AccountId: 011433970860
ContactId: 144db66d-92bd-43fb-b53e-ec9b99223145
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 557200 ms
Total Talk Time (AGENT): 304780 ms
Total Talk Time (CUSTOMER): 166319 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/144db66d-92bd-43fb-b53e-ec9b99223145_20250113T21:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Park View Noble Medical Center, and I needed to check the status of the claim for one of our patients.
[AGENT][POSITIVE] OK, I would be happy to help you with that. um, can I get a good callback number for you?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh it's [PII].
[AGENT][NEUTRAL] OK, and do you have your patient's policy number for that claim?
[CUSTOMER][NEUTRAL] Uh, let's see, I know [PII] said that it's probably not gonna be the same number as what I gave her. Let me give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, maybe not, yeah, I only have that D number and she said that might not work for you all.
[AGENT][NEUTRAL] Yeah, it doesn't that's OK though um do you have your patient's social by chance?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Um, no, we don't use socials for, uh.
[CUSTOMER][NEUTRAL] Member IDs, I'm sorry.
[AGENT][NEUTRAL] No, that's OK. um what about their name and date of birth?
[CUSTOMER][NEUTRAL] Uh patient's first name is [PII]
[CUSTOMER][NEUTRAL] And the last name is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, let's see what we can find here.
[AGENT][NEUTRAL] Uh, Crysta John 127. OK, what is the date of service and build amount that we're looking for?
[CUSTOMER][NEUTRAL] OK, it's a date range it's [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $7,411.26.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so let's see here.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let's try their other policies because I'm not finding anything on this one, but that they had two different kinds of policies, so that doesn't mean anything.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 74 1126.
[AGENT][NEUTRAL] I don't see any.
[CUSTOMER][NEUTRAL] And we just actually just billed that to uh we just built that at the end of December so.
[AGENT][NEUTRAL] OK, um, I don't see anything with that total charge amount, um.
[CUSTOMER][NEUTRAL] If that helps.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I see several for ER visits and stuff for that date, but I don't see.
[CUSTOMER][NEUTRAL] Yeah, that's what it is. It's an ER it's an ER charge.
[AGENT][NEUTRAL] Yeah, but.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, let me see if.
[AGENT][NEUTRAL] I have you guys that way I can kind of determine if any of these are for you or not.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because if so it could just be that you know Tapo for whatever reason.
[CUSTOMER][NEUTRAL] Yeah, or maybe they split it up or some split the bill. I don't know, sometimes they do that.
[AGENT][NEUTRAL] Let's
[AGENT][NEUTRAL] Right and see that's what I'm wondering if they split it up somehow.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And if you need to call APO again, the policy number that we have for this particular policy is 244.
[AGENT][NEUTRAL] 9247.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] OK, I'm gonna add these two claims together and see if this gets me that total.
[AGENT][NEUTRAL] Uh, it's a little more.
[AGENT][NEUTRAL] But they're both facility bills. Let me pull them up. OK, so this one is for, you said you're calling from Park View Noble?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] That, OK, so I have Community Hospital Noble.
[CUSTOMER][NEUTRAL] Yeah, that's us.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, and this, and you all are also the secondary, so I don't know like, you know, how the planes come through on that end, but.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, the primary did pay, so you know, depending on what that looks like on your end, that could also be a contributing factor.
[AGENT][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so community hospital Noble, let's see, it's, so I think that this is just for.
[AGENT][NEUTRAL] The ambulance, it looks like this is not for any facility charges, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, ground mileage, OK, and then the other one, the other facility bill for that day, and it's just dated the [PII], of course, so that would be why that one's not adding quite up, um, let's see, and then this one, this one's community hospitals Lagrange.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it also is not a date span. So I'm not seeing a date span. Um, the other two look like they probably were, um.
[AGENT][NEUTRAL] The physician's fees for this visit or for these visits, um, I do not see the date span.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it looks like he they stayed over.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It went from one day to the next, um, OK, I'll resubmit this, um, can I just verify the uh.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The uh mailing address on this claim, well, where it needs to go rather.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, so we have um a mailing address and we have a fax number whichever one you prefer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and you can do both that way I can put it in the notes and.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, perfect. OK, so the mailing address is just gonna be um [PII].
[AGENT][NEUTRAL] And it's going to be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] And then uh the fax number is going to be attention claims and that is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3659423.
[CUSTOMER][NEUTRAL] OK, yeah, so that might be the problem there like we, I'm sure that this, this didn't go electronically because like I said it is a secondary claim with an EOB, a primary EOB with it, but we definitely didn't have that address so.
[AGENT][NEUTRAL] Got you yeah that probably was it it probably just to be honest, it probably went to IMA first which if they have any type of like um wellness benefits um IMA will get those claims or benefits in a card um either one they will get those claims first.
[CUSTOMER][NEUTRAL] That might be the problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And sometimes for whatever for whatever reason it doesn't always forward to us and get sent to us like it's supposed to um so we have this issue all the time so it looks like because we handle the medical side and a lot of times they handle strictly the wellness side um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sometime they split it up, you know, it goes to the to benefits in a card and then they're supposed to split it up, but sometimes it just doesn't, it doesn't get where it needs to be so it, it could be that it went electronically, yeah, and it just didn't continue to make it to us after that, um, for whatever reason. I'm not really sure why it does that sometimes, but sometimes it does so that's our direct fax and mailing address so should you have any additional issues with getting claims to us, you can send those to us directly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so that might have been what happened.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, OK.
[CUSTOMER][POSITIVE] OK great thank you so much I appreciate your help and explaining that.
[AGENT][POSITIVE] Yeah, of course. No problem at all. Is there anything else I can do? OK, you too. Thanks for calling APO.
[CUSTOMER][POSITIVE] Alright you have a great rest of the day. That's it. Take care. Uh huh bye bye.
[AGENT][NEUTRAL] All right, bye bye.