AccountId: 011433970860
ContactId: dc34781c-dca1-4ed7-ad1e-1be0b22c4114
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 629710 ms
Total Talk Time (AGENT): 140340 ms
Total Talk Time (CUSTOMER): 108944 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/dc34781c-dca1-4ed7-ad1e-1be0b22c4114_20250407T13:50_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, hi [PII], my name is [PII], um, and I'm calling from Tulsa Pain Consultants, and I wanted to check on a claim. Um, I had sent a fax in for the primary EOB showing that there was a balance, and I think it came back as a duplicate, so I was needing someone to look at that with me.
[AGENT][POSITIVE] Sure, I can assist you with that, [PII].
[AGENT][NEUTRAL] I have a callback number for you and that policy number.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure, callback number is [PII].
[CUSTOMER][NEUTRAL] And the ID number is 02503347.
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure, it is [PII] and his date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], could you provide me with that callback number one more time if you don't mind? I apologize.
[CUSTOMER][NEUTRAL] Sure, absolutely that's OK, it's [PII].
[AGENT][NEUTRAL] Thank you. And are you, what's the date of service that you're inquiring about?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh, I got it
[AGENT][NEUTRAL] So the claim was originally submitted [PII].
[AGENT][NEUTRAL] It was originally submitted on [PII]. It was processed [PII]. There was no payment made on the claim, and the reason why there was no payment the very first time it was submitted is because it says benefits are payable only if the primary, if the major medical insurance provides benefits. So let me see what sent over to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] So when you resubmitted the claim, where their benefits went towards deductible, copay, and co-insurance?
[CUSTOMER][NEUTRAL] Um, yes, so primary, um, left the $60 co-pay, um, on this claim.
[AGENT][NEUTRAL] So let me verify, so let me take the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Nothing was both deductible and copay on the first submitted claim. So now let me look at the second one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][MIXED] Deductible OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 1521952.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 65633.
[AGENT][NEUTRAL] If there is a $60 payment for 64633.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, so I'm gonna send this over to the adjuster so they can look at this information. May I place you on a brief hold if you don't mind?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] While I send this information to the adjuster? You're welcome, [PII]. Hold one moment.
[CUSTOMER][POSITIVE] Absolutely I appreciate your help.
[CUSTOMER][POSITIVE] Perfect, thank you.
[CUSTOMER][NEUTRAL] OK.
[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. I apologize for the inconvenience. You did say your name was [PII], correct?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Because I'll change the name in a minute, [PII] to make sure so I've sent that information over to the adjuster to um review the claim and to verify if there's the payment should be paid so because I see do see $60 under the CPT code of 633.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The um 646-33 procedure code.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yes, perfect.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, um, do you know about how long that will take for them to review, like should like up to 30 days possibly?
[AGENT][NEUTRAL] Oh, no, it's not gonna take that long.
[CUSTOMER][POSITIVE] Oh OK good
[CUSTOMER][POSITIVE] Good deal um and then um if I just get a reference number for our call today um I sure appreciate your time and help with this.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] We don't provide reference numbers [PII], however, you can use my name which is [PII] in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect, [PII]. OK, I will do that and again thank you so much um for your time with this. I appreciate it and you have a good rest of your day.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well, [PII]. Goodbye.
[CUSTOMER][POSITIVE] Thank you bye bye uh huh bye bye.