AccountId: 011433970860
ContactId: 14257e3e-bf24-4b65-9010-32e9c4cbd758
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363920 ms
Total Talk Time (AGENT): 117198 ms
Total Talk Time (CUSTOMER): 155581 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/14257e3e-bf24-4b65-9010-32e9c4cbd758_20250213T14:02_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], good morning. My name is [PII]. I'm calling from Prisma Health in [PII]. How are you this morning?
[AGENT][NEUTRAL] I'm doing fine. How are you?
[CUSTOMER][NEUTRAL] I'm well, thank you. I don't know if I'm calling the right place, but I have a claim that denied. This is the number that's on the insurance.
[CUSTOMER][NEUTRAL] Card
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] I do 02458169.
[CUSTOMER][NEUTRAL] And your name again? I'm sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK, that's what I thought. I just wanted.
[CUSTOMER][POSITIVE] Be sure. Thank you, [PII].
[AGENT][NEUTRAL] You're welcome. Is, and what's the patient's name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And you were calling about a claim status?
[AGENT][NEGATIVE] That was denied.
[CUSTOMER][NEUTRAL] Yes, well, I have a
[CUSTOMER][NEUTRAL] Yeah, yes, it's interesting because it's, it the remit came in without any information on it. All it says is CO 16. It lacks information for submission billing errors. I have no idea.
[CUSTOMER][NEGATIVE] What it, it doesn't even um specify any codes or anything.
[AGENT][NEUTRAL] OK, and what date of service was that for?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that was on [PII], you said?
[CUSTOMER][POSITIVE] That's correct, yes.
[AGENT][NEUTRAL] OK, does it say American Public Life on the EOB?
[CUSTOMER][NEUTRAL] On the EOB.
[CUSTOMER][NEUTRAL] Now it says multi-plan PHCS contracted.
[AGENT][NEUTRAL] Yes, ma'am. That's not us. Um, we don't even have a claim for that data service.
[CUSTOMER][NEUTRAL] OK, so the information.
[CUSTOMER][NEUTRAL] In here
[CUSTOMER][NEUTRAL] I'm gonna look at her
[AGENT][NEUTRAL] I mean she has a policy with us and everything, but we just haven't received a claim for that data service. We don't have any claims for [PII] at all.
[CUSTOMER][NEUTRAL] Her card real quick.
[CUSTOMER][NEUTRAL] OK, where
[CUSTOMER][NEUTRAL] I wanna look at the the card that they put in here.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Maybe they didn't put their break.
[CUSTOMER][NEUTRAL] American Public life.
[AGENT][NEUTRAL] That's us.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] That issue, OK.
[CUSTOMER][NEUTRAL] Let me look at this card because.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so it looks like I guess we didn't bill it to the right place is that.
[CUSTOMER][NEUTRAL] Because, see, we have American Public Life.
[CUSTOMER][NEUTRAL] And it says multi plan limited benefit plan.
[AGENT][NEUTRAL] Yeah, Multiplan is the providers for this policy.
[CUSTOMER][NEUTRAL] Right, OK, so that's what we billed it to, but this is the number that's on this claim, I mean on the card.
[AGENT][NEUTRAL] The card, right, but like I said, we haven't received any claims, so that wouldn't be our denial.
[CUSTOMER][NEUTRAL] OK, so I did the call.
[CUSTOMER][NEUTRAL] Somebody else, I guess, um.
[AGENT][NEUTRAL] Now you can resend it if you would like. I can give you the address where it needs to go.
[CUSTOMER][NEUTRAL] OK, uh, let me see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Resend to OK, what is the address?
[AGENT][NEUTRAL] It will go to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Yeah, that's where we sent it actually.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah, that's
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][NEUTRAL] Yes, ma'am, and that's a repricing and it's supposed to go to them first and then they're supposed to send it to us.
[CUSTOMER][NEUTRAL] OK, so I need to resend the [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] What's weird is they must have gotten it because there's a remit.
[CUSTOMER][NEUTRAL] You know what I mean?
[AGENT][NEUTRAL] Yes, ma'am. They should have forwarded it to us.
[AGENT][NEUTRAL] For the claim processing.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So I just need to refile it. Should I refile it as a corrected claim or is it original?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Because I don't, I don't want it to deny for.
[CUSTOMER][NEUTRAL] Um, duplicate.
[AGENT][NEUTRAL] Yeah, you can
[CUSTOMER][NEUTRAL] Because like I said, it
[AGENT][NEUTRAL] Send it as a corrected claim and you can also, uh, since we didn't get it the first time, you can fax it to us.
[CUSTOMER][NEUTRAL] Said it corrected.
[CUSTOMER][NEUTRAL] OK, what's that fax number?
[AGENT][NEUTRAL] 877.
[AGENT][NEUTRAL] 3659423
[CUSTOMER][NEUTRAL] OK, and is there a reference number for the call today between you and I?
[AGENT][NEUTRAL] We do not have reference numbers. You can use my name in today's date. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, you've been awesome and I appreciate it very much, [PII]. I hope you have a great day.
[AGENT][POSITIVE] You too, [PII]. Thank you for calling APL [PII], you have a good day as well.
[CUSTOMER][POSITIVE] Thank you bye now.
[AGENT][NEUTRAL] Bye bye.