AccountId: 011433970860
ContactId: d7ee434c-2c3d-46b0-9c37-e34d959ff6a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 737080 ms
Total Talk Time (AGENT): 193458 ms
Total Talk Time (CUSTOMER): 197821 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/d7ee434c-2c3d-46b0-9c37-e34d959ff6a4_20250204T17:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling AP this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII]. I'm calling from provider office to check on the claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can I please get your callback number, sir, just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Uh, sure. Callback is [PII]. And it's a direct line?
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Patient name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK and then [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And his policy number please?
[CUSTOMER][NEUTRAL] Policy number is?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's 01
[CUSTOMER][NEUTRAL] Uh, just give
[CUSTOMER][NEUTRAL] Uh yes, 01988259.
[AGENT][NEUTRAL] OK, let me pull that policy in for us real quick, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I've got the policy pulled up. What is [PII]'s service?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] And total charge amount is $6460.90.
[AGENT][NEUTRAL] Thank you and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] So, primary they paid.
[CUSTOMER][NEUTRAL] $3,472.63 with a patient responsible of 20 $2,988.27.
[CUSTOMER][NEUTRAL] To
[AGENT][NEUTRAL] Thank you and then what is the name of the facility that you're calling for?
[CUSTOMER][NEUTRAL] I'm calling from Holy Cross Hospital.
[CUSTOMER][NEUTRAL] Very
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], thank you for holding for me. This is [PII] so I do find the claim. The claim number is 346-4789.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] And processed it on [PII].
[AGENT][NEUTRAL] The claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK. So, for this claim, the, uh, just to confirm, the claim number is 346-4789.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] You said that you received the claim on [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But, uh, is there any payment for this claim? Because uh we do see that uh there is a payment of $437.56.
[AGENT][NEUTRAL] No, this claim has not been paid because we don't have the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have the claim number for the one that was paid?
[CUSTOMER][NEUTRAL] Yes, I have the claim number 35296.
[CUSTOMER][NEUTRAL] 86, which was paid $437 and
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's son.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look at that one for you.
[AGENT][NEGATIVE] Yes, this one was paid but it was for a different amount. It wasn't for the same amount as the first.
[AGENT][NEUTRAL] Point that you gave me.
[CUSTOMER][NEUTRAL] Yes. The, uh, so for this one, actually, the date of service is [PII]. The total charge amount is $6460.90.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] The charge amount is $2,988.27.
[CUSTOMER][NEUTRAL] Uh, I'm looking for date of service, uh, [PII].
[CUSTOMER][NEUTRAL] For the total charge amount of $6460.90.
[AGENT][NEUTRAL] OK, that would be claim number 3464789 and that claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK. So then the
[CUSTOMER][NEUTRAL] Uh, paid amount $4437.56. That is for which state of service?
[AGENT][NEUTRAL] It's also so for [PII], but that's a completely different claim than this one.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Actually, on this uh 5-132024, we have billed for the total charge of $6460.90 only that claim, which was uh Blue Cross is primary.
[CUSTOMER][NEUTRAL] So, we already received a payment from them.
[AGENT][NEUTRAL] OK, that
[AGENT][NEUTRAL] OK, so the claim number is 346-4789 and the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for this one, and can I know your claim mailing address?
[AGENT][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Uh, can we, uh, you want us to submit the, you want us to submit only the primary care EOB or you want us to send the corrected claim for this one?
[AGENT][NEUTRAL] Send um the EOB and you can reference claim number 3464789.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] So you want us to send a corrected claim.
[AGENT][NEUTRAL] You don't have to correct the claim. You can just send the EOB reference claim number 3464789.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And can I have your fax number?
[AGENT][NEUTRAL] Yes sir, that's [PII].
[CUSTOMER][NEUTRAL] OK. And, do I need to mention any attention to?
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] OK. And you're the 3, right?
[AGENT][NEUTRAL] Sir, what did you just say?
[CUSTOMER][NEUTRAL] You're the secondary payer, right?
[AGENT][NEUTRAL] We're the second, secondary, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And will there be any co-pay deductible going insurance?
[AGENT][NEUTRAL] That depends on what's on the itemized statement and the explanation of benefits from the primary insurance what they paid.
[CUSTOMER][NEUTRAL] OK. OK, then, uh, thank you very much. Let me go ahead and fax, uh, fax you the primary OP and thank you very much. And can I have your call reference number?
[AGENT][NEUTRAL] Yes, you can use my name. It's [PII] and today's date.
[CUSTOMER][POSITIVE] OK. Sorry then. Thank you very much. You have a wonderful day.
[AGENT][POSITIVE] You too, [PII] thank you you have a blessed day and thanks for calling ATL.
[CUSTOMER][NEUTRAL] OK bye for now.
[AGENT][NEUTRAL] Bye bye.