AccountId: 011433970860
ContactId: c981b53f-cfea-4b54-a6e0-cfb9ce406707
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1516020 ms
Total Talk Time (AGENT): 349055 ms
Total Talk Time (CUSTOMER): 500799 ms
Interruptions: 11
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/c981b53f-cfea-4b54-a6e0-cfb9ce406707_20250211T21:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from provider's office regarding claims.
[AGENT][NEUTRAL] OK [PII], I can help you with the claim. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What's a direct landlords.
[AGENT][POSITIVE] Thank you and
[AGENT][NEUTRAL] Thank you. And what is the patient's name?
[CUSTOMER][NEUTRAL] Patient's first name is going to be uh.
[CUSTOMER][NEUTRAL] Just a second. Yeah.
[CUSTOMER][NEUTRAL] I'm sorry. Uh, I'm really sorry. Just give me my, yeah, member's first name is going to be uh.
[AGENT][POSITIVE] OK, that's fine. Take your time.
[CUSTOMER][NEUTRAL] [PII], it's [PII], [PII]. And the date, uh, last name is [PII].
[AGENT][NEUTRAL] OK, and then what is the date of birth?
[CUSTOMER][NEUTRAL] Yeah and the date of birth is uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, patient's ID number is 02337101 M as in Mike L as in Lima number 7.
[AGENT][NEUTRAL] OK, let me look up that policy.
[AGENT][NEUTRAL] OK, and then what is um the data service?
[CUSTOMER][NEUTRAL] The the service is uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With the amount of
[AGENT][NEUTRAL] And the charging
[CUSTOMER][NEUTRAL] 3480 $3480 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Actually, primary insurance.
[CUSTOMER][NEUTRAL] Paid and left over the amount of $396.
[AGENT][NEUTRAL] OK, and what's the name of the facility that you're calling from [PII]?
[CUSTOMER][NEUTRAL] I'm calling from the facility, uh.
[CUSTOMER][NEUTRAL] Galloway Anesthesia Associates.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII]. Thank you for holding for me. So looking on data service of [PII] for [PII], I do not find a claim on file for that date of service.
[CUSTOMER][NEUTRAL] OK, it's [PII] for [PII] with the buildup with the buildup amount to 3480, you haven't found any claim, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] May I know the payer ID of yours please.
[AGENT][NEUTRAL] Yes, it's 60801.
[CUSTOMER][POSITIVE] What was my favorite.
[CUSTOMER][NEUTRAL] 60801. Uh, could you please help me the mailing address office please?
[AGENT][NEUTRAL] Yes, you'll send it to [PII].
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] You find
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Could you please help me the member effect one termination date, please?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] The policy effective date is [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] OK, uh, what is the filing limit?
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][NEUTRAL] So, got it. OK. Shall we move to another claim? Uh, mhm.
[AGENT][NEUTRAL] OK, is it for the same patient?
[CUSTOMER][NEUTRAL] It's for the same number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Same member, yes.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] And those services, uh.
[CUSTOMER][NEUTRAL] For this the number.
[CUSTOMER][NEUTRAL] Yeah, the date of service, uh, same date of service like [PII] and the bill amount is different for this number.
[AGENT][NEUTRAL] OK, I do not have any claims on file at all for [PII].
[CUSTOMER][NEUTRAL] OK, you're setting for this claim also the Bellamont is 2 for $2788 the claim is not on file, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Sure, OK, got it. Uh, I don't understand about the claim. It's a different number right now. This is.
[AGENT][NEUTRAL] OK, what is the date of service?
[CUSTOMER][NEUTRAL] Sir, uh, the date of service is, uh,
[CUSTOMER][NEUTRAL] [PII]. It's for different number, OK?
[AGENT][NEUTRAL] For a different member?
[CUSTOMER][NEUTRAL] I have to.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, OK, and what is the member's name?
[CUSTOMER][NEUTRAL] Yeah, my first name is [PII] and the last name is [PII]
[CUSTOMER][NEUTRAL] So I I just.
[AGENT][NEUTRAL] OK. And then what is the patient's date of birth?
[CUSTOMER][NEUTRAL] Patient's date of birth is [PII].
[AGENT][NEUTRAL] And then what is the patient's policy number?
[CUSTOMER][NEUTRAL] Patients policy number is going to be uh oh my God.
[CUSTOMER][NEUTRAL] I'll just give me a second. Uh, let me check. Just give me a moment, please. Don't mind.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Yes, go ahead and take your time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] 402-268-10.
[CUSTOMER][NEUTRAL] so.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, like, upon checking, uh.
[CUSTOMER][NEUTRAL] Yeah, can you please uh check with the group and group number because I've been, uh.
[AGENT][NEUTRAL] It's the group number.
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] 244-06.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And how do you spell the insured's last name?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] And his last name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And how do you spell the insured's first name?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] It's an [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK thank you let me see if I can find it with the group ID number.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So, please
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] call.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 20
[CUSTOMER][NEUTRAL] I wanted to.
[CUSTOMER][NEUTRAL] [PII] right.
[AGENT][NEUTRAL] OK, I, I have the, what is the date of service? It was [PII] for [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] [PII]. Yes, you are right.
[AGENT][NEUTRAL] OK, and then what is the um
[AGENT][NEUTRAL] Amount of the claim?
[CUSTOMER][NEUTRAL] The amount of the claim is $2,862 2862 dollars even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, like it's
[CUSTOMER][NEUTRAL] $177. 50 cents.
