AccountId: 011433970860
ContactId: fee38a0a-071a-41e2-8f05-ca20b62002f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 572469 ms
Total Talk Time (AGENT): 312612 ms
Total Talk Time (CUSTOMER): 199591 ms
Interruptions: 6
Overall Sentiment: AGENT=-0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/fee38a0a-071a-41e2-8f05-ca20b62002f3_20250324T18:27_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on the care team. How you doing?
[AGENT][NEUTRAL] Fine. How are you?
[CUSTOMER][NEUTRAL] I'm doing good. I have a um provider on the other line. We were going over a claim status. So basically, we need, the explanation of benefits that they sent in doesn't match the data service. I've gone through all the documents with her that we received in OnBase, and she's still telling me that we did receive it. Um.
[CUSTOMER][NEUTRAL] So, can you help me with this?
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] It's 182-3108.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII], mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And what claims, what is the, the claim?
[CUSTOMER][NEUTRAL] That first or the last claim, there are 357-4380?
[AGENT][NEUTRAL] Number.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] For [PII]?
[CUSTOMER][NEGATIVE] That's what the claim forms say. She's saying that it's supposed to say the [PII] and I'm like, well, we haven't received that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see here.
[CUSTOMER][NEUTRAL] And she's like, well, we can't break up the forms. And I'm like, well,
[AGENT][NEUTRAL] And did you verify the pro is the provider Mount Sinai Medical Center?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And she said it should be a [PII] day of service?
[CUSTOMER][NEUTRAL] Yeah, like the explanation of benefits does say [PII], and that's the date of service she gave when she called for the claim status, but the claim form she submitted says [PII]. We don't have anything for the [PII].
[AGENT][NEUTRAL] Oh, OK, I see what you're saying. OK, so we got a UB for [PII], but the UB is for [PII]. OK, I see.
[AGENT][NEUTRAL] And that's what you explained to her that we have a E the EOB and the UB is two different things.
[CUSTOMER][NEGATIVE] Don't match. Right. And she's like, well, on the claim form, if you scroll all the way down, you'll see [PII] and [PII], and I'm like, well, I've scrolled to the bottom. I don't, we haven't received it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me see.
[CUSTOMER][NEUTRAL] So she's wanting to speak to a um claims examiner for, for more, I guess.
[AGENT][NEUTRAL] And it looks like it might have been cut off. Cause if you, if you look, mhm.
[CUSTOMER][NEUTRAL] Right, you see where it's like written on over.
[AGENT][NEGATIVE] Yeah, I mean, cause that's all I'm gonna tell it looks like it was cut off. Like maybe there should have been another page sent but it was cut off. It only shows us the received date. It doesn't show us the date of service. Oh no, wait, it does.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is. The data service is there. It is there right at the bottom you see where it says claim date [PII].
[AGENT][NEUTRAL] And the charge amount is for $15,624.23. So yeah, it is there, but it is.
[CUSTOMER][NEUTRAL] The bottom of, of what?
[AGENT][NEUTRAL] Of page 4.
[CUSTOMER][NEUTRAL] 04.
[AGENT][NEUTRAL] But it does, yeah, it does. It is cut off still though because
[AGENT][NEUTRAL] It looks like there should be the continuation of this EOB.
[AGENT][NEUTRAL] Because it shows patient responsibility. However, it looks like the page is part of the EOB that would show.
[CUSTOMER][NEUTRAL] Oh, I see what you're saying. Mhm.
[AGENT][NEGATIVE] Yeah, it looks like the part where it will show where that amount was applied towards that part is cut off.
[CUSTOMER][NEUTRAL] But still, even though it says the claim date is 1/12, these charges are for 16.
[CUSTOMER][NEUTRAL] So we still need the EOB or even the claim form that matches.
[AGENT][NEUTRAL] It's two different ELBs.
[AGENT][NEUTRAL] Yeah, it's two different EOBs, so that's where it looks like she did submit it. She did submit it, but it looks like it's cut off for 11/12, I mean 112 is what I'm saying because it it shows the different claim numbers on the top. If you look at that 16, it has a different claim number there and then when we look at the 112, it has a different claim number there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Where it has the EW 28166076, when you look at that claim number.
[AGENT][NEUTRAL] On page 4.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I see what you're saying. Yes, OK. Whoa.
[AGENT][NEUTRAL] OK. Yeah, so where it says claim date 106, then it has that claim number, that's for the 106. When you scroll all the way to the bottom, then it has that claim date 112-25 and that claim number is two different ones and it has that charge amount for the, you be on page two.
