AccountId: 011433970860
ContactId: d6667805-010c-43e1-a391-b404a6c524c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 912750 ms
Total Talk Time (AGENT): 268341 ms
Total Talk Time (CUSTOMER): 171775 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/d6667805-010c-43e1-a391-b404a6c524c6_20250523T14:25_UTC.wav
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[AGENT][POSITIVE] Good Morning, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from the provider's office. Could you hear me?
[AGENT][NEUTRAL] Yes, I can hear you. May I have the spelling of your name?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][NEUTRAL] Mhm. And Mr. [PII], may I have a callback number just in case we get disconnect then?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, please take it. It's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And where are you calling from? What facility?
[CUSTOMER][NEUTRAL] I'm calling from, from the provider's office. It's uh Nicholas Children Pediatrics. That's the name of the facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] Patient's policy number is uh.
[CUSTOMER][NEUTRAL] Yeah, here it is. It's uh 018.
[CUSTOMER][NEUTRAL] 32,520
[CUSTOMER][NEUTRAL] Then M as in Mike, L as in Lima, 7.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] That's the policy number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see what's the reason of your call today?
[CUSTOMER][NEUTRAL] I'm calling for the claim status.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, sure. The name is uh [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] That's [PII]. The amount $279.12.
[AGENT][NEUTRAL] OK. Thank you. So that's [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. And for future, you can check claim status online through our website at [PII] and that's just optional. And bear with me let me pull the details of the claim.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. You are saying that clay was reprocessed previously, right?
[AGENT][NEUTRAL] It was processed twice. The most recent one was processed as a duplicate. I'm pulling the original information of the claim.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] Bear with me.
[AGENT][NEUTRAL] OK, it's gonna be one more minute on the system.
[AGENT][NEUTRAL] OK, so the original claim was processed on [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is that OK, we pay only if major medical insurance pay, so we need the explanation of benefits showing the amount that the major medical pay and the amount applied towards the deductible co-payment and coinsurance.
[CUSTOMER][NEUTRAL] OK, the payment of the original claim is still in the process.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] 48.
[CUSTOMER][NEUTRAL] I mean, as I can see here, there's one CPT bill 92012, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh and I can also see that uh the adjustment of $107.96 has been done over this time, right?
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] White night for $171.16.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Mm. That's not with us. Bear with me just a second. Let me pull the image of the primary EOB because we're not the primary, we're the secondary, OK? One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] OK, so the 17116 by the um primary insurance is a, it's a non-covered charge. So they did not apply towards the deductible co-payment of co-insurance. We need an EOB showing that it was applied towards the deductible co-payment and co-insurance.
[AGENT][NEUTRAL] So once we receive that detailed explanation of benefits, we can reprocess the claim. We're waiting for that information if you need us to reprocess the claim.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK. So, till how much time will get uh it will take to, that we receive the UB for this one?
[AGENT][NEUTRAL] We send this your way back in February.
[CUSTOMER][NEGATIVE] But we haven't received it.
[AGENT][NEUTRAL] Now
[AGENT][NEUTRAL] OK, um, OK. And all you need to do is send in the primary EOB to us, OK? For the claim to be reprocessed.
[AGENT][NEUTRAL] Um, what is the fax number so I can send you a copy of the EOB?
[CUSTOMER][NEUTRAL] OK, just hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you're sending the secondary one, the UV, right?
[AGENT][NEUTRAL] Yeah, if I send you it's gonna be our explanation of benefits, but the one we need is the primary EOB.
[CUSTOMER][NEUTRAL] OK. It's 513.
[CUSTOMER][NEUTRAL] 993
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7441.
[AGENT][NEUTRAL] 513
[CUSTOMER][NEUTRAL] As I can see here,
[AGENT][NEUTRAL] 993.
[CUSTOMER][NEUTRAL] 513.
[CUSTOMER][NEUTRAL] Yeah, go ahead, please.
[AGENT][NEUTRAL] OK. That's [PII].
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK. Um, and do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] OK. I'd like to see the primary insurance is Cigna, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I believe so. I'll have to go back and check um.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yeah, Cigna.
[CUSTOMER][NEUTRAL] But the CPT has been paid previously like you see here.
[AGENT][NEUTRAL] Uh, I want to apologize again, we only, we have the information, we're the secondary. So if you're looking at the information from Cigna, we need that information, OK? So we're not gonna have that information, OK.
[CUSTOMER][NEUTRAL] OK. After how much time you'll receive the
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK. So how much time it will take, how much time it will take that you will receive the uh primary UV? I mean, you have to receive from home, the primary UV from Cigna, right?
[AGENT][NEUTRAL] You need to send it. You need to send it to us. No, no, no, you need to send it to us. So we are requesting the primary EOB, the detailed primary EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, OK. And where we have to send it?
[AGENT][NEUTRAL] OK, you can fax it or you can mail it.
[AGENT][NEUTRAL] The fax number is 1877.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3659423. Again, that's 18773659423.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] A pension claims.
[CUSTOMER][NEUTRAL] Got that.
[AGENT][NEUTRAL] OK, do you need the address?
[CUSTOMER][NEUTRAL] No, there's no need for that. Uh, what's the reference number for this call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like, Mr. [PII]. Um, do you need me to send the fax with the EOB from us to you or no?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, please send me because we are not having the UB of secondary one also. Yeah.
[AGENT][NEUTRAL] OK. Do you mind?
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] But before that, uh, please spell out your name. I haven't got that properly.
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. And uh your name and today it is the reference number. All right, take your time.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Correct. Yes, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Oh, thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] That's all I want.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.