AccountId: 011433970860
ContactId: f887a310-b80c-45b1-b061-0ebee558a84b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1572439 ms
Total Talk Time (AGENT): 338134 ms
Total Talk Time (CUSTOMER): 231455 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/f887a310-b80c-45b1-b061-0ebee558a84b_20250210T15:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. I'm calling to check status on a few claims for a patient, um, if you can help me with that.
[AGENT][POSITIVE] Yeah, absolutely. Happy to check on claims. What is the patient's policy number?
[CUSTOMER][NEUTRAL] It's 01986845 ML 8.
[AGENT][POSITIVE] Alright, thank you for that.
[AGENT][NEUTRAL] And if you don't mind, can I grab your first name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] And patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright thank you and then data service?
[CUSTOMER][NEUTRAL] And date of service is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the first claim is for $2,896.
[AGENT][NEUTRAL] OK, thank you. Let me take a look here.
[AGENT][NEUTRAL] OK, so I'm not showing any claims on file for [PII]. Um, I will let you know the member plan number, the policy number that you gave me, that one did terminate back in [PII]. The active policy is a different policy number. I'm not sure if you need, need that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, when did this one terminate?
[AGENT][NEUTRAL] Um, this one terminated [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, and what is the new policy number?
[AGENT][NEUTRAL] So the active policy is 025727.
[AGENT][NEUTRAL] 64.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, and is there any claims, um, is, does this policy number have a claim for that data service and bill amount?
[AGENT][NEUTRAL] It doesn't. Let me check this other one though just to make sure. One second.
[AGENT][NEUTRAL] It was 2896.
[AGENT][NEUTRAL] OK, so I don't see any claims for the 20896. Do you have a different amount after the primary?
[CUSTOMER][NEUTRAL] 1,196
[AGENT][NEUTRAL] Yeah, I don't see anything for that bill amount either.
[CUSTOMER][NEUTRAL] And what about for 540?
[AGENT][NEUTRAL] 5:40.
[CUSTOMER][NEUTRAL] For Gulfstream Anesthesia Group.
[CUSTOMER][NEUTRAL] That's weird because the patient said he received an EOB for 3 claims, which are the 3 that I.
[AGENT][NEUTRAL] So there are, yeah, there are 3. I'm gonna pull them up here and see who they're for.
[AGENT][NEUTRAL] We're just different.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] We did get a claim for Gulfstream anesthesia Group. The bill amount that came over for us was 360, and that was the amount paid on the claim.
[CUSTOMER][NEUTRAL] Is that for the same date?
[AGENT][NEUTRAL] Mhm for [PII], correct.
[CUSTOMER][NEUTRAL] And that paid how much?
[AGENT][NEUTRAL] This one paid $360.
[CUSTOMER][NEUTRAL] And is there a check number EFT or can you possibly send me the EOB by fax?
[AGENT][NEUTRAL] Um, yeah, so it was a single check. I can give you the check number and I can also fax CEOB if you need that also. Uh, the check number, do you need that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, no, if you're going to send it to me, I don't need it right now. Um, the fax number is 786.
[CUSTOMER][NEUTRAL] 497
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2989
[AGENT][NEUTRAL] OK. And should I mark attention to your name?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, [PII].
[CUSTOMER][NEUTRAL] And the other two that you have there are for whom?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see, let me pull those up. Give me just a second.
[CUSTOMER][NEUTRAL] Because the, the thing is that I'm, I'm a little confused that you're not, you're not showing ours because, well,
[CUSTOMER][NEGATIVE] The the other claims that I'm looking for is because they were all sent on the same day.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they were sent with this Gulfstream anesthesia group as well.
[CUSTOMER][NEUTRAL] So we have, we bill for 3 different companies are all in the same, you know, center done on the same day. So we bill for Palmetto Surgery Center and for digestive medicine associates and Gulfstream Anesthesia Group.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And these were all sent on the same day together.
[AGENT][NEUTRAL] OK, so there is a claim that I show for the Palmetto Surgery Center. It looks like the charge amount that came through was for 497.86 date of service [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on this claim we paid a benefit of 242 66.
[CUSTOMER][NEUTRAL] 42
[CUSTOMER][NEUTRAL] OK, can you also send me that EUP?
[AGENT][POSITIVE] Mhm, yep, absolutely. Let me just finish sending this first one.
[AGENT][NEUTRAL] And then I can go over this 3rd 1 too. Let me just get this sent over, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And then the other one that I see was for the digestive medicine associates.
[AGENT][NEUTRAL] The bill amount that I showed the charge was 34734.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we sent a benefit payment for that amount of 30 or 34734, excuse me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I need that one as well.
