AccountId: 011433970860
ContactId: f6f892cf-bf9e-465c-8175-6153fbbc7d04
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287859 ms
Total Talk Time (AGENT): 64900 ms
Total Talk Time (CUSTOMER): 139028 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/f6f892cf-bf9e-465c-8175-6153fbbc7d04_20250623T17:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII] with the provider, and I'm calling to follow up on a claim.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number for the patient?
[CUSTOMER][NEUTRAL] 01628291 ML 8.
[AGENT][NEUTRAL] Patient name and date of birth.
[CUSTOMER][NEUTRAL] Patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And date of service and bill charges.
[CUSTOMER][NEUTRAL] Looking for 2425, the charges were $172,143.
[AGENT][NEUTRAL] OK, this policy termed in 22. Let me uh pull up his recent policy.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, and you can you give me that data service again? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, 2425, and the charges were 172,143.
[AGENT][NEUTRAL] Uh, I don't show the claim on file. Um, this is a secondary policy. It shows primaries with United Healthcare.
[CUSTOMER][NEUTRAL] Yeah, yeah, and you know it's, it's funny because you guys already processed this claim and you actually made a payment, but the issue is that we have been requesting a copy of the canceled check because we haven't gotten it yet. Um, I can give you the claim number.
[AGENT][NEUTRAL] OK, what's the claim number?
[CUSTOMER][NEUTRAL] 3575592
[CUSTOMER][NEUTRAL] And the correct policy number, actually they gave me a correct policy number. I have 254-2046.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I show this claim was for 3308.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh God, you've gotta be kidding.
[CUSTOMER][NEUTRAL] Um, that's not what they told me when I called. Um, OK, I spoke with, let's see here, [PII], um, and she told me this claim was received and processed under that claim number with under the correct policy number that I just gave you, and she's telling me the claim was paid on [PII] for 1,04797 and it was sent to a different address. So we had requested a copy of that canceled check. So then that information has nothing to do with this large claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now I've got a claim for a total of 3308. The procedure code was 9356.
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][NEGATIVE] Unbelievable. I mean, how can you confuse $172,000 for a $3000 claim?
[CUSTOMER][NEUTRAL] Um, that doesn't make sense to me at all, but anyway, OK, so [PII], I guess then we're starting over. OK, so you don't show this claim for $172,000.
[AGENT][NEUTRAL] Uh, no, this is a, it looks like a physician claim. It says Baptist Health Medical Group, but I think it's medical group physicians.
[CUSTOMER][NEUTRAL] That's not us. Yeah, no, no, that, yeah, that's not us. So this claim was faxed to APL on [PII]. Um, it was faxed to [PII]. Is that correct?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, that's right. And it's a UB, right?
[CUSTOMER][NEUTRAL] Yeah, it's a UB yeah it went yeah they faxed it with the uh EOB from United.
[AGENT][NEUTRAL] Uh, we only, only UB we have on file recently would be for [PII].
[CUSTOMER][NEUTRAL] Interesting. OK, so I guess I'm gonna have to refax this over to you with the primary EOB. OK, so just use that same fax number then.
[AGENT][POSITIVE] Yes, that's correct. Yes.
[CUSTOMER][NEUTRAL] OK, do I need a reference number from you, [PII]?
[AGENT][NEUTRAL] Uh, it's just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] All right thank you so much.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a good day. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.