AccountId: 011433970860
ContactId: fe86c9bc-5322-4f61-8a7b-2db90fbc46a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 960260 ms
Total Talk Time (AGENT): 155260 ms
Total Talk Time (CUSTOMER): 250533 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/fe86c9bc-5322-4f61-8a7b-2db90fbc46a0_20250610T20:25_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 you from the provider office, specialty care surgical assist, and I'm looking for claim information, please.
[AGENT][NEUTRAL] So I can help you with claim status. [PII]. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, sure. The callback number is area code [PII]. It's a direct line.
[AGENT][NEUTRAL] Alright, and can I get the uh policy number, please?
[CUSTOMER][NEUTRAL] Sure, the policy ID for the patient is
[CUSTOMER][NEUTRAL] 1954796.
[AGENT][NEUTRAL] Give me just one moment while I look that up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, sure. Patient name, it's.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Date of birth of [PII].
[AGENT][NEUTRAL] OK, give me just one moment. That's not who I have on here. Um, so you said policy number is 1954796, correct?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, yes, but let me verify it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] Uh, just to make sure. Mhm.
[CUSTOMER][NEGATIVE] Rumble.
[CUSTOMER][NEUTRAL] 6.
[CUSTOMER][NEUTRAL] Uh, no, it's uh 95, not 6. It's 5.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you repeat the patient name and date of birth for me please? I'm sorry.
[CUSTOMER][NEUTRAL] No problem, it's um [PII].
[CUSTOMER][NEUTRAL] Date of birth of [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Uh, sure. The claim, I mean, date of service, [PII].
[CUSTOMER][NEUTRAL] And the claim number.
[CUSTOMER][NEUTRAL] It's 353-7106.
[AGENT][NEUTRAL] 353-7106.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] Alright, it looks like we paid.
[AGENT][NEUTRAL] Oh let me see here real quick.
[AGENT][NEUTRAL] It looks like it was partially denied um because benefits are only payable if the major medical insurance provider provides benefits, um, so if the major medical uh sent you an explanation of benefits we are showing that some benefits were paid, uh, we need that the copy of that EOB or explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. Um, we have sent, um, multiple UOBs, the primary EOBs, where the claim was processed and applied to patients deductible. But, um, as I made a call on [PII],
[CUSTOMER][NEUTRAL] As we already sent on March, the EOB. I tried to follow up on that and um I spoke with [PII]. I said that the EOB was received, but the denial reasons or the descriptions on the UOB was mentioned something else.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, she um asked me to send another or the correct UOB to uh process the claim. So, uh, we send the correct
[CUSTOMER][NEUTRAL] Primary you'll be where the claim was processed and allowed for, I mean, the allowed amount was supplied to the patient's deductible. Uh, we have sent it to you um through fax.
[CUSTOMER][NEUTRAL] On [PII]. So, I am looking for that status if you receive that um you'll be.
[AGENT][NEUTRAL] I don't
[AGENT][NEUTRAL] Alright, let me look here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, let me look here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, let me look.
[AGENT][NEUTRAL] Because it looks like the claim.
[AGENT][NEUTRAL] What was the total bill amount for the claim?
[CUSTOMER][NEUTRAL] Total bill charge is $745.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I am showing.
[AGENT][NEUTRAL] Let me see, let me pull up that claim real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. I'm just looking into that claim, so give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, I am seeing the EOB that you all faxed over. Um, give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me talk to someone from claims and I'll be with you in just a moment, OK?
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Ferring.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Is anyone there?
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], it's [PII] with ATL care team.
[AGENT][NEUTRAL] Uh, I have someone who's needing assistance with claim, a claim policy number is 1954795.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, it's for the data service of [PII], and he gave me the claim number of 353-7106, and I'm showing that it was denied, but then I'm seeing that the total benefit of this claim was paid in the amount of $745. It looked like it was denied because they needed the primary EOB and then I, I, I saw the primary EOB in.
[AGENT][NEUTRAL] On base and so I just wanted to know if it was still denied or if you could help look into that.
[CUSTOMER][NEUTRAL] OK, one second.
[CUSTOMER][NEUTRAL] Is the insured on the phone or the provider?
[AGENT][NEUTRAL] Uh, the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, looks like we shouldn't have paid it, but you send them on over.
[AGENT][POSITIVE] Great. Thank you so much, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alright [PII], I have claim support on the line that can help you with that.
[CUSTOMER][POSITIVE] Mhm. OK. All right, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII]. I'm looking for the uh UB status which we have sent it to you to review the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said this is a UV?
[CUSTOMER][NEUTRAL] EOB explaining some of benefits from the primary insurance. OK, I'm sorry, I thought you said UB. I'm sorry. OK, alright.
[CUSTOMER][NEUTRAL] OK, it's it's like on that claim.
[CUSTOMER][NEUTRAL] Uh, we did not make a payment.
[CUSTOMER][NEUTRAL] Because benefits are only payable if the major medical provides benefits on the claim, so it looks like the bill service was not covered by the health plan.
[CUSTOMER][NEUTRAL] No, it was the bill charges, the service was uh.
[CUSTOMER][NEUTRAL] Um, process and allowed amount, the whole charges they allowed for the whole bill charges and was applied to patients deductible.
[CUSTOMER][NEUTRAL] So it doesn't, yeah, it doesn't show there is an uh no any um non-covered charges denied on the claim.
[CUSTOMER][NEUTRAL] From the primary.
[CUSTOMER][NEUTRAL] Give me a second, let me look at this one.
[CUSTOMER][NEUTRAL] Mhm.