AccountId: 011433970860
ContactId: 13583525-badc-4f38-86d7-0d597f019700
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 840369 ms
Total Talk Time (AGENT): 239834 ms
Total Talk Time (CUSTOMER): 134063 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/13583525-badc-4f38-86d7-0d597f019700_20250505T13:08_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] here calling from provider's office to check on a claim status. So before that, uh, I got an, uh, internet connection. Yes, I got an internet connection. I do apologize for that. My call get disconnected.
[AGENT][NEUTRAL] Oh [PII]
[AGENT][NEUTRAL] OK, [PII], were you and I speaking?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, OK. Well, that's OK. I was like, oh no, I, he's gone. He looked like he just hung up. So, OK. All right, [PII], so go ahead and give me your callback number again, please.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sure. [PII], I call my extension.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, thank you. And as I mentioned to you before, any information provided will be a verification of benefits and not a guarantee of payment. You will use my name as your reference number for our call, and then, uh, the portal located at [PII] would be where you would get the EOB if you need a copy of that. So what was your next member's policy number?
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] No, uh, I, I need that information before that, uh, so I need to know before, for that, uh, patient, is it for the provider right or for the member responsible?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We do not determine patient responsibility on any of these policies. That would always be up to the provider.
[CUSTOMER][NEUTRAL] So it's uh
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] This is actually for the non-contracted cure, right? So, in this case, the total charges would be the uh patient responsibility. We can, we can end.
[AGENT][NEUTRAL] And again, we do not determine patient responsibility that would be up to the provider to determine that.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] May I know uh
[CUSTOMER][NEUTRAL] So, is this a uh this is a non-contracted cure, right?
[AGENT][NEUTRAL] I don't, I, I've explained to you this is a hospital indemnity limited benefit plan.
[AGENT][NEUTRAL] It is not major medical insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a couple of minutes.
[CUSTOMER][POSITIVE] Thank you for your patience. I appreciate your time and patience.
[AGENT][POSITIVE] Mm, you're welcome.
[CUSTOMER][NEUTRAL] So, is the provider, uh, may I know the uh network type for the provider?
[AGENT][NEUTRAL] This plan participates in the multi-plan network.
[CUSTOMER][NEUTRAL] So as you provided before, uh, the call reference number would be your name and the date, right?
[AGENT][POSITIVE] That is correct. That is correct.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] So if there's no patient responsibility means it's, it's uh, it's upon the uh contractual adjustment.
[AGENT][NEUTRAL] Again, you would need to speak to Multiplan regarding any network questions.
[CUSTOMER][POSITIVE] Got you I'm moving on to the next one. Thank you.
[AGENT][NEUTRAL] And what is the next member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Sure. And the next member ID is?
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 501
[CUSTOMER][NEUTRAL] 66 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][POSITIVE] Sure. Take your time.
[AGENT][NEUTRAL] And your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient's first name is
[CUSTOMER][NEUTRAL] [PII]. And the last name is
[CUSTOMER][NEUTRAL] [PII]'s date of birth, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Day of service and total bill amount, please.
[CUSTOMER][NEUTRAL] They have services on.
[CUSTOMER][NEUTRAL] [PII] with the bill amount of
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] $5680 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And how can I help you with this claim today?
[CUSTOMER][NEUTRAL] So, uh, for this one also I want to know about the uh
[CUSTOMER][NEUTRAL] Oh, claim, claim status.
[AGENT][NEUTRAL] So you've not called before on this claim?
[CUSTOMER][NEUTRAL] This is the first time I'm calling for this number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so this claim was received. The received date on this claim is going to be.
[AGENT][NEUTRAL] 4425 was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is going to be 358-579-9.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And one moment on the remark.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so this claim was denied and the reason for the denial is that we are unable to accept the assignment of benefits for the claim filed.
[AGENT][NEUTRAL] Due to a discrepancy reported to us by the IRS.
[AGENT][NEUTRAL] That is a combination of the name and taxpayer identification number on your account.
[AGENT][NEGATIVE] Uh, please visit the IRS website for additional information on how to resolve this issue and stop backup withholding.
[AGENT][NEUTRAL] Once this issue is resolved by with the IRS, please send APL a copy of the updated information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, could you please repeat the reason one more time?
[AGENT][NEGATIVE] We are unable to accept assignment of benefits for the claim.
[CUSTOMER][NEGATIVE] Do not reason.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Due to a discrepancy.
[AGENT][NEUTRAL] Reported to us by the IRS.
[AGENT][NEUTRAL] That is a combination of the name and taxpayer identification number on your account.
[AGENT][NEUTRAL] Please visit the IRS website.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For additional information on how to resolve this issue.
[AGENT][NEUTRAL] And stop back up with holding.
[AGENT][NEUTRAL] Once this issue is resolved with the IRS,
[AGENT][NEUTRAL] Please send APL a copy of the updated information.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] So this is the denial it has been updated from your end, right?
[AGENT][NEUTRAL] This is something that the provider needs to reach out to the IRS as I just read to you, to get corrected.
[CUSTOMER][NEUTRAL] For the tax ID, right?
[AGENT][NEUTRAL] It states that it's in combination with the tax ID.
[AGENT][NEUTRAL] And the name, it's a combination of the name and taxpayer identification number.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Got you. So thank you for your assistance. Thank you so much for your help today. Bye for now.
[AGENT][NEUTRAL] You're welcome. Oh, is that the only two you had?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, [PII]. Well then, thank you for calling APL and I hope that you have a very nice day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.