AccountId: 011433970860
ContactId: fcf68885-b18b-4a9a-9028-d73c8a68c043
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 621539 ms
Total Talk Time (AGENT): 259380 ms
Total Talk Time (CUSTOMER): 324221 ms
Interruptions: 4
Overall Sentiment: AGENT=1.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/fcf68885-b18b-4a9a-9028-d73c8a68c043_20250311T17:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, um, good afternoon, um, I am calling regarding um a few claims. I'm calling from the provider's office and we submitted a few claims and I'm needing to get some uh status of them. It's for, for one particular patient.
[AGENT][NEUTRAL] Sure, yeah, I could check those claims for you. uh, what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] It's [PII] from Monroe County Hospital.
[AGENT][NEUTRAL] OK, and then Bea, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] I do, um, it's 01807484.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then, uh, what was the name and date of birth for the insured [PII]?
[CUSTOMER][NEUTRAL] Um, it is for [PII], and, um, and what else did you need his date of birth?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Let me get that to, let's see here. Um, his date of birth is um [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perfect. OK, thank you for verifying that. Alright, um, let's see, I know there were multiple claims, uh, were they all for the same date of service?
[CUSTOMER][NEUTRAL] Um, there looks to be like there's different dates of service. There's um.
[AGENT][NEUTRAL] Sure, OK.
[CUSTOMER][NEUTRAL] Yeah, um, the first data service is [PII]. There's a 1500 claim and there's a UB claim.
[AGENT][NEUTRAL] OK, 1500 was that, I'm sorry, 1500 was the total.
[CUSTOMER][NEUTRAL] 00, no, no, um, it's, it's a professional claim, so there's 22, claims, so there's one for $17 and then there's one for $2,256.
[AGENT][NEUTRAL] 56 OK and that those were both for uh [PII]?
[CUSTOMER][NEUTRAL] Yes, uh huh.
[AGENT][POSITIVE] Got it OK thank you one moment.
[CUSTOMER][POSITIVE] Sure, thank you so much.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, so I did find one for $17. I'm sorry, you said that, uh, Monroe County Hospital, is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, OK, so we did receive this one, give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, and I imagine, well of course I'll check the other one as well. This one we were unable to pay a benefit as the maximum benefit amount for this date of service had been met, um, that allowance was $150 and that had been met prior I think give me just a moment, I'll get that other one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That other amount, I'm sorry, that was uh $2,206.
[CUSTOMER][NEUTRAL] Uh, $2,256.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't have one for that amount. I do have one for 2,206, but not 256. Let me see if this one is still through y'all.
[AGENT][NEUTRAL] No, that is a different provider. OK, so it doesn't look like we've received that claim Vesna.
[CUSTOMER][NEUTRAL] OK, for $2,256 for the same data service it's the same account, um we sent it to um you guys at [PII]. Is that your claim? Oh.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] No, ma'am. No ma'am. That is an older one, yes, um, I do have that, uh, updated one whenever you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, so that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK. And do you by any chance have a fax number?
[AGENT][POSITIVE] Absolutely. I've got a fax number and then I've also got a payer ID if you'd like.
[CUSTOMER][NEUTRAL] Oh, I think that let me just take a look. We, we, I, I, I'll, I'll grab the payer ID, but I think we, we can only pay, we only pay it by paper because it's work I think it looks like it's, is it?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No, that's perfectly fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, OK, so, um, are you ready for the fax?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, that is 877.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK. And um are you, do you, do you need the medical records on this one or just the claim is good?
[AGENT][NEUTRAL] Just the claim should be perfectly fine. Um, it's typically of course the um claim form and then the itemized statement that shows those uh diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK, so the, the our actual, um, we have, uh, the actual claim has all that information on it. OK, cool. Alright, great. OK, and um, so you didn't, that's why you didn't get it because of the address and I'm wondering if this.
[AGENT][POSITIVE] Yeah, that's perfect.
[AGENT][NEUTRAL] Right. I did get the one for $17 though. Um, did you want that claim number?
