AccountId: 011433970860
ContactId: c615a056-0a93-4280-83f8-4f72b3d3610c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 365700 ms
Total Talk Time (AGENT): 142593 ms
Total Talk Time (CUSTOMER): 150148 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/c615a056-0a93-4280-83f8-4f72b3d3610c_20250211T19:14_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm with OSU Emergency Medicine. I have a question about a claim, uh, denial for a patient. I faxed something in December, just want to make sure it was received.
[AGENT][NEUTRAL] Sure, OK, yes, I can check on that claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] I do. It is um look right at the EOB policy number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02216522
[AGENT][NEUTRAL] OK, thank you. And then what was the name and date of birth for the insured?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] This is [PII]. Date of birth [PII] I'm sorry, [PII]. I'm so sorry.
[AGENT][NEUTRAL] That's going a ways back. I know we're used to stay in the [PII].
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] [PII] that's.
[CUSTOMER][NEUTRAL] Wasn't spitting out, yep.
[AGENT][NEUTRAL] I got you. That's fine. I appreciate you verifying all that, [PII]. OK, um, so you have the, uh, claim number and we're just needing clarification on the denial, is that right?
[CUSTOMER][NEUTRAL] Yes, it, uh, it denied saying, uh, they'll only cover if major medical did, um, so I faxed the primary EOB for him for a data service, so.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, when was that faxed to you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It was faxed on December before I.
[CUSTOMER][NEUTRAL] Yep, [PII] and it was for data service [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, give me just a minute, let's take a look.
[AGENT][NEUTRAL] That was, uh, I'm sorry, OSU emergency medicine.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I think I found it. Let's see.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] I do this. One is stating that it's a duplicate, the other is stating that the insurance, the insured's primary paid in full. So let me do this. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's OK. Let me, I guess I should get eyes on that primary and see what they did.
[AGENT][NEUTRAL] Well, one of them is stating that it was a duplicate though, so that's what I'm going to verify that was uh [PII], correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Bear with me just a moment, hang on.
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Because I'm thinking I actually just.
[CUSTOMER][NEUTRAL] I think this needs to be adjusted now that I'm, I'm looking after someone else had taken a look. I believe that this is actually just gonna be adjusted. I, I think that one is correct in saying the primary paid in full, see, because you'll be allowed 372 paid, yeah, OK.
[AGENT][NEUTRAL] Mhm. How is what.
[AGENT][NEUTRAL] Well, and I'm not even quite sure because this member, um, [PII], he's not currently active under this policy, so I'm trying to see when that was.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm just trying to make sure he was active at this data service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, he was this one it says he was dropped that was [PII], so he was OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, if you want to, it's completely up to you, [PII]. I can um reach out to our claims specialist. I kind of just see surface level, um, so I can have them take a look to make sure that this was uh all of the correct information we need, um, because I'm not sure why it would register as a duplicate if you know it's additional information that we did not have, uh, so that might have been a mistake. Did you want me to go ahead and do that for you?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, mm, let me just read this little bit right here.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] As such, member considered provider liability.
[CUSTOMER][NEUTRAL] Uh, no, I actually think as I'm as I placed the call I think I figured out the, the issue is our system didn't take the.
[AGENT][POSITIVE] No, that's good. Sometimes that's what it needs.
[CUSTOMER][NEGATIVE] Contractual, yeah, the, the system did not take the contractual adjustment from the primary, so it left a balance to secondary, but really it just needs adjusted so I think I just wasted 5 minutes of all of our time so.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] I don't, you know what, if it helps you come to that, then that was not a waste.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It is
[AGENT][POSITIVE] Not a waste.
[CUSTOMER][POSITIVE] Yeah, I think that's it, and I can let you carry on with your day.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] No worries.
[AGENT][NEUTRAL] Was there anything else I can help you with, [PII]? Of course.
[CUSTOMER][POSITIVE] I appreciate you though. No, just have a good one.
[AGENT][POSITIVE] All right, you too. Thank you. Bye bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.