AccountId: 011433970860
ContactId: ff44d077-2e91-4d93-9e04-082aa51bb203
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1061920 ms
Total Talk Time (AGENT): 292630 ms
Total Talk Time (CUSTOMER): 256805 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/ff44d077-2e91-4d93-9e04-082aa51bb203_20250609T17:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. My name is [PII] calling for Medical University Hospital Authority. I'm looking for claims.
[AGENT][NEUTRAL] OK, [PII], I can help you with claims. Can I please get your callback number, sir, just in case the call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII]. Is that correct?
[AGENT][NEUTRAL] Thank you sir and then what is the member's name, date of birth, and policy number so I can get you the claim information?
[CUSTOMER][NEUTRAL] Uh-huh. Member name [PII]. Date of birth [PII] 13 and uh total charges, one moment.
[AGENT][NEUTRAL] Uh, I'll need their policy number first, please.
[CUSTOMER][NEUTRAL] Total charges 56.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] The policy number 023.
[CUSTOMER][NEUTRAL] 389
[CUSTOMER][NEUTRAL] 387
[AGENT][NEUTRAL] OK, let me pull up the policy.
[AGENT][NEUTRAL] OK. Do you see a
[CUSTOMER][NEUTRAL] Uh, member name [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] the.
[AGENT][NEUTRAL] And let me see, uh, policy number is a little long to be ours, 233893887.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I said 2, I'm so sorry, 02389.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 387.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let me look it up real quick.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, [PII], alright and then what is the date of service please?
[CUSTOMER][NEUTRAL] [PII] and uh $56 even.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 56 even. OK, and what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $39 455 cents.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a quick hold [PII] while I look up this claim for us and I'll be right back sir.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 3583297.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you very much for holding for me, [PII]. So the claim number is 3583297.
[AGENT][NEUTRAL] And the claim has been denied because we need the explanation.
[CUSTOMER][NEUTRAL] One moment. Sorry to interrupt you.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, yeah, yeah, correct. Actually, uh, we have already resubmitted the claim on [PII] with the primary EB.
[AGENT][NEGATIVE] Right and we received it back stating that it was a duplicate because the information that was sent was also the same information that was sent the first time but did not include the explanation of benefits with the diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] So you guys ask for the primary, with the primary you, right?
[AGENT][NEUTRAL] Yes, we need the primary EOB.
[AGENT][NEUTRAL] From the major medical insurance.
[CUSTOMER][NEUTRAL] OK. Then, can you repeat one when did you guys received?
[AGENT][NEUTRAL] Uh, this claim, let's see.
[AGENT][NEUTRAL] Give me just a minute, let me look it up.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] On
[CUSTOMER][NEUTRAL] [PII]. Mhm. Can I have the claim number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, it's 361.
[AGENT][NEUTRAL] 0497.
[AGENT][NEUTRAL] Wait a minute, let me make sure that's correct, yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm. OK, I repeat the claim number, 3610497, right?
[AGENT][NEUTRAL] Um, no, that's a different claim. Hold on, let me give it to you. It's 3583297.
[CUSTOMER][NEUTRAL] 358
[AGENT][NEUTRAL] Yes, 3583297.
[CUSTOMER][NEUTRAL] Can you repeat one more time sorry.
[AGENT][NEUTRAL] Yes, 35832.
[AGENT][NEUTRAL] 97.
[CUSTOMER][NEUTRAL] 97. Got it. OK. Can I have the process date as well?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And received on [PII].
[CUSTOMER][NEUTRAL] But you said [PII] you said?
[AGENT][NEUTRAL] Yeah, I gave you the wrong number, so I had to give you the correct one.
[CUSTOMER][NEUTRAL] OK. OK. OK. Can you repeat the
[CUSTOMER][NEUTRAL] Uh, received date is [PII], right? [PII] you said?
[AGENT][NEUTRAL] [PII] and we processed it on [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] [PII]. Got it. OK. Is that uh uh duplicate denial you said?