[CUSTOMER][NEUTRAL] OK, uh, yes, please.
[AGENT][NEUTRAL] OK, so it is 34.
[AGENT][NEUTRAL] 77
[AGENT][NEUTRAL] 772.
[CUSTOMER][NEUTRAL] OK. And um.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, um, and, um, is it possible for you to fax the, the denial, um, the EOB to me? OK.
[AGENT][POSITIVE] Oh sure, yeah, I can send that EOB absolutely, absolutely. What was that fax number for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 320634 and then 1337.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm going to read that back, make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I will get that sent to you. Let's see, you should get it within um within 10 to 15 minutes I'd say. Alrighty. And then, um, did we have other clients we needed to look at?
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] Um, there is another one for our rural health clinic, um, for, OK, this, this year, uh, you might have not gotten this one.
[AGENT][NEUTRAL] We'll see we can.
[CUSTOMER][NEUTRAL] It looks like
[CUSTOMER][NEUTRAL] Um, for data service of 7-1824.
[AGENT][NEUTRAL] 718 OK and then uh what was that bill amount please?
[CUSTOMER][NEUTRAL] $90.
[AGENT][NEUTRAL] All right, one moment, let's take a look.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, I don't have any claims for that date of service. You did say that was [PII], correct?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes, that explains why you didn't get it.
[AGENT][NEUTRAL] Yeah, I don't have any claims for that data service.
[CUSTOMER][NEUTRAL] OK, I think I might have, I know this is, that is good and I would have liked to have gotten the $22,000.01.
[AGENT][NEUTRAL] Well, we got the one.
[AGENT][NEUTRAL] Of course, yeah.
[AGENT][NEUTRAL] I can imagine.
[CUSTOMER][NEUTRAL] And I actually have an um actually on that same date of service I think the same same day [PII] um for um we also had a another claim let's see 32 or maybe.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Maybe that's a, OK, that is the one that, um, yup, I guess it's the one that, yup, that's the one that that I gave you. I just wanna make sure cause I know I had a bunch for, for [PII], so, but that does, that's, that does it. I mean, you, you've been so helpful. I really appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, of course, so there wasn't more I could do, but yeah, at least there's no timely filing limit, so just whenever you're able to you can get them to us and hopefully we get them processed for you.
[CUSTOMER][POSITIVE] OK, that would be great. I like the sounds of the no timely.
[AGENT][POSITIVE] Yes, that's very nice.
[CUSTOMER][POSITIVE] That makes a lot. Yes, that's good. He did good. He did good with you guys.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Was there anything else I can help you with [PII]?
[CUSTOMER][NEUTRAL] Uh, nope. I, I am going to, um, cause I was just got off the phone with, with, um, another, uh, another, um, insurance company. So, um, I'm, um, might be a little bit longer, um, getting, um, that faxed over to you and um.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, no, that's, yeah, no rush.
[CUSTOMER][NEUTRAL] OK, um, I'm gonna try to, I'm gonna try to send it to you directly so it's gonna come from me. So if sometimes the fax, I don't know, I guess it depends on where you send it. Um, if you don't get the information, if you don't get those claims, um, please let me know because sometimes my facts, I have issues with the facts, but I wanna get it out to you today so we could get it rolling.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure, yeah, well, as it's Tuesday, I think a general rule of thumb for faxes, um, is to allow up to about I'd say 48 hours, um, so here in a couple of days you can uh give us a call just to make sure we received it, um, from there it can take about 7 to 10 business days for it to process, um, but we should at least be able to let you know whether or not that's been received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, awesome. All right, you've been so helpful. I really appreciate your help and, oh, great. Um I hope you have a great rest of your day and um hopefully, oh, you're welcome. And thanks again for all your help.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Yeah, happy to help.
[AGENT][POSITIVE] You too, [PII], thank you.
[AGENT][POSITIVE] You are very welcome thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You're welcome. Thank you so much. Bye bye now.
[AGENT][POSITIVE] Thank you, bye bye.