AccountId: 011433970860
ContactId: c9c021fd-0952-4f7b-8bf0-4ed036b70ab5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1035520 ms
Total Talk Time (AGENT): 227618 ms
Total Talk Time (CUSTOMER): 287189 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/c9c021fd-0952-4f7b-8bf0-4ed036b70ab5_20250512T16:38_UTC.wav
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[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, thank you for calling it for APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling from provider's office and I need a claim status regarding a member.
[AGENT][NEUTRAL] OK [PII], I can help you with claim status. May I please get your call back number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Sure. The callback number is
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The patient's name is
[CUSTOMER][NEUTRAL] One second. Uh, [PII]. And the date of birth is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 02363909.
[AGENT][NEUTRAL] OK. Let me look that up.
[AGENT][NEUTRAL] OK, alright, and then may I please get the data service, the charge amount?
[CUSTOMER][NEUTRAL] So this member has different date of services. So we can go one by one, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So, the first date of service is uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then the charge amount please.
[CUSTOMER][NEUTRAL] And the bill amount is
[CUSTOMER][NEUTRAL] The bill amount is $218.23.
[AGENT][NEUTRAL] OK, and then may I have charges after the primary insurance pay their part?
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEGATIVE] Your voice is breaking.
[AGENT][NEUTRAL] The charge.
[AGENT][NEUTRAL] Yes, the charges after the primary insurance paid their part.
[CUSTOMER][NEUTRAL] But I.
[CUSTOMER][NEUTRAL] No, it is the total bill amount.
[AGENT][NEUTRAL] OK, and what is the name of the facility?
[CUSTOMER][NEUTRAL] Sure. The name of the facility is Urology Surgeons of Oklahoma.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this claim and I'll be right back.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] For for me [PII], so looking on data service of [PII], I do not find a claim on file.
[CUSTOMER][NEUTRAL] OK. So, actually, uh, the last time we called for this claim, the, that said the same thing, the claim was not on file. So we resubmitted the claim.
[CUSTOMER][NEUTRAL] So, did you, do not get the claim or what?
[AGENT][NEUTRAL] Let me look, what day did you resubmit?
[CUSTOMER][NEUTRAL] One second. The date of resubmission was [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So this claim was resubmitted on [PII].
[AGENT][NEUTRAL] OK, and did you do it by fax, EOR electronic or or did you mail it in?
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] So we mailed the uh we mailed the uh claim.
[AGENT][NEUTRAL] And what um.
[CUSTOMER][NEUTRAL] To the address.
[AGENT][NEUTRAL] Right, and then what address did you mail it to?
[CUSTOMER][NEUTRAL] Sure. [PII]. OK. [PII].
[AGENT][NEUTRAL] OK, thank you. Let me look and see.
[AGENT][NEUTRAL] If I can find anything I'm not finding anything for that that data service that we have received it yet.
[CUSTOMER][NEUTRAL] So do you need the claim need more time or uh is the claim not
[CUSTOMER][NEUTRAL] Found it.
[AGENT][NEUTRAL] It may need more time since you mailed it in you might wanna try back um we don't have a timely filing limit so you'll be OK um if you choose to you can um submit it uh uh through electronic and I can give you the payer ID number.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, that is 60801.
[AGENT][NEUTRAL] And
[CUSTOMER][POSITIVE] OK. Thank you so much. And uh the same number, so the same member has 2 more data services so we can go next, right?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what
[AGENT][NEUTRAL] Yes. What's the next day of service?
[CUSTOMER][NEUTRAL] So the next date of service is [PII].
[AGENT][NEUTRAL] And the charge amount
[CUSTOMER][NEUTRAL] And the bill amount is 5, the bill amount is $568.43.
[AGENT][NEUTRAL] OK, and then what were the charges after the primary insurance paid?
[CUSTOMER][NEUTRAL] So, it is $401.45.
[AGENT][NEUTRAL] OK. And it's for the same um facility, Urology Surgery of Oklahoma?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a quick hold and look this one up and I'll be right back.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh. You are on hold.
[AGENT][NEUTRAL] 48.
[AGENT][NEUTRAL] 401.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK [PII] looking on this data service of [PII], I'm not finding a claim that matches the amount for this one either, so I'm not seeing a claim on file.
[CUSTOMER][NEUTRAL] 915.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information. And so I have one more date of service. So,
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Can we check on that also?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] So the date of services.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what is the charge amount?
[CUSTOMER][NEUTRAL] The charge amount is uh
[CUSTOMER][NEUTRAL] You need after the
[CUSTOMER][NEUTRAL] Primary insurance paid, right?
[AGENT][NEUTRAL] both before and after.
[CUSTOMER][NEUTRAL] OK. So before is $568.43. And after is $294.
[AGENT][POSITIVE] OK, I'm gonna put you on a quick hold again and look this one up and I'll be right back with you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um, this one's found.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Alright, thank you for holding for me [PII]. I did find this claim information for you.
[AGENT][NEUTRAL] The claim number is 3,589,840.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And, and it was paid $294.
[AGENT][NEUTRAL] With check number.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 203.
[AGENT][NEUTRAL] 9770.
[AGENT][NEUTRAL] And it was paid on [PII] and the check is still outstanding as it's just been sent.
[CUSTOMER][NEUTRAL] So, the check is not yet cashed, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] So the allowed amount was $294 and the paid amount was also $294 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information. So, uh,
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, for the um uh [PII], uh, I told you the wrong bill amount. So, can you please check again?
[CUSTOMER][NEUTRAL] For this date of service?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, sir. Yes, what is the billed amount before and after?
[CUSTOMER][NEUTRAL] So the
[CUSTOMER][NEUTRAL] So, the bill amount before is uh $1,293.63.
[CUSTOMER][NEUTRAL] And after is
[CUSTOMER][NEUTRAL] $401.45.
[AGENT][NEUTRAL] OK, let me look for this one for you. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much for holding for me, [PII]. So looking on that data service of [PII].
[AGENT][NEUTRAL] I do not find a claim on file for that amount given.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, OK. Thank you so much for the information. And can I get the call reference number?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Today's day.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for all this information. Have a nice day.
[AGENT][POSITIVE] You too, [PII]. Thank you very much for calling APL. I hope you have a good week. Bye-bye, sir.