AccountId: 011433970860
ContactId: bfd70ab3-5a91-4cfc-bc8b-74afc56ed17b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 685869 ms
Total Talk Time (AGENT): 174293 ms
Total Talk Time (CUSTOMER): 159642 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/bfd70ab3-5a91-4cfc-bc8b-74afc56ed17b_20250418T16:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII]. I'm calling on behalf of a doctor's office, and this is regarding a claim.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with claim status. May I please get your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Alright, the name is [PII], um date of birth is [PII]. Policy number is 025.
[CUSTOMER][NEUTRAL] 984-09 M L like Larry and number 8.
[AGENT][NEUTRAL] OK, let me pull up that policy real quick for us.
[AGENT][NEUTRAL] All right, and then may I please get the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] Charge amount was $1,477.41.
[AGENT][NEUTRAL] OK, and then what were the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] After the primary is the charge of $45.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And then may I please get the name of the facility you're calling for Ms. [PII]?
[CUSTOMER][NEUTRAL] Cancer Healthcare Associates.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look this claim up and I will be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, Ms. [PII]. This is [PII] back with you again. I've got a claim for that data service for your facility, but it's not matching the amount that you gave me.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's why I'm calling.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Is not matching? So we received a check. We see. Mhm.
[AGENT][NEUTRAL] No, um,
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, go ahead.
[CUSTOMER][NEUTRAL] We received a check dated [PII]. Um, I have the claim number and I, from my understanding, you guys cover, you know, the, I guess the copays, and his co-pay was only $45. So the check came up to $450 and that was my reason of my phone call, you know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think it was an error on this part, but I just calling to confirm this.
[AGENT][NEUTRAL] OK, so on um this claim procedure code G 6015, the charge amount was $450.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Therefore, the payment was also $450.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On procedure 77014.
[AGENT][NEUTRAL] The charge amount was $373.26.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that charge was not paid because the major medical coverage provided full benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But how come?
[CUSTOMER][NEUTRAL] So why did they pay like that? Because usually I have another claim, the same thing, and you guys pay correctly on that claim.
[AGENT][NEUTRAL] OK. So what I can do um to help you further is I can, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Have a claims examiner call you back, a specialist and they can go over with how they paid with you if you would like.
[AGENT][NEUTRAL] For me to do that for you.
[CUSTOMER][NEUTRAL] OK, yeah, cause
[CUSTOMER][NEGATIVE] Yeah, cause I don't understand. You guys pay other claims, you know, with the same CPT code, and he only was responsible for $45 per day of service, which you guys are picking up that $45. But this one's totally different, it's $450 so I don't know if it was incorrect on your side or or or or is correct, so I, I don't know, that's why I'm calling you guys. Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] OK all right well I'll make sure a claim specialist calls you. I'm going to put you on a quick hold while I get that um request sent in for you to get a call back so it's gonna be a brief hold while I get that together for you, OK? Thank you so much, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. All right, thank you. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 34.
[AGENT][NEUTRAL] 35
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Miss [PII], thank you so much for holding for me. I've got that request in with the information about the claim and then um.
[AGENT][NEUTRAL] The callback number is the number that you gave me at the beginning of the call if we were disconnected and you should be getting a call back within 24 hours um if you don't receive the call back today it will be Monday uh because we do close the office for the weekends, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect alright um do you provide reference number for this call?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name. It's [PII], in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much [PII] have a nice weekend.
[AGENT][POSITIVE] You too, Ms. [PII]. You have a wonderful Easter and thanks for calling APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Bye-bye, ma'am.
[CUSTOMER][POSITIVE] Thank you bye bye.