AccountId: 011433970860
ContactId: 06e1d1d1-a656-4122-8e60-dcfe5f0810e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 778900 ms
Total Talk Time (AGENT): 349672 ms
Total Talk Time (CUSTOMER): 224436 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/06e1d1d1-a656-4122-8e60-dcfe5f0810e9_20250307T20:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling about a claim, um, that is. I got a letter in the mail. I don't know what's going on with it. Can you help me?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with your claim. And may I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Uh, [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 024.
[CUSTOMER][NEUTRAL] 89846.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth, your mailing, and email address on file.
[CUSTOMER][NEUTRAL] Uh yeah, OK, um date of birth [PII].
[CUSTOMER][NEUTRAL] Uh, and my mailing address is [PII].
[CUSTOMER][NEUTRAL] And the email is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um for the claim, so was the claim for you or your spouse or dependent?
[CUSTOMER][NEUTRAL] Uh, it's for my son.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It would be for [PII].
[AGENT][NEUTRAL] OK, here it is. I see. Hold on one moment.
[AGENT][NEUTRAL] OK. So we originally received the claim on [PII] and it was denied because the documents that's being sent in. So the balance forward is like your patient bill. We need the itemized bill from the provider. Um, it was this a hospital?
[CUSTOMER][NEUTRAL] No, it's an ASA, uh, ambulance service.
[AGENT][NEUTRAL] OK, um, so I will reach out to the emergency medical service, um, you know, on their bill, they'll have a contact number for you. Reach out to them and let them know that we're needing an itemized bill. They can even give us a call if they need more direction, you know, more clarity on what's needed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, no, um, I, I did that already.
[AGENT][NEUTRAL] Right, but what's being submitted is not an itemized bill.
[CUSTOMER][NEUTRAL] I got the itemized.
[AGENT][NEUTRAL] So like you
[CUSTOMER][NEUTRAL] I, I reached out to them and ask for an itemized bill and they send it to me in the mail and I emailed that to you guys already.
[AGENT][NEUTRAL] OK, so let me pull up the documents so I can try to explain it further. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] What they're giving you is your patient bill. This is not an itemized bill. This is just your patient bill. They have an itemized bill that shows the diagnosis, what you needed the emergency services for, what treatment was given, if any, while you were on the ambulance or in the ambulance, and then what this $1,452 total, what made that up?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] All the charges. So that is what is on the bill that we're asking for, so that we can prove medical necessity. This just shows you, your name or your your son's name, the data service and the amount. We need to be able to prove why you needed this.
[CUSTOMER][NEUTRAL] Oh, so did you not get the other email that with the itemized bill?
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] I sent a 2nd email, yeah, I sent a 2nd email.
[AGENT][NEUTRAL] Let me see if I can reach out to um this is what I'll do. I'll send a request over to the claims examiner um to give you a call if you'd like, if, if you don't mind holding, I can try to call them on the other line so that I mean, I do see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Where there is a line for the base rate and then there is a line for the mileage. I don't.
[CUSTOMER][NEUTRAL] Uh-huh, but yeah, like that's all they did.
[AGENT][NEUTRAL] Let me see what they're looking for.
[CUSTOMER][NEGATIVE] That's all they did was uh transfer him from one hospital to another. They didn't provide any medical.
[CUSTOMER][NEUTRAL] During that that that travel distance.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Let me see if I can reach out to someone in claims. Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] That's fine. I'll hold.
[AGENT][NEUTRAL] OK, and before I do that, was there anything else I can assist you with just in case they want me to transfer you to them?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] No, not at this moment.
[AGENT][NEUTRAL] OK, hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And then, uh, Medicare secondary to us? Oh.
[AGENT][NEUTRAL] Hold on
[CUSTOMER][NEUTRAL] ring
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEUTRAL] I'm good. I'm trying to go over this claim with the insured. Can you look at this with me? Uh, if maybe if you can explain to me, I might not have to transfer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the policy number is 2489846.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's for part 4.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's um 357-050-2.
[CUSTOMER][NEUTRAL] So that one did not as a duplicate, see what the first one.
[AGENT][NEUTRAL] Of the the first one was the balance forward statement and we need an itemized bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So he's like, well, I sent in, I'm looking at the documents that he sent in on OnBase.