[AGENT][NEGATIVE] But it looks like page 43 might be missing cause it's like it might continue. Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Missing.
[AGENT][NEUTRAL] So I will let them know we got a partial of the, we didn't get the full pages of the EOB for the [PII] data service.
[AGENT][NEUTRAL] Cause it looks like did they fax this.
[AGENT][NEUTRAL] Yeah, it was faxed.
[CUSTOMER][NEUTRAL] But her, but what she's saying, but she doesn't want the 12, she wants the 6.
[AGENT][NEUTRAL] OK, so on the [PII], OK, let me pull up because like we got something. We paid something for the 6th. Let me look at this generated 6 data service that we already paid. Let me see if it's the same claim.
[CUSTOMER][NEUTRAL] So we either need to get a
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Which was processed on the [PII]. Let me pull that up real quick.
[AGENT][POSITIVE] Which I'm sure that, I bet this is what it is too.
[AGENT][NEUTRAL] So, 16.
[AGENT][NEUTRAL] See if it's the same bill amount of of this EOB.
[AGENT][NEUTRAL] OK, let's see 16 looks like the bill amount was for.
[CUSTOMER][NEUTRAL] Wait a minute, wait a minute, wait a minute. Wait, wait, wait.
[AGENT][NEUTRAL] OK, so this one is.
[CUSTOMER][NEGATIVE] I think I got it mixed up. She's calling about the 12th. The claim form says the 12th. The EOB says the 6th and the 7th. That's the problem. OK. I had to get it straight.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah. OK, so she is in fact calling about the 12th regarding the UB that we did. OK. So, yeah, it looks like we did receive partial of the EOB for the 12th.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] It looks like page 43 is missing, like the continuation of the EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you see what I'm looking at?
[CUSTOMER][NEUTRAL] Yeah, I'm looking. I see it and then I, and I see down at the bottom where it says 42 or 50. Yeah, I'm following you.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEGATIVE] Yeah, and it looks like the patient responsibility is 1269, but it looks like the full EOB is missing.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEGATIVE] So it looks like maybe it should have there should have been a page 43 possibly that it continued on.
[CUSTOMER][NEUTRAL] With showing those charges. OK.
[AGENT][NEUTRAL] Mhm. For the 112.
[AGENT][NEUTRAL] Yeah, I was advise them to resubmit the EOB for 112 cause like we received partial of that page.
[CUSTOMER][NEUTRAL] Well, she wants to talk to you.
[AGENT][NEUTRAL] That's fine. I can explain it to her.
[CUSTOMER][NEUTRAL] OK, um, hold on one.
[AGENT][NEUTRAL] And what's her name?
[CUSTOMER][NEUTRAL] I was about to say [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, hold on one second, all right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello, [PII].
[CUSTOMER][POSITIVE] Hello, [PII]. Yes. Hi, thank you so much for holding. I have [PII] on the line and she'll be assisting you further, OK?
[CUSTOMER][POSITIVE] OK, thank you. You're welcome.
[AGENT][NEUTRAL] Hi
[AGENT][NEUTRAL] Hi, [PII], this is [PII], and you have a question in regards to the 11225 data service?
[CUSTOMER][NEGATIVE] Yes, we sent the primary EOP, but it looks like you guys are not, um, are not seeing that the, the EOB that I sent, it's only one, and then all the way on the page, all the way down is the data service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I.
[AGENT][NEUTRAL] OK, so I do have the document pulled up and it looks like we received partial of the EOB. Um, it looks like maybe this was faxed, so we didn't receive the full EOB for the 11225 data service. So if you can resubmit that EOB for the 11225 data service, we can reconsider the claim. Looks like we received partial of the page.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] Even though that is, it does say patient responsibility for data service, [PII].
[AGENT][NEUTRAL] We need the detailed EOB that shows this amount was applied towards the deductible co-pay co-insurance. So we would need the full EOB.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK. What would be the reference number?
[AGENT][NEUTRAL] It'll be just my name in today's date and then when you resubmit that EOB if you'll please just reference the policy number and claim number, let me give you the claim number.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that claim number is?
[CUSTOMER][NEUTRAL] OK. Uh no, I have it, I have it.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][POSITIVE] No, that was all. Thank you.
[AGENT][POSITIVE] OK. You're welcome. Thank you for calling APO. You have a good day.