AccountId: 011433970860
ContactId: c1e7dc43-9d21-49af-a7cb-8e1e72bfd2b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 500489 ms
Total Talk Time (AGENT): 189591 ms
Total Talk Time (CUSTOMER): 161759 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/c1e7dc43-9d21-49af-a7cb-8e1e72bfd2b8_20250115T20:32_UTC.wav
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[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi sorry I'm calling regarding claims.
[AGENT][NEUTRAL] OK, I can help you with the claim. Can you please give me your name and your callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And uh the uh Machado and the phone number is [PII].
[AGENT][POSITIVE] Thank you so much, Ms. [PII]. What is the patient's name?
[CUSTOMER][NEUTRAL] Is it um [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number, please?
[CUSTOMER][NEUTRAL] Excuse me, 02352722 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK, thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] 1800.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and then what is the charge after the primary paid their part?
[CUSTOMER][NEGATIVE] Oh, the primer did not pay.
[AGENT][NEUTRAL] OK and then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Radilogy diagnostic medical imaging.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, um, Ms. [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Thank you. You are on hold.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you, Ms. [PII], for holding for me. So looking um for Venetia on data service [PII].
[AGENT][NEUTRAL] I do not find a claim on file for that date of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, it was sent to attention by fax to um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On [PII] it was sent to her on 101?
[AGENT][NEUTRAL] On what day?
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] OK, I do not see anything received on [PII].
[CUSTOMER][NEUTRAL] We said it 5 8877365-9423.
[AGENT][NEUTRAL] Uh, can
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Yeah, that's the number that I faxed it to.
[AGENT][NEUTRAL] OK. Yes, I don't see that it was received.
[CUSTOMER][NEUTRAL] Wow, I have a confirmation. OK, is it OK if I send it again?
[AGENT][POSITIVE] Yes, please do.
[CUSTOMER][NEUTRAL] I mean, I have the confirmation. I just, is it gonna be on, you know, due to untimely filing or how is this process?
[AGENT][NEUTRAL] Uh, there's not a timely filing limit with our company.
[CUSTOMER][NEGATIVE] OK, so I'm gonna go ahead and fax it again. I was trying to register online for the uh IA APL and it's asking me for a patient account number and I've never billed, I guess since you didn't receive this claim, I can't, I can't, there's no way to check. There's no way to add a new register.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right until we've um received the claim and pay.
[AGENT][NEUTRAL] The patient account number doesn't get put in until we receive the claim and pay it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Got it. OK, so I'm gonna anybody's attention or?
[AGENT][NEUTRAL] You could put attention claims.
[CUSTOMER][NEUTRAL] Claims OK.
[CUSTOMER][NEUTRAL] OK, I'm gonna go ahead and.
[AGENT][NEUTRAL] Let me actually hold on, I'm gonna check something real quick because I just noticed while we were on the phone that that policy number you gave me is a lapsed policy, but she has an active policy so let me check to see if it's on the active policy, and we just had the wrong policy number at the beginning of the call. Let's check that real quick.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] At least try all of our options anyway.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Oh yeah, here it is the the 02473332.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] be just a second, I pull it up.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] I found it.
[CUSTOMER][NEUTRAL] OK, what account number did you?
[AGENT][NEUTRAL] It was um the policy number that you gave me at the beginning of the call was the policy that I looked on, and it wasn't on that policy. The um in just a second, I'll give you the correct policy number, the one that's active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But uh, we received the claim. Let me give you the claim number.
[AGENT][NEUTRAL] It's 351-372-0.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEGATIVE] And it has been denied because we need the explanation of benefits from the major medical insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it was attached to the front.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Yeah, I can't see what came in on the fax. I could just verify how the claim was processed and it says that um.
[AGENT][NEUTRAL] Benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEGATIVE] Yeah, the the insurance didn't pay anything. Her her [PII] didn't pay anything.
[AGENT][NEUTRAL] So we don't pay anything. It has to be covered by the major medical also.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Uh, is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's it.
[AGENT][POSITIVE] OK, well, you have a blessed day, Miss [PII]. Thank you so much for calling APL. You're welcome.
[CUSTOMER][POSITIVE] You too thank you.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.