AccountId: 011433970860
ContactId: b7dcda87-4b35-4652-a834-8cfbcc81291f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1323819 ms
Total Talk Time (AGENT): 206020 ms
Total Talk Time (CUSTOMER): 410468 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/b7dcda87-4b35-4652-a834-8cfbcc81291f_20250506T14:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, my name is [PII] calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][NEUTRAL] And the policy number for the patient?
[CUSTOMER][NEUTRAL] It's 02249087 M as in Mike, L as in Lima, 7.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK. May I know your name?
[AGENT][NEUTRAL] Opening.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You have the patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have the policy or the date of service and bill charges?
[CUSTOMER][NEUTRAL] It's [PII] and the bill charges is 13,000.
[CUSTOMER][NEUTRAL] $432 even.
[AGENT][NEUTRAL] OK, looks like we received the claim on [PII].
[AGENT][NEUTRAL] Process 3105.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it looks like we received the primary EOB, but it does not list the amounts that have been applied to the deductible co-pay or co-insurance.
[AGENT][NEUTRAL] Do we need an explanation that shows that?
[CUSTOMER][NEUTRAL] Yes, sir. I've already, uh, we have already received the denial EOB regarding this, like, uh, there is no clear information regarding the patient responsibility and we have recently sent the one more primary EOB to the fax number. Just give me a moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] We have sent it on yesterday.
[CUSTOMER][NEUTRAL] To the fax number [PII]. Is it correct?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Um, the fax number is [PII].
[CUSTOMER][POSITIVE] Thank you so much for that information.
[CUSTOMER][NEUTRAL] We have the, the primary you will be setting the complete uh $3,219.60 is applied towards deductible. Uh, do we need to send that UOB to this fax number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Just give me a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Do, uh, do you need any other information apart from this?
[AGENT][NEUTRAL] Uh, no, just the EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment. Can you please help me with a few more claims?
[AGENT][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just be my woman. I'm opening.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Uh, can I like, uh, can I provide you the claim number directly because we have, uh, received the same information like it is also denied for uh primary OB.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Like requesting primary OP.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] It's 356-383-0.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and when did you send the primary AB?
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] You know when you sent the primary EOB.
[CUSTOMER][NEUTRAL] I'm checking it.
[CUSTOMER][NEUTRAL] On [PII], uh, to the fax number [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, um, I don't have it on file yet.
[AGENT][NEUTRAL] So I
[CUSTOMER][NEUTRAL] You're unable to find it?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Do we need to send again?
[AGENT][POSITIVE] Uh, yes, if you could, that'd be great.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, uh, along with primary we need an AUB 04 or just the primary OB is enough.
[AGENT][NEUTRAL] Just the primary EOB.
[CUSTOMER][POSITIVE] OK, thank you so much for that information.
[CUSTOMER][NEUTRAL] To the same fax number, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Just give me a moment, I'll pull up the next screen.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You have the next policy.
[CUSTOMER][NEUTRAL] OK. Can I provide you the
[AGENT][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Yes, yes. Uh, policy, uh, policy number or the claim number?
[AGENT][NEUTRAL] Uh, policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 01780690. M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] It's [PII] and the total charges is $16,719 even.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, and what was the claim number on that?
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] It's 351-390-2.
[CUSTOMER][NEUTRAL] think.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, it looks like we were requesting the primary EOB.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Looks like we received a duplicate claim.
[CUSTOMER][NEUTRAL] Really.
[AGENT][NEUTRAL] I don't think, I mean look see if anything was attached.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Sorry, I didn't get it.
[CUSTOMER][NEUTRAL] If the claim is denied for duplicate.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] May I know the original claim status?
[AGENT][NEUTRAL] The denial claim status?
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Like it is for duplicate or primary will be needed.
[AGENT][NEUTRAL] Yes, it's
[AGENT][NEUTRAL] Yeah, we need the primary EOB. A claim was submitted as a duplicate, but there was no primary EOB attached.
[AGENT][NEUTRAL] So we still need the primary AOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the received date?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Along with primary OB we need to send UB04?