[AGENT][NEUTRAL] OK and what is facility?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mm, sure, yeah, yeah, the facility name is
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Gastro Health LLC.
[CUSTOMER][NEUTRAL] It's going to be 786-717-01.
[AGENT][NEUTRAL] OK, and are you the insured's policy number for your records?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is 194.
[AGENT][NEUTRAL] 7 597.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] 19475
[CUSTOMER][NEUTRAL] H I V D L G O S O.
[AGENT][NEUTRAL] Yes, 19475997.
[CUSTOMER][POSITIVE] I'm sorry, can you repeat it once, and I'm really sorry. 194.
[AGENT][NEUTRAL] 19475997.
[CUSTOMER][NEUTRAL] Sure, got it.
[AGENT][NEUTRAL] OK, and I'm gonna put you on hold. I'm gonna look up that claim for you. I'll be right back.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, [PII], I have the claim for you. Um, the claim number is 355.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2283.
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Huh.
[AGENT][NEUTRAL] And process the claim on [PII].
[AGENT][NEUTRAL] And the claim was denied because we did receive an explanation of benefits from the primary insurance, but there was no charges for deductible, co-pay, or co-insurance. So we need a better detailed report, itemized statement that includes the amounts of the deductible co-pay or co-insurance that was paid.
[CUSTOMER][NEUTRAL] I think that's.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Oh, you're sending you need the primary insurance COB to process the claim, right?
[AGENT][NEUTRAL] Yes, but it needs to be detailed and include.
[AGENT][NEUTRAL] The deductible, co-pay or co-insurance that was paid.
[CUSTOMER][NEUTRAL] Yeah, sure, OK, like I want checking how we need to submit the primary OB. Can we be like, uh, we need to like submit the claim, uh, again with the primary ICN number or else we need to send through fax.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, that's correct. You can resubmit you can resubmit it through the fax number if you would like to. I can give you the fax number.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK, that's.
[AGENT][NEUTRAL] 3659423.
[CUSTOMER][NEUTRAL] 942-3 stating. Uh, we can submit the fax and do you have any another option to submit the OB.
[CUSTOMER][NEUTRAL] I be.
[AGENT][NEUTRAL] By fax, um, payer ID or through the mail either way is fine.
[CUSTOMER][NEUTRAL] OK. Can I just submit the claim along with the payer ID as well?
[AGENT][NEUTRAL] Yes, the payer ID number is 60801.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, we will just uh like we will uh refile the the claim again to the same payer ID with the primary ICN number. Is it OK for you?
[AGENT][NEUTRAL] Yeah, but it needs to say on there see because this policy only covers.
[AGENT][NEUTRAL] Uh, benefits for deductible, co-pay, or co-insurance. So on that primary EOB it must state that deductible, co-pay or co-insurance was paid.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Yeah, so, got it. Uh, like, OK, actually I would rather claim. I do got it. Um, mhm. 4500.
[AGENT][NEUTRAL] OK, good. OK and then um the next claim is is it for the same insured?
[CUSTOMER][NEUTRAL] No, it's for different insured.
[AGENT][NEUTRAL] OK, what's the insured's name?
[CUSTOMER][NEUTRAL] And the first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] OK. And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] And it
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, and then what is the insured's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Insured's policy number is going to be.
[CUSTOMER][NEUTRAL] 01673442 M as in Mike L as in Lima H.
[AGENT][NEUTRAL] OK, let me look up that policy number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] OK, and what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] date of service is [PII] with the bill amount of $348 even.
[CUSTOMER][NEUTRAL] Like.
[AGENT][NEUTRAL] And then what is the amount after primary paid their part?
[CUSTOMER][NEUTRAL] The primary pay the part, the leftover amount is $60 even.
[AGENT][NEUTRAL] OK, and what is the name of the facility?
[CUSTOMER][NEUTRAL] Uh, uh, just give me one second.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] The name of the facility is uh
[CUSTOMER][NEUTRAL] The same Gastro Health LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again so I can look this up. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh, come on.
[AGENT][NEUTRAL] Hi, [PII], this is [PII]. OK, so this claim number is 3552103.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was received on [PII] and was processed on [PII].
[AGENT][NEUTRAL] And the claim was denied because office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, office, uh, visits are not covered under business plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] May I know what does the member plan have? Could you please tell me the member's plan name?
[AGENT][NEUTRAL] It's a Medin.
[CUSTOMER][NEUTRAL] It's MED LI and Ming plan, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And uh she think it does not cover offices.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can you send me the copy of you with the fax.
[AGENT][NEUTRAL] Yes, I can send you a copy of the EOB. What is your fax number?
[CUSTOMER][NEUTRAL] 615.
[CUSTOMER][NEUTRAL] 777.
[CUSTOMER][NEUTRAL] 3536.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I get that fax ready for you. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] Sure. Thank you, [PII]. Uh, can you spell your name and the last name is.
[CUSTOMER][NEUTRAL] At least
[AGENT][NEUTRAL] Yes, it's, yes, sir, it's [PII] and my last initial is [PII]
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII] yeah and yeah sure. OK. Can you please help me in the parts?
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you for. That's the information and the conversations. Have a wonderful day ahead.
[AGENT][POSITIVE] You too, [PII], thank you. Thanks for calling APL.
[CUSTOMER][NEUTRAL] I I'm taking this.