AccountId: 011433970860
ContactId: c4042496-537c-4c17-9957-616bab504318
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 669260 ms
Total Talk Time (AGENT): 166143 ms
Total Talk Time (CUSTOMER): 135540 ms
Interruptions: 2
Overall Sentiment: AGENT=1.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/c4042496-537c-4c17-9957-616bab504318_20250430T15:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Tidal Health [PII] and um I had sent in a W-9 a couple weeks ago for um I have a couple claims that hadn't processed because they said they needed that information updated.
[CUSTOMER][NEUTRAL] So I was calling actually to see if possible, you know, if the claims had been reprocessed yet or not.
[AGENT][NEUTRAL] Yes, ma'am. OK.
[AGENT][NEUTRAL] OK, um, I can check them for you and what can you spell your first name again for me please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. Uh my name is [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you, Miss [PII] and then also may I get your callback number just in case the call is dropped I'll be able to call you right back.
[CUSTOMER][NEUTRAL] Mhm [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then um what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah, uh, the policy number is 02140646.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the patient is [PII].
[AGENT][NEUTRAL] OK. And then um what is Clota's date of birth, please?
[CUSTOMER][NEUTRAL] Oh yeah, date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then um can you give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, this one is [PII] and the total charges are $537.
[AGENT][NEUTRAL] OK, let me pull up that patient real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK and then can you give me the charges after the primary paid?
[CUSTOMER][NEUTRAL] Uh, 4 looks like 4:30 497.
[AGENT][NEUTRAL] Thank you. And then one more time, I know you said it at the beginning of the call, but I didn't catch it. Can you give me the name of the facility you're calling from, please?
[CUSTOMER][NEUTRAL] Mhm yeah it's Tidal Health Nana Coke.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, Ms. [PII], while I'll, I look up this claim and we're gonna check to see if um it's been reprocessed for you. I'll be right back with you.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] OK doke thank you.
[AGENT][POSITIVE] Thank you. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] 434, 5:37.
[AGENT][NEUTRAL] 357-8179.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much Ms. [PII] for holding for me so I do see that they did process the claim after um the B notice information was sent in and the claim was denied because the benefits were maxed for the calendar year.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, will they be sending a new EOB out?
[CUSTOMER][NEUTRAL] I'm assuming they do.
[AGENT][NEUTRAL] They do, but if you want me to fax you one now I can do that for you.
[CUSTOMER][POSITIVE] Oh, that would be great.
[AGENT][NEUTRAL] Yes, ma'am. What is your fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][POSITIVE] OK. I'm gonna put you on a quick hold and get this faxed together and I'll be right back just as soon as I have it sent, OK?
[CUSTOMER][NEUTRAL] OK, I have one more data service too, so I don't know if you want that one as well and that's yep.
[AGENT][POSITIVE] Yes, what is, yeah, I can do them together.
[CUSTOMER][NEUTRAL] OK, yep, let's see, let me get this is data service 23 of 25, and let me.
[CUSTOMER][NEUTRAL] Total charges before Medicare were 699 28, so it looks like.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 552 46 would have been the charges after Medicare.
[AGENT][NEUTRAL] OK. All right. I'm gonna pull that one up. Um, I'm a, I'm thinking it's probably gonna be the same, um, but let me, but let's look and see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Hopefully yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let me pull that up so I can have both of them together.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna see if it has any remarks.
[AGENT][NEUTRAL] Yes ma'am, that one was also denied outpatient benefit for this calendar year has been.
[AGENT][NEUTRAL] That. So now I'm gonna put you on a quick hold. I'm gonna send both of these EOBs over to you so you have them right away. OK? All right. It's gonna be a quick hold. You're welcome, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEGATIVE] Come on, hurry up.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Ms. [PII]. I have both of those EOBs on their way to you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][POSITIVE] All right [PII], well thank you for your help.
[AGENT][POSITIVE] You're welcome. Is there anything else I can assist you with before we go?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] OK, well you have a great week and thank you for calling APL.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.