[AGENT][POSITIVE] And I can fax this one, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, perfect, um.
[CUSTOMER][NEUTRAL] And these are all being processed under that new policy number that you gave me.
[AGENT][NEUTRAL] Actually, this
[CUSTOMER][NEUTRAL] The 0257.
[AGENT][NEUTRAL] Um, it was actually a different policy number at that time, [PII]. Do you want it? It's not active anymore, but
[CUSTOMER][NEUTRAL] And that was active from 1 to 1.
[AGENT][NEUTRAL] Let me give you the dates on this, sorry, give me just a second.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, so these claims processed under a policy that was active from [PII] to [PII] of 24.
[CUSTOMER][NEUTRAL] 12 1.
[CUSTOMER][NEUTRAL] 24 OK.
[CUSTOMER][NEUTRAL] And I'm so I'm guessing that this new policy number is active from 12-124 to current.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that policy number is
[AGENT][NEUTRAL] The one that's currently active?
[CUSTOMER][NEUTRAL] No, the one that this process under.
[AGENT][NEUTRAL] Oh, the one that they processed under was 228.
[AGENT][NEUTRAL] 4007.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] If you can send me those um 3 EOBs, I would greatly appreciate it.
[AGENT][POSITIVE] Yeah, absolutely. I'm sending the last one now so they should be coming through here in a few minutes.
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] This is weird because I'm showing on the EOB for the Gulfstream Anesthesia Group 0 was paid.
[AGENT][NEUTRAL] Oh, weird. Let me go back to that one then. Give me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I wonder if there were 2 of them. Maybe I sent you the wrong one.
[AGENT][NEUTRAL] Let me see here.
[AGENT][NEGATIVE] Uh, the first one shows 0 pay of course.
[AGENT][POSITIVE] It's Monday. I'm sorry.
[CUSTOMER][POSITIVE] It's OK, I completely understand.
[AGENT][NEUTRAL] Let me see the second one.
[CUSTOMER][POSITIVE] Luckily I checked it before we hung up because then I would have to call back and see this one.
[AGENT][NEUTRAL] Try this.
[AGENT][NEUTRAL] I know, right, like a crease, let's see.
[CUSTOMER][NEUTRAL] And the one for digestive medicine is also at 0.
[AGENT][NEUTRAL] Did they both show 0? Looks like at one point they were like a waiting eligibility, so.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was paid to the provider. It wasn't paid to the patient. I was like, let me double check that too, make sure.
[AGENT][NEUTRAL] OK, 360 let me send this one.
[AGENT][NEUTRAL] And you said the digestive medicine one too?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah, don't print it out. No, no, cause they're gonna resend it. This is the wrong one. Don't print it.
[CUSTOMER][NEUTRAL] Yes, I saw them.
[AGENT][NEUTRAL] OK, so I res.
[AGENT][NEUTRAL] The one showing the 360 and then the 34734.
[AGENT][POSITIVE] Hopefully, I send the right ones.
[CUSTOMER][NEUTRAL] OK, so then we still need the 3rd 1.
[CUSTOMER][NEUTRAL] The 242 66.
[AGENT][NEUTRAL] You haven't gotten that one yet?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] Let me try reset.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so I got the one for 360.
[AGENT][POSITIVE] OK, good deal.
[AGENT][NEUTRAL] The 347 34 should be coming right behind that one.
[AGENT][NEUTRAL] And then I'm resending this other one right now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like the last one just shows it successfully sent.
[AGENT][NEUTRAL] On my side.
[CUSTOMER][POSITIVE] OK, yes, I got it.
[CUSTOMER][NEUTRAL] Let me just make sure that I have.
[CUSTOMER][NEUTRAL] But um
[CUSTOMER][NEUTRAL] Just the medicine.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Street
[CUSTOMER][NEGATIVE] I'm still missing the one for the Palmetto Surgery Center, the one that's paid for 24264.
[AGENT][NEUTRAL] Yeah, that's the one that I just got the sent message on.
[CUSTOMER][NEUTRAL] Oh, OK, so it should be coming in then.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] It should be coming, yeah. Um.
[CUSTOMER][NEUTRAL] 343.
[CUSTOMER][NEUTRAL] Still has not come in yet.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Alright, I resend it again just to make sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] I still haven't got any yet.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Where are the other two and then this one.
[CUSTOMER][POSITIVE] OK, I think I just got it.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][POSITIVE] Yes, I got it. Thank you so very much for your help.
[AGENT][NEUTRAL] Oh yeah, not a problem, [PII]. Anything else we need to check on?
[CUSTOMER][POSITIVE] That's it, thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] OK.