[AGENT][NEUTRAL] So he's, he's saying because it's an ambulance service, this is all they have. What can I explain to him that we're looking for like outside of this?
[CUSTOMER][NEUTRAL] Alright, give me one second to pull it up to see what he's in here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Excuse me, I'm sorry.
[AGENT][NEUTRAL] Oh yeah fine.
[CUSTOMER][NEUTRAL] For statement it has fully itemized.
[CUSTOMER][NEUTRAL] Now I don't know if they'll give it to him because he's uh because he probably owes a balance, but there's a 1500 form.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That they usually that they use, they usually deal with.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, if, if he can send that in, if he can get that, he can send that in, um, I don't know if he has any other insurance.
[AGENT][NEUTRAL] I think it said Medicaid.
[CUSTOMER][NEUTRAL] Yeah, Medicaid, so.
[CUSTOMER][NEUTRAL] Uh yeah, tell him he we would need the um.
[CUSTOMER][NEUTRAL] There's a form called a 1500 form that's gonna have the, the codes for the ambulance is gonna have the CPT code and the uh the diagnosis code.
[AGENT][NEUTRAL] Cos
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] This this information does not have that.
[AGENT][NEUTRAL] I'll explain it to him again. I told him that, but I'll explain it to him again. I just wanted to make sure it wasn't something I was missing because he was like, well, this is an ambulance, and I'm like, let me just make sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, they do. We if they deal with us there's that they send that form into us.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I will let him know. Thank you.
[CUSTOMER][POSITIVE] You're welcome have a great day.
[AGENT][NEUTRAL] All right, bye bye. You too. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. So the form that I'm um speaking of that has the codes and ambulances, ambulance services do use this as well. It's called a 1500 form.
[AGENT][NEUTRAL] Is what your bill that you're that you sent in is what your bill comes from.
[AGENT][NEUTRAL] It'll have the codes and all the charge everything um it listed by item.
[AGENT][NEUTRAL] The diagnosis codes tell us what the medical necessity was, the the CPT codes are the treatment or in this case, it would be transport, but
[AGENT][NEUTRAL] That's what we're needing, the um 1500 form, not the um patient bill or balance forward statement.
[CUSTOMER][NEUTRAL] OK, let me write this down.
[CUSTOMER][NEUTRAL] It's called a 1500 form.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So I just call the ambulance service and then uh tell them I need the 1500 form and not an itemized.
[CUSTOMER][NEUTRAL] Statement or what?
[AGENT][NEUTRAL] The itemized statement is the 1500 form. What you, the 1500 form is what your bill that you sent in which they took the information from the 1500 form and made the patient bill with just patient information. We need all of the treatment, medical necessity, everything, not just
[AGENT][NEUTRAL] What you received and what you paid for.
[CUSTOMER][NEGATIVE] Oh, so I didn't get what I was asking for.
[AGENT][NEUTRAL] Well, I mean, an itemized bill to the patient, yes, that may be what they thought you meant, but we need it for insurance, not for, you know, for like patient records.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] Oh, OK, so, so as for an itemized statement for the insurance company, not for a patient.
[AGENT][NEUTRAL] Right, we need to itemize the itemized billing like it would go to an insurance company, not a patient bill.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, let me reach out to them. Should I, should I know anything else before I call them? I don't know all about this, all this medical coding and stuff.
[AGENT][NEUTRAL] Um, no, I, I, once you give them a call, I would just ask for the 1500 form. They usually um can email it to you and then if you wanted to upload it, you can, or if you, um,
[CUSTOMER][NEUTRAL] Uh, they won't email it.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I mean last time I asked for an itemized statement I asked if they can email it so it'll be faster they they know they wanna they can only mail it out.
[AGENT][NEUTRAL] Oh, OK. Well, yes, every provider is different, unfortunately, so if they mail it out, then yes, we'll we'll have to wait for the mail.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, alright, let me reach out back to them.
[AGENT][POSITIVE] Alrighty. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, uh, what was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] And uh, OK, thank you [PII].
[AGENT][POSITIVE] You're very welcome. And again, just for the call, all the information provided was a verification of benefits, not a guarantee of payment, and thank you so much for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] You too have a good weekend bye.
[AGENT][POSITIVE] Thank you. Bye bye.