AccountId: 011433970860
ContactId: ba9397f5-0298-4240-8d5b-e0b8e04210bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 607630 ms
Total Talk Time (AGENT): 234235 ms
Total Talk Time (CUSTOMER): 257670 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/ba9397f5-0298-4240-8d5b-e0b8e04210bc_20250303T15:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, so my name is [PII]. I'm calling from a provider's office. I wanted to check claim status on a patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, Miss?
[CUSTOMER][NEUTRAL] 02464971 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Perfect. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The first date of service is [PII]. The amount of the claim is $2,608.
[AGENT][NEUTRAL] OK, let me see if I can find this claim, and that was [PII].
[CUSTOMER][NEUTRAL] Yeah, once you're paying after it, which seems weird.
[CUSTOMER][NEUTRAL] So I just need to know whether or not I need to refile these.
[AGENT][NEUTRAL] OK, um, let me look at this claim.
[AGENT][NEUTRAL] Waiting on the system, bear with me.
[CUSTOMER][NEUTRAL] Sure
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, no, I don't have that claim on file for $2608.
[CUSTOMER][NEUTRAL] OK, yeah, the portal is telling me it's not there, but you know what it's telling me dates that you did pay are not there either, so I don't know what's going on with that but um the next claim is [PII].
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] For $122.
[AGENT][NEUTRAL] OK, let me look at this.
[AGENT][NEUTRAL] OK, so this one is here, um, the one for 122 is under claim number 3549207.
[CUSTOMER][NEUTRAL] OK, that's the claim number, OK, and did it process?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, it processed on [PII].
[AGENT][NEUTRAL] No, we send a benefit amount of $10.04. We only pay for the procedure, we do not cover the office visit for this number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And is there a check number?
[AGENT][NEUTRAL] Yes. The check number is 2021845.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then the next date of service is 12-12 24 in the amount of $22.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Look for the check so I go under here which is insurance payments.
[CUSTOMER][NEUTRAL] I do search.
[CUSTOMER][NEUTRAL] I'm gonna search for the check number because usually I'll enter it when I post it.
[CUSTOMER][NEUTRAL] Maybe sometimes I miss a line and it's left out.
[CUSTOMER][NEGATIVE] So I didn't receive it.
[AGENT][NEUTRAL] Right. OK. I did find the one for $22 as well. So let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim number is 3549209.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the check number is 2021854.
[CUSTOMER][NEUTRAL] Are you able to see if these checks are cleared?
[CUSTOMER][NEUTRAL] If they've been cashed.
[AGENT][NEUTRAL] Um, I can check and see if how are they showing on my end, um, bear with me.
[CUSTOMER][NEUTRAL] That last one, does it have a payment date?
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] So they paid the same day on different checks.
[AGENT][NEUTRAL] Mhm. And what is um the correct address?
[CUSTOMER][NEUTRAL] It should be [PII].
[AGENT][NEUTRAL] OK, so that is the correct address.
[CUSTOMER][NEUTRAL] I believe that because I get her other checks I just got one the other day like I say it's just weird that.
[CUSTOMER][NEUTRAL] You know, usually claims pay in order of date of service in the primary payment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, well, we pay in order we get the claims, so, um, but yeah, it looks like that is the correct address now, um, the one for um the $22 for [PII] is still outstanding, has not been cashed. Um, let me check the other one.
[AGENT][NEUTRAL] 122.
[AGENT][NEUTRAL] All
[AGENT][POSITIVE] OK, and this one also is still outstanding and it was sent to the correct address as well.
[CUSTOMER][NEUTRAL] OK, and what is how long do we have to wait before we can put a trace or request reissue of the check?
[AGENT][NEUTRAL] It's usually 30 days, 30 business days.
[CUSTOMER][NEUTRAL] 30 business days from the check date.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then the next one.
[CUSTOMER][NEUTRAL] Because I have another one.
[CUSTOMER][NEUTRAL] Uh, we did what we do 12 5.
[CUSTOMER][NEUTRAL] We did 123, 125. I have a 1212.
[CUSTOMER][NEUTRAL] For $22? No, I'm sorry, we did that one. The next one is $1231 for $2,608.
[AGENT][NEUTRAL] We already did that one. Uh-huh.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII] $2,608 even.
[AGENT][NEUTRAL] OK, I don't see that one.
[CUSTOMER][NEUTRAL] No claim.
[AGENT][NEUTRAL] Mm mm. No.
[CUSTOMER][NEGATIVE] OK, so 2 I have to refile and then 2 I have to um wait and then check back after 30 days to request reissue of the check if it's still outstanding.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes. Now, on the first one that you provided to me, the [PII], is that amount correct, um, the 2608 or do you think that they charged less than that?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, that's the amount that went out to the primary, so do you guys look at the full amount billed to the primary or minus the primary payment? Do you, do you see a claim for that date for a different amount?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I do, um, do you have like a procedure code so I can check and see if this is yours.
[CUSTOMER][NEUTRAL] Yeah, the procedure code is 96372.
[CUSTOMER][NEUTRAL] 963-7276 XU.
[CUSTOMER][NEUTRAL] And J 2357.
[AGENT][NEUTRAL] OK, so it looks like we only got the J2357 charge. Um, let me look at the paperwork.
[CUSTOMER][NEUTRAL] Oh never mind, you know what? You're right because the primary paid the administration so I apologize that so that would be the claim for just the $2520.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so yes, we did receive that one. it was processed on the same date, [PII], and we send um $80 and the claim number is 354.
[CUSTOMER][NEUTRAL] I'm sorry, you sent 80?
[AGENT][NEUTRAL] 80. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 354-9196.
[CUSTOMER][NEUTRAL] 354-919-6
[AGENT][NEUTRAL] Mhm. And the check number is 2021844.
[CUSTOMER][NEUTRAL] OK, I wonder if these were all in the same envelope and then the 1231, let me check the amount on that because it's probably the same situation, yeah, the primary is paid.
[AGENT][NEGATIVE] Oh, we have no.
[CUSTOMER][NEUTRAL] On the administrations.
[AGENT][NEUTRAL] Yeah, we have not
[CUSTOMER][NEUTRAL] So that would be a 25/20 as well, but there's no claim at all on that one.
[AGENT][NEUTRAL] There's no claim on there no yeah.
[CUSTOMER][NEUTRAL] OK, so that one I'll reprint the primary EOB and resend the other ones.
[AGENT][POSITIVE] Yeah, thank you. Mhm.
[CUSTOMER][NEUTRAL] I'm gonna have to check into and see what's going on.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, if you don't find the checks and you need to call back to uh cancel them, you can, um, yeah, right now they're outstanding.
[CUSTOMER][NEUTRAL] Yeah, OK, yeah, we might have to reissue those, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] After 30 business days, OK, thank you. Is there a reference number for our call soul?
[AGENT][NEUTRAL] Mm. You're welcome, Ms.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, is it [PII]?
[AGENT][NEUTRAL] That's correct. [PII] last initial [PII]
[CUSTOMER][POSITIVE] Um great. OK, thank you so much.
[AGENT][POSITIVE] Mhm. You're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.