AccountId: 011433970860
ContactId: f252210c-bcdc-40bb-b673-554974298d10
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 390230 ms
Total Talk Time (AGENT): 186056 ms
Total Talk Time (CUSTOMER): 108536 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/f252210c-bcdc-40bb-b673-554974298d10_20250623T16:56_UTC.wav
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[AGENT][NEUTRAL] APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I'm calling from Tiff Regional Medical Center. We had received a looks like we received a claim from you all that denied for missing the uh primary EOB with the secondary that we sent you all, but we had mailed the secondary claim with primary EOB, so I just wanna understand why there was a discrepancy like that.
[AGENT][POSITIVE] I'd be happy to assist with the claim. Can you repeat your first name for me?
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][POSITIVE] [PII]? OK, and [PII], if I can get a good contact number for you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is 02435569.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the data service for the claim?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you for that information.
[AGENT][NEGATIVE] I'm not showing this denied as needing a primary EOB. I'm showing that it denied because, um, there.
[AGENT][NEGATIVE] It wasn't covered or there was no patient responsibility assigned.
[AGENT][NEUTRAL] By the insurance, um, let me pull up the EOB.
[CUSTOMER][NEUTRAL] So we receive.
[CUSTOMER][NEGATIVE] Yeah, we received on [PII]. It says secondary payment not paid without EOB primary.
[AGENT][NEUTRAL] Are you, are these the same dates of service because I only see.
[CUSTOMER][POSITIVE] Correct, it
[AGENT][NEUTRAL] What's the claim number you have then? Let me pull it up by claim number.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Um, claim number.
[CUSTOMER][NEUTRAL] I got our claim number uh it was 102.
[CUSTOMER][NEUTRAL] 05 0 you can't do that.
[AGENT][NEUTRAL] I can't not I need our claim number if we, if, if you're saying we denied it for needing the EOB then there's a claim number on that EOB we sent you. That's the claim number I need.
[CUSTOMER][NEUTRAL] Uh well.
[CUSTOMER][NEUTRAL] I'm trying to see if I can locate it, but, uh, I mean like I said I can give you a data service and a total build amount.
[AGENT][NEUTRAL] OK, I'm telling you that we've only received a claim for you one time. What's the, um, matter of fact, what is your, uh, tax ID? Let me make sure that you're this is even.
[AGENT][NEUTRAL] The correct tax ID.
[CUSTOMER][NEUTRAL] OK, tax ID it is [PII].
[AGENT][NEUTRAL] OK, that is the tax ID that we have. I'm showing we only received the claim for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One time that's the only claim we receive from anyone for that data service so if you received an explanation of benefits from us saying that we need an EOB that's not matching my records so I need that claim number that you're you're saying is attached to what we were asking for.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Now is the charge amount 2000.
[CUSTOMER][NEUTRAL] What was the one that it said cause I know you said it was.
[AGENT][NEGATIVE] Is the charge amount 20079512, OK, yeah, we only received that once and we denied it stating um one moment let me pull it up. This denial is for.
[CUSTOMER][NEUTRAL] Yeah, 2007
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] Benefits are only payable if it's covered by the um primary, so.
[AGENT][NEUTRAL] One moment, let me, let me pull up the um EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can you see the EOB that you sent us?
[CUSTOMER][NEUTRAL] I cannot, no, I just see what's kind of listed.
[AGENT][NEUTRAL] OK. Well, the EOB.
[AGENT][NEGATIVE] OK, the EOB that you sent us, nothing was approved by the primary. Um, the first line of adjudication denied because benefit maximum for this time period or occurrence has been reached. That was also the denial for the second line of adjudication. The third line of adjudication, um, denied because pre-certification, authorization, or notification may be valid but does not apply to the bill services, so they denied that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let's see, 4th line of adjudication denied for the same thing, pre-certification authorization notification. 5th line denied for benefit maximum is for for this time period of recurrence has been reached, so did the 6th line.
[CUSTOMER][NEUTRAL] Um-hum.
[AGENT][NEGATIVE] So there was nothing for us to pay because none of the claim was covered and that's why we sent the denial. We never said anything about needing an EOB because we clearly have the EOB.
[CUSTOMER][NEUTRAL] OK, that's what I was curious how it was worded too so basically because essentially nothing was paid by the primary you you all are gonna cover.
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] Right, there was no patient responsibility covered patient responsibility for us to pay because nothing was applied to their deductible co-insurance or co-pay.
[CUSTOMER][POSITIVE] OK, alright, well, no worries then. I'll just make note of that as well if I could just get a reference number for this call I greatly appreciate it.
[AGENT][NEUTRAL] OK, reference is just my name [PII], last initial [PII] as [PII] [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Uh, no, that'll be it.
[AGENT][POSITIVE] OK, well thank you for calling APO you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mhm.