIVE] Alrighty you too.
[CUSTOMER][NEUTRAL] All right, thanks. Bye-bye.
[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII], and how can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. My name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The reason for my call is regarding a claim, please.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, you said you were calling to see what was missing on a claim or something to that nature, is that correct?
[CUSTOMER][NEGATIVE] Yes, yes, I already spoke to another representative. I was telling her that um I sent a correct the claim because we were um we were missing one of the codes.
[CUSTOMER][NEUTRAL] Um, but she said that what they receive is the same claim without the, the code that I'm looking for because it's only two codes that um primary made patient responsible for copay.
[CUSTOMER][NEUTRAL] So she gave me um the claim number 3,609,710.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know if you can help me out.
[AGENT][NEUTRAL] And which code are we missing?
[CUSTOMER][NEUTRAL] Um, I'm looking for code 73,130 RT.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With the modifier RT.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, looks like we denied that one as a duplicate, so we just need to, uh, and it's not a duplicate. I don't see where we.
[AGENT][NEUTRAL] Allowed benefits in the past so we can just rec process that claim for you.
[CUSTOMER][NEUTRAL] OK, but did you find the, the, that code with the RT, right?
[AGENT][POSITIVE] Yes ma'am, yes ma'am.
[CUSTOMER][NEUTRAL] OK, perfect, because maybe somebody missed that code or something. So you can process that claim again?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, we will.
[CUSTOMER][POSITIVE] OK, sounds perfect. um, so I don't have to send anything else uh do you have a call reference for me please?
[AGENT][NEUTRAL] We don't do car reference numbers. You can um use my name and date of birth. Look at me date of birth. I'm sorry. You can use my name in today's date.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It's OK. It's OK, [PII]. So that'll be [PII] [PII].
[AGENT][NEUTRAL] Mhm. And that's [PII]
[CUSTOMER][POSITIVE] I, oh, OK. Perfect. All right, [PII]. Um, do you know like around um when we'll be ready? I don't know.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Uh, I'm gonna go ahead and send it back today for reprocessing, so you wanna check back on Monday?
[AGENT][NEUTRAL] Give it a couple of days to get reprocessed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] OK, sounds perfect. But the other ones were denied, right? Yes, I mean, there's no, no payment at all for that one, for those.
[AGENT][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] Anyway,
[AGENT][NEUTRAL] Let me look at the EOB just to be sure.
[AGENT][NEUTRAL] Uh, that's correct. Looks like all of those were paid in full by the major medical.
[CUSTOMER][NEUTRAL] Uh-huh. Yeah. No, we are look, I'm looking for those, um, the RT, um, oh, I'm sorry. I thought it was an MRI. It's an X-ray.
[CUSTOMER][NEUTRAL] It's um 73,130 modify RT, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][POSITIVE] OK. Sounds perfect. All right, my dear, I appreciate you helping. Have a good day, OK?
[AGENT][POSITIVE] You as well and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] All right, bye-bye.
[CUSTOMER][NEUTRAL] Bye.