AccountId: 011433970860
ContactId: d782de51-7f27-493e-bbe9-8e0d0ff12bfc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 579059 ms
Total Talk Time (AGENT): 107882 ms
Total Talk Time (CUSTOMER): 200818 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/d782de51-7f27-493e-bbe9-8e0d0ff12bfc_20250324T16:14_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, can you hear me?
[CUSTOMER][NEUTRAL] Uh, I can now.
[AGENT][POSITIVE] How can I assist you today?
[CUSTOMER][NEUTRAL] Are you still there?
[CUSTOMER][NEUTRAL] Yes, um, so I'm calling from Complete Health Center. Uh, there wasn't really, uh, a selection to choose for chiropractic for, uh, a patient of ours. I have the policy number if that will help to see if I'm in the right spot here.
[AGENT][POSITIVE] I'd be happy to assist with benefits and eligibility. May I have your first name please?
[CUSTOMER][NEUTRAL] Uh, this is actually regarding a claim. Uh my name is [PII] from Complete Health Center.
[AGENT][POSITIVE] And [PII], if I can get a good call back number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Is 02559705
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you for that information.
[AGENT][NEUTRAL] And what's the date of service for the claim?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, the actual data service service is 35 of 25, um, but we've got the explanation of benefits is dated [PII], and I think what possibly happened is we had received one payment for Nakira, um, for 175, and then, uh, we.
[CUSTOMER][NEUTRAL] Processed a claim on the same date of [PII] for the same amount for her daughter [PII].
[CUSTOMER][NEUTRAL] And I'm wondering if they processed them both as [PII] instead of one as [PII] because they both were new patients on that day, so they both had a new patient exam and it was the same amount. It was the 175 that was submitted.
[AGENT][NEUTRAL] OK, one moment, um, and what's the claim number that you have?
[CUSTOMER][NEUTRAL] Uh, the claim number on the paper that said it was a duplicate is 3576281.
[CUSTOMER][NEUTRAL] And then I'm, I'm not really understanding the, the other things that came back saying I mean we got that one payment for Akira for $50 and then all the other claims say that they're waiting on information to confirm eligibility for benefits in a card.
[AGENT][NEUTRAL] OK, because it looks like I'm pulling up the claim and it was a duplicate for [PII].
[AGENT][NEUTRAL] We don't, I don't see one for.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think they processed it wrong then because one was submitted under [PII]. I mean it's her policy, but it's one was submitted on that date under her daughter [PII] and then one was submitted.
[CUSTOMER][NEUTRAL] Under and the name is spelled wrong on on the form that we got from you. It's spelled [PII] but it's supposed to be [PII]
[CUSTOMER][NEUTRAL] But one was sent in for the same data service for [PII] and one was sent for [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] 35.
[AGENT][NEUTRAL] And 312, so I'll need to send that one back to be reprocessed.
[AGENT][NEUTRAL] For
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] OK, I've sent that back to the examiner so she can um take a look at it and get it reprocessed if you can please allow 7 to 10 business days for that updated explanation of benefits.
[CUSTOMER][NEUTRAL] OK and then is that why, um, is that why the future, the ones after that have come back saying they're waiting on information to confirm eligibility?
[AGENT][NEUTRAL] Now, for those, um.
[CUSTOMER][NEGATIVE] It just seems odd that after the first one and they paid that one, then now it's saying that they're waiting for.
[AGENT][NEUTRAL] So 224 to 32, 33 to 39, 310 to 316.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So there's um the four dates of service that we sent for [PII] are 35, 312, 314, and 319.
[CUSTOMER][NEUTRAL] And then the dates of service for [PII] are 35 as well, and then 3-10, 312 and 314.
[CUSTOMER][NEUTRAL] And the only payment we've gotten is the one payment for [PII] for the data service of 35.
[AGENT][NEUTRAL] So we just received updated um information.
[AGENT][NEUTRAL] Which we just got it in their file just updated today and it's really their premium just updated we don't like to tell that to the.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Customer because then they run back and like um you know, so we just, you know, but that's what's going on. We were waiting for premium for those dates of service. Um, the [PII] we haven't gotten yet, but once, um, once they see because we just got the premium in for the [PII] through the [PII], so they're gonna go back and reprocess those claims.
[CUSTOMER][NEUTRAL] Oh sure, I understand.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, perfect and then is there like a reference number for the call?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call.
[CUSTOMER][POSITIVE] OK perfect all right I really appreciate it thank you so much.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too mhm bye.
[AGENT][NEUTRAL] Mhm.