AccountId: 011433970860
ContactId: f9a622b2-006c-4806-b8d7-f9b550f6fbe4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 442230 ms
Total Talk Time (AGENT): 173430 ms
Total Talk Time (CUSTOMER): 129115 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/f9a622b2-006c-4806-b8d7-f9b550f6fbe4_20250529T21:40_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], my name is [PII]. I'm calling on behalf of Cedar Sign and Hospital, and I was hoping you could help me with the status of a claim.
[AGENT][NEUTRAL] I can help you with claim status. [PII]. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] I'm sorry, I have [PII], and then what was the rest? The last 4?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. And what's the policy number?
[CUSTOMER][NEUTRAL] And just for verification, I am calling APL Insurance correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, uh, policy number is 01939659.
[AGENT][NEUTRAL] OK, one moment while I look that up.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the
[AGENT][NEUTRAL] Uh, claim number or the date of service?
[CUSTOMER][NEUTRAL] The data service is 26 to 27 [PII]. The bill amount 54,41652 cents, and we are billing a secondary to Aetna.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you said [PII] of this year, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just one moment while I look it up.
[AGENT][NEUTRAL] And you said the total bill charged was.
[AGENT][NEUTRAL] 54,000.
[CUSTOMER][NEUTRAL] 54,41652 cents.
[AGENT][NEUTRAL] And do you have the procedure code?
[CUSTOMER][NEUTRAL] Um, I'm, I should, uh, let me just verify really quickly.
[CUSTOMER][NEUTRAL] The principal procedure code is 807.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] Sorry, I was about to sneeze. Um, I am showing a claim for that date of service but not that amount and not that procedure code. Um, oh, because you said it was over a few days, correct? So it was.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] The [PII], is that what you said?
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] OK, yeah, I'm not showing a claim. I am showing one for Cedar Sinai but not for that.
[AGENT][NEUTRAL] Procedure.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Is it for the same bill amount?
[AGENT][NEUTRAL] Uh, no, it's, uh, it's for about $8000.
[CUSTOMER][NEUTRAL] And it is not for this data service?
[AGENT][NEUTRAL] It's only for the [PII]. It wasn't for the [PII] and [PII]. It was an inpatient procedure.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, I'm not showing.
[CUSTOMER][NEUTRAL] Yeah, so sometimes what they do is, yeah, so sometimes what they do is they'll split the claim, um, so it is possible that they did that, um.
[AGENT][NEUTRAL] Yeah, because I was seeing one part um and that one's already been processed but I'm not seeing one for the full.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And what's the status of this claim that you're you're showing?
[AGENT][NEUTRAL] OK, I'm showing that we received that claim on [PII]. It was processed on [PII]. Uh, the total bill amount was, I believe it was 8000.
[AGENT][NEUTRAL] Oops.
[AGENT][NEUTRAL] The total bill was $8,901.
[AGENT][NEUTRAL] For procedure code 59,400, it looks like we paid $1000 towards that claim.
[CUSTOMER][NEUTRAL] And the status?
[CUSTOMER][NEUTRAL] Is there patient liability?
[AGENT][NEUTRAL] Um, I'm not seeing that on here and we don't determine patient responsibility either.
[AGENT][NEUTRAL] But I don't see anything on that.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] 59,400.
[CUSTOMER][NEUTRAL] You said that's in what you have there is an outpatient claim?
[AGENT][NEUTRAL] Inpatient.
[AGENT][NEUTRAL] I'm not showing any outpatient, yes.
[CUSTOMER][NEUTRAL] So that one is also inpatient?
[CUSTOMER][NEUTRAL] No, well, this one is also impatient.
[AGENT][NEUTRAL] Yeah, and I'm not, that's the only one that I'm seeing.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 59,400. OK, is there a fax number where I can send over this claim?
[AGENT][NEUTRAL] Sure, the fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] 3 and you'll do attention claims department.
[CUSTOMER][NEUTRAL] And just for verification, what's your claim's address?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Give me the zip code one more time please.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, it went to the incorrect, um, address. That's probably why you don't have it. And um is there a payer ID for electronic claim submissions?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][POSITIVE] OK, great. OK, thank you so much so we'll go ahead and rebuild this one and do you provide uh call reference numbers?
[AGENT][NEUTRAL] Uh, we don't have call reference numbers, but you can use my name and last initial in today's date. So [PII] and today's date.
[CUSTOMER][POSITIVE] OK great thank you so much for your help have a good day.
[AGENT][POSITIVE] Have a great day. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Goodbye.