[AGENT][NEUTRAL] We just need the primary EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] we need to submit the claim again.
[AGENT][NEUTRAL] No, we don't need the claim, we need the primary explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, we'll share it to the same fax number. Is that fine?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On [PII] we have submitted the primary UB also like uh is it received, it is under review or do we need to send again?
[AGENT][NEGATIVE] Need to send again we didn't receive that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The claim number is the same, right?
[AGENT][NEUTRAL] Uh, claim numbers, yes, 3351-3902.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much. Please be online. I'll pull up the next thing.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Just give me a moment. I'm pulling up the details.
[CUSTOMER][NEUTRAL] Policy number 02511179 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] your name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] a service and bill charges.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Let's get my one.
[CUSTOMER][NEUTRAL] It's December [PII], 2024 and the bill charges is $152,013 even.
[AGENT][NEUTRAL] And what was the bill charges?
[CUSTOMER][NEUTRAL] $152013 even.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah I got.
[AGENT][NEUTRAL] I don't have a claim on file for that build out.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Just give me a moment. I'll recheck it one second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Uh, we have submitted the claim with the same bill amount. It's $152013 even.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] So 152013.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I, I don't show a claim on file for that amount.
[CUSTOMER][NEUTRAL] Oh, can you please check with 1,52397?
[AGENT][NEUTRAL] I don't have a claim on file for that amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, we have a claim number. Can you please search with that?
[AGENT][NEUTRAL] that
[CUSTOMER][NEUTRAL] We have a claim number. It's 356-519-2.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, we have a claim for $152,0013. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] And we're needing the primary explanation of benefits not been received.
[CUSTOMER][NEUTRAL] OK. Can you please help me with the received date of this claim?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Also it's [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for that information.
[CUSTOMER][NEUTRAL] Please help me with the last name. Just give me a moment.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, it is also the same thing. We have faxed it the primary OV.
[CUSTOMER][NEUTRAL] Uh, let's you with the claim number. Can you please check whether it has been received or not?
[AGENT][NEUTRAL] OK, claim number.
[CUSTOMER][NEUTRAL] It's 3,504,880.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Hm, patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's 629-2024?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Sorry, 6:29. What is it?
[AGENT][NEUTRAL] Data service
[CUSTOMER][NEUTRAL] It's 6-19 2024.
[AGENT][NEUTRAL] OK, and that what were the total bill charges?
[CUSTOMER][NEUTRAL] It's $12,839 even.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, we processed that received on [PII]. Proceed 2-11-2025.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] These services are not covered under the policy.
[CUSTOMER][NEUTRAL] 27 and 217.
[CUSTOMER][NEUTRAL] Two levels, sorry.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. The services are not covered under the patient's plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But we have received that you will be requesting for primary will be.
[AGENT][NEUTRAL] Yes, and then we received the primary EOB and then we've processed it and the services are not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Like whatever the services that patient has taken, those services are not covered as per patient plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I know what type of services is that?
[AGENT][NEUTRAL] The services that were billed.
[AGENT][NEUTRAL] You, you have the claim information, so can you see what services there?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, just give me my system got sir. May I know the total charges is patient responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility because we're a secondary policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, secondary, but uh whatever the patient plan is not covered, may I know the balance will fall under the patient's plan or provide a contract?
[AGENT][NEUTRAL] We can't tell you if it's patient responsibility because we're a secondary policy. We can just process the claim according to the policy.
[CUSTOMER][NEUTRAL] Can you please fax us an EOB?
[AGENT][NEUTRAL] OK, what's the facts?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. Anything else I can help with today?
[CUSTOMER][NEUTRAL] They get about.
[CUSTOMER][NEUTRAL] No. Can you please help me with the claim number?
[AGENT][NEUTRAL] 3,562,350.
[CUSTOMER][NEUTRAL] 2350.
[CUSTOMER][NEUTRAL] Call reference number [PII].
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][POSITIVE] Thank you so much for helping me. Have a great day. Bye.
[AGENT][NEUTRAL] Right.