AccountId: 011433970860
ContactId: cd93082a-aa6a-445d-8645-1cc5350fb5d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 566679 ms
Total Talk Time (AGENT): 113236 ms
Total Talk Time (CUSTOMER): 220206 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/cd93082a-aa6a-445d-8645-1cc5350fb5d6_20250519T17:30_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling from provider's office to check the status of the claim. Can you please uh spell your name?
[AGENT][NEUTRAL] Yes, it's [PII]. It's [PII]
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] Do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] And policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah, it is 60801.
[AGENT][NEUTRAL] Um, that's our payer ID. Do you have the actual policy number?
[CUSTOMER][NEUTRAL] Just one minute, yeah, yeah. Just one minute. Uh yeah, policy number is 0243.
[CUSTOMER][NEUTRAL] 3300.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's uh name, last name [PII]. First name, it is [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Data service. It is um
[CUSTOMER][NEUTRAL] [PII] and the bill amount for this claim is $13,193.25.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, it looks like we received the claim on [PII].
[AGENT][NEUTRAL] Process 4525.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, insurance, primary insurance provided full benefits, therefore, no benefits are payable.
[CUSTOMER][NEGATIVE] Sorry, can you repeat the denied reason once again denied 4.
[AGENT][NEUTRAL] Insured, the primary insurance provided full benefits, but nothing is payable.
[CUSTOMER][NEUTRAL] OK. Just stating that uh insured, primary insurance has provided all the benefits. No, uh, additional benefits will be provided by secondary payer, right?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Just give me one moment.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, uh, primary paid more than the secondary.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] The primary paid in full, so we don't have anything left to pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the primary paid amount?
[AGENT][NEUTRAL] You submitted the claim with the primary explanation of benefits do you have it pulled up?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Actually, we need to check for that.
[AGENT][NEUTRAL] Oh wait
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, here it is not showing anything. Actually, we have United Healthcare. It is a uh primary, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But here we have UB it is stating that uh the zero amount has been paid.
[AGENT][NEUTRAL] Let me pull it up. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] You submitted the primary EOB. It shows that
[AGENT][NEUTRAL] 13,000 19325.
[AGENT][NEUTRAL] Processed
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] What is the allowed amount?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEGATIVE] Oh, it does, it doesn't show anything paid.
[AGENT][NEUTRAL] So I that's.
[CUSTOMER][NEUTRAL] Yeah, that's what I'm saying.
[AGENT][NEUTRAL] Yeah, so we need to see something paid on it so we need to corrected explanation of benefits. Can you get that submitted?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, can you please provide me the fax number so that we'll be submitting it to you?
[AGENT][NEUTRAL] Yes, it's 877-365-99423.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 9403, right?
[AGENT][NEUTRAL] 0, 942-3.
[CUSTOMER][NEUTRAL] 9423, my mistake. OK. Can you please provide me call reference number for this call?
[AGENT][NEUTRAL] That's my name, [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you, [PII], for helping me with this information.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] And can you please help?
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] What did you need help with something else?
[CUSTOMER][NEUTRAL] Oh yeah. Um, can you please help me with the other claim status on this call? I'm having one more claim.
[AGENT][NEUTRAL] For the same patient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, it is of different patient.
[AGENT][NEUTRAL] OK, can you hold on one moment?
[CUSTOMER][POSITIVE] Yeah, sure. No problem.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, sorry about that. What's that policy number?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, you have the policy number?
[CUSTOMER][NEUTRAL] The policy number, it is 02497688.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's last name, it is [PII] First name, [PII] The date of birth, [PII].
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] Data service, uh [PII]. And the bill amount is $1,191 even.
[CUSTOMER][NEUTRAL] Really
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, I don't have a claim on file, but the policy terminated on 10-1-2024.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, just, can you please provide me
[CUSTOMER][NEUTRAL] The effective date also?
[AGENT][NEUTRAL] Uh, effective date is.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. And it was terminated on [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh, so,
[CUSTOMER][NEUTRAL] The patient has any other insurance?
[AGENT][NEUTRAL] Uh, no, I don't show anything on file.
[CUSTOMER][NEUTRAL] OK. No, the insurance form. Yeah, thank you very much for helping with this information. And uh, yeah, uh, can I use call reference number, your name and the date?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Yeah, thank you very much for helping this information.
[AGENT][POSITIVE] OK, well thank you for calling [PII]. I hope you have a good day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Bye, thank you.
[AGENT][NEUTRAL] If you