AccountId: 011433970860
ContactId: bd24759a-bc08-4927-97f0-efdbe80b3811
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 608030 ms
Total Talk Time (AGENT): 231653 ms
Total Talk Time (CUSTOMER): 159962 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/bd24759a-bc08-4927-97f0-efdbe80b3811_20250213T20:24_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, uh, yes, I'm calling in regards to claim status.
[AGENT][NEUTRAL] OK. I can verify claim status for you. And your name is?
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] OK, um, it is.
[CUSTOMER][NEUTRAL] 1015605.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] See, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's a long extension. Let's see.
[AGENT][NEUTRAL] And Ms. [PII], verify that patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII] and then [PII].
[AGENT][NEUTRAL] OK. And can I give you the current policy number, that number you gave me terminated in [PII].
[CUSTOMER][POSITIVE] OK, yes, that'd be great.
[AGENT][NEUTRAL] OK, it's 18543557.
[AGENT][NEUTRAL] And this is for [PII], um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1021, 20. OK. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] The data service was 11-27-2023.
[AGENT][NEUTRAL] And the amount of the charge?
[CUSTOMER][NEUTRAL] And then the amount was $1,565.
[AGENT][NEUTRAL] OK. And do you have the balance after primary has processed the claim?
[CUSTOMER][NEUTRAL] Uh, yes, it was.
[AGENT][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] Um, hold on.
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEGATIVE] Uh, ENT and allergy Associates of Florida. There should have been $96.27 left.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Was there multiple um line items?
[CUSTOMER][NEUTRAL] Yes, those two line items. One got paid and the other one didn't, so, um, we had filed a corrective claim. I just wanted to see if you guys ever received that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Allergy associates or let's see.
[AGENT][NEUTRAL] Was it for procedure code 15, I'm sorry, 41,520 and then 694. OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Of course, my computer don't wanna work.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Oh, OK. I think I found it. And it looks like we paid 3804 for two cos and this other one.
[AGENT][NEUTRAL] This process is not covered. Let's see.
[AGENT][NEUTRAL] Benefits are payable only at the major medical. Did y'all submit the EOB, uh, because it looks like it processes benefits payable only as primary pays, meaning if they applied any amounts towards deductible, co-pay, or co-insurance and for the info we received, they did not.
[CUSTOMER][NEUTRAL] Um, the info you received originally or the info you received with the correct claim because we sent one with the, the new primary EOB back in [PII].
[AGENT][NEUTRAL] OK, let me double check. Give me one moment. 127 23.
[AGENT][NEUTRAL] 35.
[AGENT][NEUTRAL] Uh, it looks like we were seated, but it processed as a duplicate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] have
[CUSTOMER][NEUTRAL] Alrighty then, can you just tell me um when you guys received it and when you guys processed it?
[AGENT][NEUTRAL] Uh, yes, ma'am. Give me a moment.
[AGENT][NEUTRAL] OK, it looks like it was received on
[AGENT][NEUTRAL] Well, this one shows [PII] of [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Uh, I'm not so sure that might be the right one because.
[AGENT][NEUTRAL] 35.
[CUSTOMER][NEUTRAL] We had sent uh uh one in December of last year.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, there was one that came, uh, uh, came in [PII] and it processed on [PII] and it was uh processed as a duplicate as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it came in [PII] and it was processed.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That's a duplicate.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and can I get um the EOB of that response?
[CUSTOMER][NEGATIVE] To the corrective claim because I don't have anything on our end that indicates that you guys even got it or processed it as a duplicate.
[AGENT][NEUTRAL] OK. What is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I will fax this over to you in a few moments.
[CUSTOMER][NEUTRAL] OK thank you and then I'll just get um a call reference number.
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK, [PII], um, and then if I were to try and send a corrective claim still I just wanna verify the address.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK uh.
[CUSTOMER][NEUTRAL] Is that [PII], [PII], and then what was the uh zip?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, I see what you're saying. Give me a second.
[AGENT][NEUTRAL] Did they look at it? Give me one moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2460.
[AGENT][NEUTRAL] Nope, it's not.
[AGENT][NEUTRAL] But if its are payable a major medical insurance provider.
[AGENT][NEUTRAL] Oh, I'll send this claim back because I do show.
[AGENT][NEUTRAL] Uh, for that code amount was applied towards the co-insurance. So I'll send this back to the claims department asking them to relook at this claim, but I'll send you that EOB of the duplicate, or do you want to wait until after it's been reprocessed?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, still send me the EOB of the duplicate. Is there some sort of like, uh, processing ticket number or something so I can just have reference if I wanna call back and check on that status?
[AGENT][NEUTRAL] Uh, no, ma'am, but if you like, you can just use my name that you talked to me and I will send in the claim back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, for review, OK.
[AGENT][NEUTRAL] Huh, well, they missed that one. All right. Well, is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][POSITIVE] No, thank you so much um.
[CUSTOMER][NEUTRAL] And you'll be sending it back for reprocessing, correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK thank you alright have a good day OK?
[AGENT][POSITIVE] Alright, you too. Thanks for calling APL. Bye.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Alright bye bye.