[AGENT][NEUTRAL] There was a duplicate for the same claim.
[AGENT][NEUTRAL] Let me look at that one.
[AGENT][NEUTRAL] Give me just a moment. I need to pull it in again.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It was also for $56. It's a duplicate claim for data service of [PII] and the claim number is 358-5216.
[CUSTOMER][NEUTRAL] OK, one minute.
[CUSTOMER][NEUTRAL] So this is original claim, right? You're talking about?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEGATIVE] No, that's not the original.
[CUSTOMER][NEUTRAL] Uh, can I have the original claim number one more time?
[AGENT][NEUTRAL] It's 358-521-6. That's the duplicate claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3358
[AGENT][NEUTRAL] 521 6.
[CUSTOMER][NEUTRAL] Got it. So this is duplicate on previously when you said.
[CUSTOMER][NEUTRAL] 3583297. This is the original.
[AGENT][NEUTRAL] That's the original claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what is the denial in the version of?
[AGENT][NEUTRAL] We need the explanation of benefits from the primary insurance carrier.
[AGENT][NEUTRAL] So you'll just need to resubmit the EOB.
[CUSTOMER][NEUTRAL] OK, can I have the fax number or something so we can submit the primary through fax?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, is there any time frame for that?
[AGENT][NEGATIVE] No sir, we don't have a timely filing limit.
[CUSTOMER][NEUTRAL] Can I have the call reference number?
[AGENT][NEUTRAL] Yes, sir. You can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much sorry for the information you just provided. I'm so sorry.
[CUSTOMER][NEUTRAL] One moment, um, it has another two dates, uh, with the data service whenever you're ready.
[AGENT][NEUTRAL] For the same member?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, and what's the date of service and the charge amount?
[CUSTOMER][NEUTRAL] [PII] and uh the charge is one minute.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] $191 even.
[AGENT][NEUTRAL] OK, and then the charges after the primary paid.
[CUSTOMER][NEUTRAL] $30 even.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this one and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 35833.
[AGENT][NEUTRAL] Hi, [PII], this is [PII]. Let me give you that claim number.
[AGENT][NEUTRAL] It's 358-331-1.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it was denied for the same reason, we need the explanation of benefits from the primary insurance carrier.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, may I know when did you guys receive this, uh, claim?
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] I mean.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] We received it on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah. So you, you people not received any uh exponential benefit, right from the prime end?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Because we have resubmitted on [PII].
[AGENT][NEUTRAL] I don't have those.
[CUSTOMER][POSITIVE] It's a primary you'll be OK.
[AGENT][NEUTRAL] I don't have those, no sir.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Uh-huh. OK. Member has the last, uh, data service whenever you're ready.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] Uh, we're 21, 2024.
[AGENT][NEUTRAL] OK, what was that again?
[CUSTOMER][NEUTRAL] And the total charges of $191.
[AGENT][NEUTRAL] Can you give me the date one more time?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, and the amount?
[CUSTOMER][NEUTRAL] 2024.
[CUSTOMER][NEUTRAL] $191 even and after the primary process.
[CUSTOMER][NEUTRAL] $60 even.
[AGENT][NEUTRAL] 50 or 60?
[CUSTOMER][NEUTRAL] 60, 60.
[AGENT][NEUTRAL] 60. OK. OK, I'm gonna put you on hold again. I'll be right back, [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 35833.
[AGENT][POSITIVE] Thank you for holding for me [PII]. I have that claim pulled up for you and the claim number is 3583304.
[AGENT][NEUTRAL] And let me look for the date that we received it.
[AGENT][NEGATIVE] We received it on [PII] and processed it also on [PII] and the claim was denied for the same reason needing the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] OK. Thank you so much, uh, sorry for the information you just provided. Uh, thank you and have a nice day. Bye-bye.
[AGENT][POSITIVE] You have a wonderful day too, [PII]. Thank you for calling APL. You take care, sir.