AccountId: 011433970860
ContactId: e50d778e-0796-46c8-9562-ebe932d9e396
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1340719 ms
Total Talk Time (AGENT): 485598 ms
Total Talk Time (CUSTOMER): 362160 ms
Interruptions: 10
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/e50d778e-0796-46c8-9562-ebe932d9e396_20250610T16:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes [PII], my name is [PII] and I'm calling from NMed Health. I have like 4 claims to check on please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], are they for the same number that you're needing to check for in multiple dates of service or 4 different patients?
[CUSTOMER][NEUTRAL] They're all
[CUSTOMER][NEUTRAL] 4 different patients.
[AGENT][NEUTRAL] Yes ma'am, I can help you with that, and [PII], you will use my name that I gave you along with today's date as each of your call reference numbers. Also, any information that is provided will be a verification of benefits and not a guarantee of payment. And then lastly, if we do have the claims on file once I provide you with the claim number, you should be able to print the explanation of benefits from our portal if you need a copy of it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] By going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] put a D on it.
[AGENT][NEUTRAL] Uh-huh, so it's [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] All right. You're welcome. And what is a good callback number for you, please, [PII]?
[CUSTOMER][NEUTRAL] OK, I had to.
[CUSTOMER][NEUTRAL] It's [PII] and that is correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. Thank you. And what is the first patient policy number?
[CUSTOMER][NEUTRAL] 02456511
[AGENT][POSITIVE] Alright thank you one moment.
[AGENT][NEUTRAL] OK, so what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And the date of service and total bill amounts, please.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And total charges are $32,062.
[AGENT][NEUTRAL] OK, so that was 413 4:30. Is that correct?
[AGENT][NEUTRAL] Of [PII]. All right, one moment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this claim has been received more than once, um, the most recently received claim was denied as a duplicate of previously submitted expenses. Do you need the original claim information?
[CUSTOMER][NEUTRAL] Well, we have the EOB and it says that the um that the primary EOB doesn't have co-insurance, um, deductible and copay on it, but it should have.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She, it's only co-insurance that is.
[CUSTOMER][NEUTRAL] Left on the primary $889.88.
[CUSTOMER][NEUTRAL] Is that what you're showing the main reason?
[AGENT][NEUTRAL] Yes, is that we were needing a detailed explanation of benefits.
[AGENT][NEUTRAL] So are you saying that that's what was submitted the 2nd time?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I was, it should have been, it was submitted the first time the explanation of benefits has right on it that the patient owes 889-88 coinsurance. So I'm not sure if y'all didn't receive that EOB or you, you can't see it on it or.
[AGENT][NEUTRAL] OK, let me, let me just see if I can.
[CUSTOMER][NEUTRAL] What I need to do.
[AGENT][NEUTRAL] Bear with me just a second
[AGENT][NEUTRAL] That's the bill.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] I see co-insurance. Let me go back to that remark.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so bear with me just a moment it's gonna take me a few minutes to do this, but I'm gonna send a request to have this claim re-reviewed, reprocessed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because you do see that on the primary EOB?
[AGENT][NEUTRAL] I can see that, yes, ma'am. So all I can do is, yeah, just send that, yeah, so give me just a moment.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Well, I say give me a moment, it's gonna take me more than a moment to do it.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] That's OK. I, I got all day.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] All right. Thank you for understanding and your patience.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Um
[AGENT][NEGATIVE] OK, so do you need any additional information on this number, [PII]? I mean, [PII]? Oh my goodness, I'm losing it.
[CUSTOMER][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] No, ma'am, that's all I needed on. That's OK.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][POSITIVE] That's all I needed on that one.
[AGENT][NEUTRAL] All right, so let me just finish this up then.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Well, bear with me one second.
[CUSTOMER][NEUTRAL] OK, you're fine.
[AGENT][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] OK, so I have gotten that one submitted for it to be re-reviewed for potential reprocessing, OK?
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, and what is your next patient's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] It's 02587162.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEGATIVE] Oh [PII]. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the day the service and total bill amount for him?
[CUSTOMER][NEUTRAL] Um, it's [PII] for $1,398.29.
[AGENT][NEUTRAL] OK, so 51 2025 for $1,398.29 is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for him for that data service.
[AGENT][NEUTRAL] [PII] of 2025.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Can I fax that to you or?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You certainly can. The fax number you would send that to is [PII] Attention claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] Let
[AGENT][NEUTRAL] Do you need any other information on this number?
[CUSTOMER][NEUTRAL] No, ma'am, I, that's all.
[AGENT][NEUTRAL] All right, and the next station's policy number?
[CUSTOMER][NEUTRAL] It is 02137656.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And your patient's name and date of birth on this one?
[CUSTOMER][NEUTRAL] [PII], um, date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the data service and total bill amount for him?
[CUSTOMER][NEUTRAL] It's [PII] $462.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And for 426 of 2024, there is also no claim on file for him.
[CUSTOMER][NEGATIVE] Uh, what is your filing limit limit? Uh, can I talk filing no timely.
[AGENT][NEGATIVE] There's no timely filing. Yes, there's no, we do not have a timely, correct.
[CUSTOMER][POSITIVE] Wow, OK.
[CUSTOMER][POSITIVE] Alright, I'll send that one over as well and my last one if you don't mind.
[AGENT][NEUTRAL] Alright, alright, alright, so give me just a second.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] Wonder, um,
[AGENT][NEUTRAL] Did you have another question on Mr. [PII]'s coverage?
