AccountId: 011433970860
ContactId: e19c2e9f-f8bc-4b62-90ae-e78c89989121
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 815669 ms
Total Talk Time (AGENT): 180024 ms
Total Talk Time (CUSTOMER): 188349 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/e19c2e9f-f8bc-4b62-90ae-e78c89989121_20250604T14:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII] now calling from provider's office to check up on a claim status. Also this call has been recorded for quality and training purposes. Are you OK with that?
[AGENT][NEUTRAL] Yes, ma'am. And what was your name again?
[CUSTOMER][NEUTRAL] It's [PII] spelled as [PII] initial to my last name would be [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is your callback number?
[CUSTOMER][NEUTRAL] Um, yeah, it's [PII].
[AGENT][POSITIVE] Thank you very much. And I can help you with your claim information. Can you please give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, yeah, sure, just give me a moment.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mm patient's name.
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] The member's policy ID number would be 01622818.
[AGENT][NEUTRAL] OK, let me pull up that policy.
[AGENT][NEUTRAL] OK, and what is the member's name and date of birth?
[CUSTOMER][NEUTRAL] Oh yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you very much. And then may I get the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] with the total charge $905 even.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It was $277 even for both of the codes, the total amount.
[AGENT][NEUTRAL] OK, and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's diagnostic Center for Women LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this claim for you and I will be right back.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you very much for holding for me, Ms. [PII].
[AGENT][NEUTRAL] I have the claim number for you.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] 360-1953
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the claim and the claim has been denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um, yeah, can you help me with the fax number where I can submit the primary EOB to you?
[AGENT][NEUTRAL] Yes, ma'am. That is 1877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 942-3. OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Also, can you help me with the call for this number?
[AGENT][NEUTRAL] Yes, you can use my name [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] OK, thank you. Actually, I do have one more claim with me. Can you help me with those that claim as well?
[AGENT][NEUTRAL] Yes, ma'am. Can you give me the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, yeah, sure. The policy number would be 022.
[CUSTOMER][NEUTRAL] 98883.
[AGENT][NEUTRAL] OK, let me pull up that one.
[AGENT][NEUTRAL] OK, and what is the member's name and date of birth?
[CUSTOMER][NEUTRAL] Um, yeah, the member's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and then may I have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Um, yeah, the date of service is [PII]. Total charge $500 even.
[AGENT][NEUTRAL] OK, and what are the charges after the primary in part?
[CUSTOMER][NEUTRAL] Um, it's actually $383.30.
[AGENT][NEUTRAL] And the name of the facility?
[CUSTOMER][NEUTRAL] Um, it's the same diagnostic center for Women LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold and you look up this claim and I'll be right back.
[CUSTOMER][NEUTRAL] Um, yeah, sure.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 68782.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me. I have this claim information for you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The claim number is
[CUSTOMER][NEUTRAL] Actually I.
[CUSTOMER][NEUTRAL] Um, sorry to interrupt you. Actually, uh, this is for the primary EOB which we have already sent on [PII] through fax.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK it's gonna be a brief hold while I pull the I'll be right back.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you for holding for me uh so the claim information.
[AGENT][NEUTRAL] Is the claim number is 37.
[AGENT][NEUTRAL] 9189.
[AGENT][NEUTRAL] And the claim has been denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is the remark that's on the claim.
[AGENT][NEUTRAL] Uh, it, the incorrect EOB was sent receipt of the reference claim is acknowledged. However, in order for us to process this claim, we need the explanation of benefits that matches the claim information.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] When did you receive that primary GOB?
[AGENT][NEUTRAL] Let's let you know um.
[AGENT][NEUTRAL] We received it on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, and processed it.
[CUSTOMER][NEUTRAL] Yeah, but after that we.
[CUSTOMER][NEUTRAL] Yeah, after that we have, uh, again sent the primary GOB to you on [PII].
[AGENT][NEGATIVE] I do not show that we have received it.
[AGENT][NEUTRAL] You may need to resubmit.
[CUSTOMER][POSITIVE] OK, sure, no problem. I can resubmit that.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Yeah, thank you so much for your help.
[CUSTOMER][NEUTRAL] That's it for the day.
[AGENT][POSITIVE] You're very welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Uh, no, thank you so much. That's it for the day. Hope you have a wonderful day.
[AGENT][POSITIVE] OK, you have a wonderful day too, and thank you for calling APL.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Bye bye take care.
[AGENT][NEUTRAL] You too.