AccountId: 011433970860
ContactId: c0790bd6-090b-4748-9a6e-c95291ac9f98
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1121359 ms
Total Talk Time (AGENT): 241550 ms
Total Talk Time (CUSTOMER): 253615 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/c0790bd6-090b-4748-9a6e-c95291ac9f98_20250326T15:06_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling you from the provider office section. I'm looking for the claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with client status, Miss [PII]. May I have a callback number just in case we get disconnected? And may I have the name of the facility one more time?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure. And the callback number is [PII].
[CUSTOMER][NEUTRAL] And the facility name is Saint Joseph Candler Urgent Care Center.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Sure. Policy number is D as in Delta 48400306.
[AGENT][NEUTRAL] OK. Do you see a policy certificate number? It's gonna start with the 0 followed by 7 digits. That's gonna be our number.
[CUSTOMER][NEUTRAL] One second, let me check if I found anything.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On the ID card, it's showing that D as in Delta 48400600306. That's all I can see here. And I have policy or card number.
[AGENT][NEUTRAL] That's another number.
[CUSTOMER][NEUTRAL] Which is 02381784. This is policy or card number.
[AGENT][NEUTRAL] 84. OK. 02381784. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure. Patient name is uh [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the data service and the amount of the claim?
[CUSTOMER][NEUTRAL] 1027 2024. Total bill amount is $395 even.
[AGENT][NEUTRAL] So that's [PII] for 395?
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for future. You can check claim status online through our website at [PII], and that's just optional.
[AGENT][NEUTRAL] And what is the procedure code?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, procedure code is
[CUSTOMER][NEUTRAL] Uh, one second, 99204 and 73,660.
[AGENT][NEUTRAL] Alright, OK.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, so it looks like we processed this twice. The last one was processed as a duplicate. So I'm gonna give you the information of the original claim, OK?
[CUSTOMER][NEUTRAL] Uh, please, sir, could you please tell me that, uh, the original, uh, claim when it was submitted and
[CUSTOMER][NEUTRAL] Like uh when you receive the same.
[AGENT][NEUTRAL] The original? OK, let me pull that information. One moment.
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] OK, the original claim was received [PII], processed [PII].
[AGENT][NEUTRAL] And the claim was denied. The denial reason is that on this um our records indicate that the premium for the date of service was not received. Therefore, benefits are not payable.
[CUSTOMER][NEUTRAL] You didn't understand. Could you please repeat once again slowly?
[AGENT][NEUTRAL] Our records.
[AGENT][NEUTRAL] Indicate
[AGENT][NEUTRAL] That the premium
[AGENT][NEUTRAL] For the date of service.
[AGENT][NEGATIVE] Was not received.
[AGENT][POSITIVE] Therefore benefits.
[AGENT][NEGATIVE] Are not payable.
[CUSTOMER][NEUTRAL] Like patient, uh, under the patient plan, this, uh, two code is not covered?
[AGENT][NEUTRAL] No, uh uh. Do you need me to repeat it so you can write it down because no, that's not what I said.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Actually I do not actually understand what is the deny reason exact.
[AGENT][NEUTRAL] You need to write it down as I give it to you so you will understand it because uh exactly what is in the EOB is what I'm giving you. So I'm just reading off the EOB. If you wanna write it down, that will help you understand.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me know when you're ready.
[CUSTOMER][POSITIVE] Yes, I'm ready. Please tell me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Our records.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All records or our records?
[AGENT][NEUTRAL] RR records, 00 U R, our records.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Indicate
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That the premium.
[AGENT][NEUTRAL] For the date of service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Was not received.
[AGENT][POSITIVE] Therefore benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Are not payable.
[CUSTOMER][NEUTRAL] Care for benefits.
[AGENT][NEUTRAL] Therefore, benefits are not payable.
[CUSTOMER][NEUTRAL] So what we need to do like, uh, I, uh, just a second, OK, and let me ask my senior regarding this, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, sure. Um
[CUSTOMER][NEUTRAL] Could you please uh provide me the claim number?
[AGENT][NEUTRAL] Yes, the claim number is 352.
[AGENT][NEUTRAL] 59
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 46.
[CUSTOMER][NEUTRAL] 352-594-6, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And uh could you please tell me one thing that um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I said the patient know about this whole thing like uh you are already send the patient for this regarding any letter?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, they always receive a copy of the EOB.
[CUSTOMER][NEUTRAL] OK. When you send
[CUSTOMER][NEUTRAL] OK. And any letter that you send for the premium that you, uh, the patient is not uh
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Premium and is handled by a third party on this one on this group, so we did send out the information, the same information you have is the same information the patient has. We did send a copy of it.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. When you send, send, OK. When you send to the patient this information?
[AGENT][NEUTRAL] The same, the same day we send it to the provider.
[CUSTOMER][NEUTRAL] Uh, could you please provide me the date?
[CUSTOMER][NEUTRAL] And so that I can note it on our end.
[AGENT][NEUTRAL] Is this same process date um let me go back to it one moment.
[AGENT][NEUTRAL] One moment, I'm waiting on the system.
[CUSTOMER][POSITIVE] Sure, not an issue. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Process on [PII].
[CUSTOMER][NEUTRAL] Uh sorry, November.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And this claim was processed on [PII], right? Or uh [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII] disclaimers process. OK, sure.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, could you please send us the UB regarding this?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Could you please, uh, OK. Uh, first, I, uh, need to ask you one thing. Then after that, when you received the claim, uh, the, w[PII] we submitted the, again the claim which was denied as a duplicate on [PII]. Could you please provide that claim information which was denied as a duplicate, receive date, process date, and claim number?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, I'll have to go back to that. OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just provide me the claim number.
[AGENT][NEUTRAL] That is 356.
[AGENT][NEUTRAL] 342 4.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, sure. One second, let me jot it down.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Sure. Uh, could you please send us the UB, the both UB which was denied as a, um, and which was denied as a duplicate.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Via fax?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, it is starting with [PII]. OK.
[AGENT][NEUTRAL] Yes, what attention?
[CUSTOMER][NEUTRAL] My name, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold so I can send this out to you right now, OK? So you need to hold for me while I send this out, OK? One moment.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII]. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, reference number and your name.
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last initial is [PII]. We don't have reference numbers. You can use my name in today's name.
[CUSTOMER][POSITIVE] OK, thank you so much. You have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling APL. Bye-bye.