AccountId: 011433970860
ContactId: c31e23af-2ab3-4088-9d94-9210abc6b22e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 630320 ms
Total Talk Time (AGENT): 156380 ms
Total Talk Time (CUSTOMER): 169690 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/c31e23af-2ab3-4088-9d94-9210abc6b22e_20250502T20:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling for check to check on claim status.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, and are you calling from the provider's office?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All right. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII] and our office callback number is [PII], no extension.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, yes, it's 02308028 M as in mom, L as in Lima 8.
[AGENT][POSITIVE] Thank you for that hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is uh [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um may I have the date of service and the total bill for the claims?
[CUSTOMER][NEUTRAL] Providing any information.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So there's 2 dates of service here.
[AGENT][NEUTRAL] OK. May I have both in the total bill?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] One was not 11 was not covered. It's the one that um, OK, it's for um [PII].
[CUSTOMER][NEUTRAL] And the total bill amount for that date of service is $150.
[AGENT][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] And I did send
[CUSTOMER][NEUTRAL] I did. I sent the EOB because I sent the fax like 3 times.
[CUSTOMER][NEGATIVE] Like 2 or 3 times, but the last time I sent it I sent it with where the procedure, the diagnosis code appears and the copay, co-insurance deductible, the other whatever they were requesting.
[AGENT][NEUTRAL] Alright, do you mind if I place you on just a brief hold while I look at this claim?
[CUSTOMER][POSITIVE] Yes ma'am, thank you.
[AGENT][NEUTRAL] Alright, hold on one moment. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for the for the wait. So for this claim, OK, so for this data service and this total bill, we have both you and the insured, not you specifically, but the provider and the insured, both filing claims for this data service. Um, so the last claim that we received from you all, we requested the um explanation of benefits with all the charges and everything, and you said that you sent that in.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, I did. I'll tell you the date I sent it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, that was the 3rd time I sent it, and it was [PII], so [PII].
[CUSTOMER][NEUTRAL] I've been trying to get this claim done. It's it.
[AGENT][NEUTRAL] So it looks like this.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] The issue is that both you and the insured are submitting the claim for the same data service and the same total bill. So this was actually paid to the insured. Um, let me see, I can't.
[CUSTOMER][NEUTRAL] Go on.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see this all the time. I don't understand. I don't remember she said she didn't tell me she she.
[CUSTOMER][NEUTRAL] This is OK. I'm gonna have to tell her to call that to tell her to call personally because she didn't tell me she was requesting this happened to me with another patient. That's weird, um, so.
[AGENT][NEUTRAL] So she, so, go ahead.
[CUSTOMER][NEUTRAL] So since the insured is requesting they they requesting the payment for that date of service, mm the the one that for the pro it's not gonna be processed, right? That's what you're trying to say.
[AGENT][NEUTRAL] Right, it has been processed and it was paid to the insured. So if you give me just a moment, I'm going to get the check information. I can't give it to you, but I'm going to see if it at least cleared. So then you'll, you'll know, um, the insured doesn't need to call us, they need to pay you if something is owed to you. I mean, they can call us if they'd like, but the payment was made to them, so they'll need to make the payment to you. Um, but if you give me just a moment, I'm gonna check and see if this has been cleared, um, that at least let us know that the payment is out there.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] All right, hold on one moment, OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. Hello, [PII].
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] All right. So, yes, this payment, I was, I was checking to see if it was making sure it's the same claim, same procedure code. So yes, it's the same exact thing. um, and the payment was made to the insured. Now they, the check is still outstanding, um, but it is coming from Oklahoma. So that would have to be collected by the patient or from the patient.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So you're mailing a check to the patient for that for that date of service.
[AGENT][NEUTRAL] Yes, the patient filed a claim as you filed a claim and the patient submitted the information first, so that claim was processed first.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, alright, I'll I'll call the patient and speak to her.
[AGENT][NEUTRAL] All right, well, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh ma'am, you, oh wait, wait, I think, let me see, let me see before I hang up and then I have to call again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You know what? No, no, there, it's a different insurance company. OK, thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Well, thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][POSITIVE] Thank you. Bye-bye.