[CUSTOMER][NEUTRAL] No, mm mm, I was trying, I guess I'm wondering we fax, um, may we submit these electronically. I was wondering what um payer ID we used, but.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] 60801. OK, I'm gonna check that too to make sure.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] We have it correct.
[AGENT][NEUTRAL] Alright, and then I'm ready whenever you are, [PII] said the last one.
[CUSTOMER][NEUTRAL] It's, well, it looks different. I have 994158.
[CUSTOMER][NEUTRAL] It looks different from the other ones I've given you.
[AGENT][NEUTRAL] Mm, let me just see if that's an older policy. OK.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] All right, thank you. So that is a valid number and yes, it's just because she's had this policy or had the policy for quite some time. So.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is her um date of birth one more time, please?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, thank you and her data service and total bill amount?
[CUSTOMER][NEUTRAL] It's [PII] $891.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so, and that was the total bill amount $891?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so I don't have a claim on file for her for that data service and build out.
[CUSTOMER][NEUTRAL] OK, so I noticed on, I checked two of them just now that you don't have. We don't have the payer ID right, so that could be it, but the one that you, the one that you do have that, you know, so the primary OB didn't show the coinsurance and all that.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We don't have the payer ID right on it either, so.
[AGENT][NEUTRAL] Oh, I don't know if that was mailed. Maybe it was mailed in. It would have had to be because if the payer ID is not right, we could not have received it that way.
[CUSTOMER][NEUTRAL] I mean, on that one.
[CUSTOMER][NEUTRAL] Yeah, OK, so I'm gonna try to get these payer IDs corrected and I'm gonna fax the ones that you don't have with the primary EOB.
[AGENT][NEUTRAL] Let me see, yeah.
[AGENT][NEUTRAL] Yeah, cause I can't tell.
[AGENT][NEUTRAL] OK, I can't tell on that one that I sent back for reprocessing.
[AGENT][NEUTRAL] How it was actually.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Received.
[CUSTOMER][NEUTRAL] I'm gonna look and see if we have notes on how we sent it.
[AGENT][NEUTRAL] Uh, it looks.
[AGENT][NEUTRAL] It looks like maybe as a fax.
[AGENT][NEUTRAL] Maybe it's a fax.
[CUSTOMER][NEUTRAL] Yes, it was faxed to y'all 85 I mean 528.
[AGENT][NEUTRAL] Uh, 4:15. 0.
[CUSTOMER][NEUTRAL] Submitted
[CUSTOMER][NEUTRAL] Let's see, from the very start I think we mailed it.
[CUSTOMER][NEUTRAL] Now we've got lots of notes on that very first one, but.
[CUSTOMER][NEUTRAL] Yeah, I think that's what happened. We mailed that first one, sure did. We mailed it on.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Actually [PII] is our note. I'm gonna get this corrected. um I do have one more question so when you use your website you said you have to have the claim number?
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You should not have to provided that you have the uh if we have a claim on file for the member that has been processed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you have the other information that it's asking for for the patient that you're looking for, then you should be able to find it again provided the tax ID number, the patient account number now the patient account number, we have a new portal so I'm not 100% familiar with it yet. I mean this is like really new, like a week new um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But if it asks you for the patient account number, that is not their APL policy number [PII], that is going to be the patient account number that you all have for the member.
[CUSTOMER][POSITIVE] Oh goodness.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That you're using on your claim. It's, it's the provider's patient account number for them.
[CUSTOMER][POSITIVE] Oh, OK. Great. Mhm.
[AGENT][NEUTRAL] So in the past some people have gotten confused on that, but if you're not able to find it and you have all of the criteria that's required to search for the claim, then yes, once uh you call us and we provide you the claim number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You should be able to to access it if it's on file.
[CUSTOMER][NEUTRAL] Yeah, OK, and the ones like.
[AGENT][NEGATIVE] Of course it would be a claim number if we didn't have it on file so that's kind of silly for me to even say that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] That's OK, but would it tell me that there's no claim there for on this data service, I guess, right? Or just wouldn't, oh, OK.
[AGENT][NEUTRAL] I don't think that it's, yeah, I don't know that exactly how it would be worded. It just may say, you know, uh, no information found or patient not found. I mean, it should give you some form of message.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So again,
[CUSTOMER][NEUTRAL] OK and one more thing too, can you verify, I'm sorry.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The correct mailing address because the second one we mailed to you and you didn't have it so.
[AGENT][NEUTRAL] The correct address for these claims would be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, so we, the second one I asked you about, we actually mailed it [PII], so I don't know if it's not had enough time to get to y'all get in your system since it's actually been mailed.
[AGENT][NEUTRAL] Now, if it was just mailed on the [PII], that was last, yeah, that, that could be, that could be it because obviously with the mail service, it's not quite as.
[CUSTOMER][NEUTRAL] Um, so, I mean, that's just a week or two.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Um, swift as it used to be.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But um, so yes, we may receive that if you choose to send that one again, you know, hypothetically via fax.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I mean, we'll still review both so we would process kind of like that when I read you the remark on that I sent back for review again where we denied it as a duplicate of previously submitted expenses so you know there's no harm or foul if we receive it twice.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes. Mhm.
[CUSTOMER][POSITIVE] OK, I will send these over. Thank you for your help.
[AGENT][POSITIVE] All right. You are certainly very welcome. Is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am, that's all thank you.
[AGENT][POSITIVE] OK. Well, you're welcome, [PII], and thank you for calling APL. I hope you have a wonderful rest of your day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.