AccountId: 011433970860
ContactId: f09b0f33-faa7-4a97-b4b1-c45197f8d729
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 822940 ms
Total Talk Time (AGENT): 198703 ms
Total Talk Time (CUSTOMER): 200870 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/f09b0f33-faa7-4a97-b4b1-c45197f8d729_20250123T17:31_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII] calling from the provider's office regarding claims.
[AGENT][NEUTRAL] OK, I can help you with claims. Can you give me your name again please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, call back number [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And it, what is the patient's name?
[CUSTOMER][NEUTRAL] Patient's name [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] First name is [PII] and the last name [PII]
[AGENT][NEUTRAL] OK. And then what's the patient's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then the patient's policy number, please?
[CUSTOMER][NEUTRAL] 023 00519 M as in Mary, L as in Lima.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] Thank you and then what's the date of service?
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] $17,600 even.
[AGENT][NEUTRAL] $600 even? OK, and what is the charge amount after the primary paid their part?
[CUSTOMER][NEUTRAL] Yeah, patient responsibility is $286.77.
[AGENT][NEUTRAL] Thank you. And then the first initial charge is 600 even. Is that correct?
[CUSTOMER][NEUTRAL] $17,600 even.
[AGENT][NEUTRAL] OK, thank you and then what is the name of the facility that you're calling for?
[CUSTOMER][NEUTRAL] Gastro Health LLC.
[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][POSITIVE] OK thank you so much for holding for me [PII] I did find the claim.
[AGENT][NEUTRAL] The claim number is 3349-6135.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim denied because the insured was not eligible.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, it is 349-613-5.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] Member is not eligible for data service.
[AGENT][NEGATIVE] Right, the member was not right on the date of service.
[CUSTOMER][NEUTRAL] OK. May I have the effective dates?
[AGENT][NEUTRAL] Yes, the effective date was [PII].
[AGENT][NEUTRAL] And the policy lapsed on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Stone.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And is there any other policy active for the member it is?
[CUSTOMER][NEUTRAL] Let me double check.
[CUSTOMER][NEUTRAL] Because we have received the payments from APL.
[CUSTOMER][NEUTRAL] Uh, September and November dates.
[AGENT][NEUTRAL] Uh, let me check. I did find an active policy. Let me give you that policy number. It's 250.
[AGENT][NEUTRAL] 689-3.
[AGENT][NEUTRAL] Let me check on this policy for you real quick to see if it's actually filed on this one.
[AGENT][NEUTRAL] No sir, I don't find a claim filed.
[AGENT][NEUTRAL] With the amounts that you've given me.
[CUSTOMER][NEUTRAL] For [PII] data service, uh we have received a payment from APL.
[CUSTOMER][NEUTRAL] Under the same member ID.
[AGENT][NEGATIVE] OK, I just gave you the new policy number, but this particular claim you're asking about what hasn't, it's not on file, it hasn't been received.
[CUSTOMER][NEUTRAL] [PII] data service.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But you have give the claim number, right?
[AGENT][NEUTRAL] No, I don't have a claim number because the claim is not on file.
[CUSTOMER][NEUTRAL] Again, the data service is 7-15-2024.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You said claim number 3496135 member is not eligible for date of service.
[AGENT][NEUTRAL] Right with the old policy number 2300519, you asked me to look to see if we have any active policies and I gave you um the new policy number that is active, which is 2506893 and the claim is not on file.
[AGENT][NEUTRAL] For the new policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, so under the new policy, there's no active claim, OK. There's no claim, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And then can I get the effective dates for a new policy?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] The effective date is [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is there any alphabets and the member ID, new, new policy ID?
[AGENT][NEUTRAL] Yes, that's the policy number that I gave you 2506893.
[CUSTOMER][NEUTRAL] OK, let's 2506893.
[CUSTOMER][NEUTRAL] And there's a timely following limit?
[AGENT][NEUTRAL] There isn't one.
[CUSTOMER][NEUTRAL] No time.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] And can you please uh spell out your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the last name initial?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And may I have the reference number?
[AGENT][NEUTRAL] Yes, you can use my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK. And I do have one more claim.
[AGENT][NEUTRAL] OK, what is the next member's name?
[CUSTOMER][NEUTRAL] a moment um.
[CUSTOMER][NEUTRAL] [PII], it's [PII] and the last name [PII] sorry [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And then what is Ada's date of birth?
[CUSTOMER][NEUTRAL] No, sorry. [PII].
[AGENT][NEUTRAL] OK, and what is, uh, Ada's policy number?
[CUSTOMER][NEUTRAL] 02430719.
[AGENT][NEUTRAL] OK, let me look that policy up.
[AGENT][NEUTRAL] OK, and then what is the date of service?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm sorry, can you give me the amount again?
[CUSTOMER][NEUTRAL] 116 $2024141.28.
[AGENT][NEUTRAL] $141.28. OK, and then what is the amount after primary paid their part?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, bill amount is $16,600 even and the prime leftover amount is 100, uh, 1 moment.
[CUSTOMER][NEUTRAL] Yeah, $186.28.
[AGENT][NEUTRAL] OK, so the first, you're gonna have to give me the first charge amount again please. You said $141.28?
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Oh, I'm sorry for that. So the original bill amount, total bill amount is $16,600 even and leftover is $186.28.
[AGENT][NEUTRAL] OK, thank you. And then what is the name of the facility?
[CUSTOMER][NEUTRAL] Gastro Health LLC.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I'm gonna put you on a brief hold again, [PII]. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.