AccountId: 011433970860
ContactId: d6e19471-efe8-4ba7-ac45-0760dd9e847d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 530679 ms
Total Talk Time (AGENT): 125610 ms
Total Talk Time (CUSTOMER): 250157 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/d6e19471-efe8-4ba7-ac45-0760dd9e847d_20250422T12:47_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling to follow up on some points.
[AGENT][NEUTRAL] OK, [PII], do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] [PII]. That's a direct line.
[AGENT][NEUTRAL] OK. And do you have the policy number?
[CUSTOMER][NEUTRAL] 02553145
[AGENT][POSITIVE] Thank you, [PII]. Hold on one moment, please.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were just needing some claim status?
[CUSTOMER][NEUTRAL] Well, I have their status I guess.
[CUSTOMER][NEUTRAL] to get a
[CUSTOMER][NEUTRAL] So, um, he had 2 claims that I had talked to a representative on.
[CUSTOMER][NEUTRAL] And they told me that there was no claim on file, so I faxed them over and then I got a denial back for the maximum allowable, um, so let's take a look at those first. Uh, that data service was 182025.
[CUSTOMER][NEUTRAL] Uh, the first bill amount is $745.
[AGENT][NEUTRAL] OK, hold on just a moment, I'll look that up for you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, on this policy, he only gets $1000 per occurrence, and we had already paid that $1000 out.
[CUSTOMER][NEUTRAL] And so you're saying just in general not necessary for the CPT code I was a little confused with how it came across because it said that um.
[CUSTOMER][NEUTRAL] Treatment for the same related condition. I thought maybe it was bundling with something else, but you're just saying in general, he only has $1000 for a 90 day period.
[AGENT][NEUTRAL] Right. Mhm.
[CUSTOMER][NEUTRAL] OK, well, I, I, I'm just not familiar with you, so that's why I just wanna make sure because of course I'll have to send it to his responsibility and of course he'll call us and let you wanting to know why, um, he has several other claims. I talked to a representative on, uh, let's start with this 1, 1114 [PII] that bill amount was $400.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I talked with um.
[CUSTOMER][NEUTRAL] They're having it they were having an issue they thought was.
[CUSTOMER][NEUTRAL] They were needing the W-9.
[CUSTOMER][NEUTRAL] I talked to a representative named I finally got to someone named [PII]. She said she wasn't sure exactly what was needed, but the info requested was from a third party that advised that the 79 could be sent to her, and she took my email address and I sent it over to her, um.
[CUSTOMER][NEGATIVE] Do you see a reason why it still hasn't paid? He has a 3 on [PII] that haven't paid, and this one on [PII] that I'm sure she'll show showing my work queue and just with a denial of lack of info needed, um, provider must update insurance so.
[AGENT][NEUTRAL] Hold on just a second, let me look up the denial reason.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, it was for.
[AGENT][NEUTRAL] You said you talked to [PII] on that. We sent a letter out on that explaining the reason that it was denied.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] Something with the W-9 and it was denied back to the insured as since we had a discrepancy, we had to process the claim to the insured and it was denied to the insured as uh [PII].
[CUSTOMER][NEUTRAL] So you did reprocess these claims?
[AGENT][NEUTRAL] Yes, they were processed, yeah, to the insurance.
[CUSTOMER][NEGATIVE] And once again they've denied due to.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, the bags and that, um, is there, I, for some odd reason we don't have those, um, AOBs uh do you know when they were sent out?
[AGENT][NEUTRAL] We do not send out when we deny something to the insured, it's only to the insured, um, for HIPAA reasons, it doesn't go to the provider, it only goes to the insured.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] So did you get the
[CUSTOMER][NEUTRAL] I'm, I'm confused. I do apologize.
[AGENT][NEUTRAL] Did you get the W-9?
[AGENT][NEUTRAL] Um, worked out with [PII].
[CUSTOMER][NEUTRAL] Well, I mean, I sent it over to her. I emailed it to her on [PII].
[CUSTOMER][NEUTRAL] Do I need to follow up with her? Let me see if I can find her email again.
[AGENT][POSITIVE] Um, I can check on this and give you a call back on this one.
[CUSTOMER][NEUTRAL] Uh her name is [PII].
[AGENT][NEUTRAL] Right, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I mean, it's up to you. I just need to know. I just need to know that if, if there's any additional information that we need to try and get this processed to get me an EOB so I if they are gonna deny for that, I just need to send them over, but I can't do it without a specific EOV stating that for a certain reason, you see what I'm saying.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'll um call you back on that one.
[AGENT][NEUTRAL] Um, what?
[CUSTOMER][NEUTRAL] OK, did you want the other dates?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] So he, he has 3 more on [PII].
[CUSTOMER][NEUTRAL] Um, the first amount was $746.
[CUSTOMER][NEUTRAL] And then the other two were $380 each.
[AGENT][NEUTRAL] Yeah, it would be for the same reason.
[CUSTOMER][NEUTRAL] I mean, I sent all that over. I told her that these are the 4 that were outstanding that you know here's the W-9, um, so yeah, I just need to know if there's another reason why they still haven't reprocessed or.
[AGENT][NEUTRAL] Is that the only dates of service you have?
[CUSTOMER][NEUTRAL] Uh, that's the only ones on my work queue.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] It's a surprise every day.
[AGENT][NEUTRAL] I know how you feel.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] I know you never know what you're gonna walk into, do you? Um, I'll mark the other two that they are truly patient responsibility because he's met, he has a limited plan and he has been met the maximum. So I did verify that and then the other 4 that you're gonna follow up with [PII] concerning the W-9, correct?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, well I do appreciate you looking into that for me and it looks like I just used your name and I.
[AGENT][POSITIVE] And I'll give you a call back shortly.
[CUSTOMER][NEUTRAL] Oh, OK, I appreciate that um and I just use your name and today's date for a reference number correct?
[AGENT][POSITIVE] Yes, ma'am. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] I appreciate all the assistance. You have a good day. Hopefully I'll talk to you soon.
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] But
[AGENT][POSITIVE] You as well. I'll call you shortly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.