AccountId: 011433970860
ContactId: c7951f0e-0d21-4c47-be01-a5e9233ba309
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 660000 ms
Total Talk Time (AGENT): 256123 ms
Total Talk Time (CUSTOMER): 172750 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/c7951f0e-0d21-4c47-be01-a5e9233ba309_20250317T20:13_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] Um, hi, [PII]. Um, this is me again, [PII].
[AGENT][NEUTRAL] Hey, [PII]. Hold on one moment. Let me go back to the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hi. OK, so I, um, claims actually ended up giving me a call back, so, so you can disregard the voicemail that I sent you. The difference between the two claims that we paid out on is the modifier, one was on the left and one was on the right. So, um, did you need the claim status for both?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, hold on, let me double check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, for the left only, no, that's what I'm, that's the claim I'm calling about.
[AGENT][NEUTRAL] The left, OK, let's, hold on one second.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the second one? Hold on one moment, I'm just bringing everything back up.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] I'm gonna have to pull up the documents cause this doesn't give me the modifier. Hold on one second.
[CUSTOMER][POSITIVE] No worry.
[AGENT][NEUTRAL] And [PII], is it OK if I place you on just a brief hold?
[CUSTOMER][POSITIVE] OK sure thanks.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] This is right.
[AGENT][NEUTRAL] So I need left.
[AGENT][NEUTRAL] Well, it's the same claim. It doesn't matter. OK. OK, hello, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, thanks so much for holding. So since it's a new call, we don't have to verify because I already talked to you today, um, but just for the disclaimer, all the information provided is a verification of benefits, not a guarantee of payment. So the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's claim number 337.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 0990.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider a total of $83.34.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, just want to, um, ask you this one. did you receive, um, the updated UB from
[CUSTOMER][NEUTRAL] Uh, the primary insurance because they made an adjustment on their payment and the, uh, patient responsibility also changed. So it's going to be um an overpayment on your side for $34 998 dollars.
[AGENT][NEUTRAL] $34.98.
[CUSTOMER][NEUTRAL] Mhm. Yeah, I actually.
[AGENT][NEGATIVE] That we overpaid.
[CUSTOMER][NEUTRAL] Yes. Uh, we, uh, mailed the the updated primary will be on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. And that reflects the new patient responsibility, which is $48.36.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. The documents are coming up now. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you're, so let me see, so I have the documents here. So the, you're saying the [PII] should be different?
[CUSTOMER][NEUTRAL] I'm sorry, which?
[AGENT][NEUTRAL] So you're saying that um I see the documents here, I see on the 2nd page, it has the explanation of payment from Blue Cross Blue Shield. You're saying that the patient responsibility has changed.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, to $48.36.
[AGENT][NEUTRAL] $48.36.
[AGENT][NEUTRAL] OK, I see it here. Patient responsibility 4836. OK. Um, so I can, so you want I can send this back to be reprocessed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'll go ahead and send this back to be reprocessed for you and then they'll go and I'll point that out to them and then um they'll provide you with the determination.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty, so for that it would still be the same 7 to 10 business days. It could be less time than that, um, because it's already a claim and, you know, that's been processed, but just in case we do give that turnaround for, for the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK and when did you receive the documents for?
[AGENT][NEUTRAL] We received this. Hold on one second.
[CUSTOMER][NEUTRAL] For documentation purposes.
[AGENT][NEUTRAL] We received it on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it was denied as a duplicate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So I'll go ahead and have it reprocessed for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And do we have a call reference number for this patient?
[AGENT][NEUTRAL] So there's no call reference number. It'll be my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you. And can you assist me with one more patient?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's that member's policy number?
[CUSTOMER][NEUTRAL] Um, I have here 02563037 ML 8.
[AGENT][NEUTRAL] OK, and is the callback number just um since it's a new call, the callback number still the [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] You said 256303 was the policy number?
[CUSTOMER][NEUTRAL] Um, 20563.
[CUSTOMER][NEUTRAL] 037 ML 8.
[AGENT][NEGATIVE] OK, wait a minute, I'm getting something wrong.
[AGENT][NEUTRAL] 205630-37.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] That's too many numbers. It's giving me an error. Can you um give the whole number with the ML 7 or 8 at the end?
[CUSTOMER][NEUTRAL] 02563037 ML 8.
[AGENT][NEUTRAL] Let me try without the 7.
[AGENT][NEUTRAL] What's the member's first and last name?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, this is her, and then may I have the date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And uh may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the member hasn't had any um active policies with APL since [PII], but I did look on the hustle indemnity policy that you gave, but there was no claims on file for this data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the num um just to confirm the ID number I provided is that correct? Because that's the one provided by the previous representative I believe.
[AGENT][NEUTRAL] It doesn't have a 7 at the end.
[AGENT][NEUTRAL] It's just 256303.
[CUSTOMER][NEUTRAL] Um, mhm.
[CUSTOMER][NEUTRAL] Uh, maybe that's why there's no claim on file because we have the incorrect ID number. Hold on 25. All right.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Um, the policy, I was just gonna say the policy, um, is not active though.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Oh OK. She's not active as well.
[CUSTOMER][NEUTRAL] And that is effective or term date [PII], correct?
[AGENT][NEUTRAL] Yes, it was effective from [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. And never reinstated the plan, correct? OK.
[AGENT][NEUTRAL] Correct, not with APL, correct.
[CUSTOMER][POSITIVE] Alright, thank you so much and [PII], I believe that's all for today and I really appreciate your help.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] Um, no, thank you so much for your help.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You so.
[AGENT][POSITIVE] Thank you. Bye