AccountId: 011433970860
ContactId: d44d3a76-6113-4cc2-b071-c973fa32301a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393140 ms
Total Talk Time (AGENT): 172397 ms
Total Talk Time (CUSTOMER): 134932 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/d44d3a76-6113-4cc2-b071-c973fa32301a_20250613T17:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII] calling from Washington University. I am calling for clarification on a claim, ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, well, I can verify claim status for you, Ms. [PII]. And what is the policy number, please?
[CUSTOMER][NEUTRAL] I have 02277776.
[AGENT][POSITIVE] on the 7. OK, thank you, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, my phone number is [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] I have a date of service of [PII] for a build amount $1,055.
[AGENT][NEUTRAL] Uh, give me one moment.
[AGENT][NEUTRAL] OK, I'm sure that policy number you gave it terminated on [PII], and I can give you the current policy number when you're ready.
[CUSTOMER][NEUTRAL] Sure, go ahead.
[AGENT][NEUTRAL] OK, it's 244-028-8.
[AGENT][NEUTRAL] And let me see as far as we received the claim that don't show the claim has been received, uh, but can you verify the mailing address it was submitted to?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yep, give me one second, let me.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] Yes, [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, I did get a a remittance back from the insurance company on this. I have a claim number.
[AGENT][NEUTRAL] What's that claim number?
[CUSTOMER][NEUTRAL] It looks like it denied, yeah, the claim number is 3576546.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEGATIVE] And it looks like it states that it's it was denied as a duplicate.
[AGENT][NEUTRAL] Uh, let me see what's going on.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh, I know what I'm doing.
[CUSTOMER][NEUTRAL] I just don't have a duplicate that it was.
[AGENT][NEUTRAL] I'm looking at the wrong person. I'm sorry. I was looking at the insured.
[CUSTOMER][NEUTRAL] That's OK. It's
[AGENT][NEUTRAL] 1425.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] Um, that is, let me get back there, um, $614.37.
[AGENT][NEUTRAL] 37. OK, let's see what's going on.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] 17288.
[AGENT][NEUTRAL] 117.
[AGENT][NEUTRAL] Uh, yes, ma'am. It shows that initially processed and paid that's 61437.
[CUSTOMER][NEUTRAL] 9928.
[AGENT][NEUTRAL] And I'll give you that information, checking information when you're ready.
[AGENT][NEUTRAL] Let me see when it processed.
[CUSTOMER][NEUTRAL] Um, yep.
[CUSTOMER][NEUTRAL] Um, I'm just wondering because it looks like they paid 61437 patient was seen in the ER and I have CPT code 99285 was billed by two separate providers at two separate times on the same day.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So I'm showing that [PII] was paid the 614 and my outstanding claim is for [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, let me see who this one's for. Give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, let me see and which one you said is outstanding?
[CUSTOMER][POSITIVE] The outstanding one is for [PII] on my end anyway.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, because the one we paid it looks like it was for.
[AGENT][NEUTRAL] If I could go back, [PII].
[CUSTOMER][NEUTRAL] [PII] correct yes that was the same day, same data service same CPT code just two different providers at two separate times.
[AGENT][NEUTRAL] OK, and let me look at this other one that was processed as a duplicate. Let me double check.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, you said the one that's showing out saying is from Miss [PII]?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, I see.
[CUSTOMER][MIXED] It gets confusing. I totally understand.
[AGENT][NEUTRAL] And yeah, because.
[AGENT][NEUTRAL] There's no modifier to separate them and um.
[AGENT][NEUTRAL] It looks like it was sent to the same address, so I guess they put it under the other one, but um.
[AGENT][NEUTRAL] I'll send a request for claims department to look at this claim and show them that it was two different uh providers because it shows two different uh facilities.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So I'll send a request for this to be looked at and possibly reprocessed again. Um, I would say give it about 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do you do reference numbers [PII]?
[AGENT][NEUTRAL] Uh, no, ma'am, but if you like, you may use my name. Oh well, you may use my name at today's date as a reference. I'm sorry.
[CUSTOMER][POSITIVE] OK, thank you so much have a great afternoon.
[AGENT][POSITIVE] Alright, you too. Thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, ma'am. Bye.
[CUSTOMER][NEUTRAL] All right bye bye.