AccountId: 011433970860
ContactId: 14539a17-9251-4cf8-b08f-8ebeca80ec85
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1451810 ms
Total Talk Time (AGENT): 416812 ms
Total Talk Time (CUSTOMER): 501230 ms
Interruptions: 5
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/14539a17-9251-4cf8-b08f-8ebeca80ec85_20250128T13:21_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] Good morning [PII]. My name is [PII]. I'm from the central billing department with the Trident Surgery Center, and this call is a follow up on the status of a member's claim, please.
[AGENT][NEUTRAL] OK, and did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII], uh-huh.
[AGENT][NEUTRAL] OK, OK, thank you. And you're needing to follow up on a claim status, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes, yes, yes, there was, um, medical records, I believe that was being requested and they were sent over on [PII].
[AGENT][NEUTRAL] Yes ma'am. Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, alright, well I'll be happy to check that for you. And so first off, [PII], what is a good call back number in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Uh, I have that number as.
[CUSTOMER][NEUTRAL] 02550705
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up please.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] This patient's name is gonna be [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount please?
[CUSTOMER][NEUTRAL] Uh, 10 9 2024 for $13,990.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me look at a few things because I don't see right off the bat, um, and just glancing at it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, let me see if there's a claim number.
[AGENT][NEUTRAL] Any claims for that total bill amount. OK.
[CUSTOMER][NEUTRAL] Let me show here
[CUSTOMER][NEUTRAL] Um, this is a miscellaneous account, uh, miscellaneous and
[CUSTOMER][NEUTRAL] Let me see if there's a claim number that was provided.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I wanna make sure that is the, and I think that charge was higher and.
[CUSTOMER][NEUTRAL] Uh, hold on.
[CUSTOMER][NEUTRAL] That was a higher charge.
[CUSTOMER][NEUTRAL] So let me see, can I find that claim number.
[CUSTOMER][NEUTRAL] 114 set.
[CUSTOMER][NEGATIVE] Cause these charges can begin to run together if you're not careful here.
[CUSTOMER][NEUTRAL] Y 14.
[CUSTOMER][NEUTRAL] 650.
[CUSTOMER][NEUTRAL] Oops.
[CUSTOMER][NEUTRAL] It's not her.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I don't have a
[AGENT][NEUTRAL] I haven't found a claim yet for that bill amount, for the total bill amount.
[CUSTOMER][NEUTRAL] I have a
[CUSTOMER][NEUTRAL] I have a claim number.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Have a barrier.
[CUSTOMER][NEUTRAL] I'm looking at the claim right now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] It says the claim number.
[CUSTOMER][NEUTRAL] On the form here.
[CUSTOMER][NEUTRAL] Which is kind of odd to me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Where is that claim number that I saw 353-7981 for [PII].
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Looking at it.
[AGENT][NEUTRAL] 353-7981. Is that what you said?
[CUSTOMER][NEUTRAL] Mhm, I have it as the claim number on form.
[CUSTOMER][NEUTRAL] E B
[CUSTOMER][NEUTRAL] 353.
[CUSTOMER][NEUTRAL] 7981.
[CUSTOMER][NEUTRAL] It came from American Public Life Insurance Company.
[AGENT][NEUTRAL] OK, that's
[AGENT][NEUTRAL] And it's showing, let me look up that claim number because that's not on her profile.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it has her name, his name, and her.
[CUSTOMER][NEUTRAL] Really? Now, let me.
[CUSTOMER][NEUTRAL] I'm gonna tell you what, I'm gonna tell you what's odd. Yeah, you're right. It's something that's odd. It says claimant name [PII], then insured name [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And has the policy ID number 02550704.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And on this remit, it says, in order to give consideration to this procedure, please send the pathology report for the data service 109.
[AGENT][NEUTRAL] OK, I know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, this is, um,
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Yeah, there is something odd with, OK, that's because they have two different policies.
[CUSTOMER][POSITIVE] Wow, that's what it is.
[AGENT][NEUTRAL] If you'll notice that policy number is different. So is the claim on her supplemental policy or is it on her?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] Now guess what, there's another claim number here.
[CUSTOMER][NEUTRAL] 353, did I give you that number? It's the same number 353 yeah it's the same number.
[AGENT][NEUTRAL] Uh-huh. And then what?
[CUSTOMER][NEUTRAL] But it's
[AGENT][NEUTRAL] Yeah, and what's the policy number?
[CUSTOMER][NEGATIVE] It's so odd.
[CUSTOMER][NEUTRAL] The policy number
[AGENT][NEUTRAL] Does it end in a 4?
[CUSTOMER][NEUTRAL] Uh-huh, it does, but then.
[AGENT][NEUTRAL] OK, cause that's on her.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] That's on our cancer policy, that claim is.
[CUSTOMER][NEUTRAL] And, and then there is another claim.
[CUSTOMER][NEUTRAL] Another policy ended in
[AGENT][NEUTRAL] And we do need the pathology report for that.
[CUSTOMER][NEUTRAL] 705.
[CUSTOMER][POSITIVE] This is interesting.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] 705, that's not on for for that data service on either policy.
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, that's the policy ID number, so they must, we received the EOB back.
[AGENT][NEUTRAL] OK, wait.
[AGENT][NEUTRAL] Uh, we're kind of
[AGENT][NEUTRAL] Let's see if we can rein this in just a little bit, [PII], because we're all over and I have to look at each policy independently.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She has a supplemental.
[AGENT][NEUTRAL] Medical gap policy.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] That ends in claim and policy number.
[AGENT][NEUTRAL] 705.
[AGENT][NEUTRAL] She has a cancer policy that ends in 704.
[AGENT][NEUTRAL] The claim number that you gave me, 353-7981, that is on her cancer policy.
[AGENT][NEUTRAL] And we do need a pathology report, and that is the claim for the $13,990.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that pathology report was faxed over.
[CUSTOMER][NEUTRAL] To the fax number that I was given by a representative on [PII].
[AGENT][NEUTRAL] OK. And which policy number did you reference?
[AGENT][NEUTRAL] On the
[CUSTOMER][NEUTRAL] I referenced the policy number.
[CUSTOMER][NEUTRAL] That was provided by the representative.
[CUSTOMER][NEUTRAL] 04.
[AGENT][NEUTRAL] OK. Now, I do not show.
[AGENT][NEUTRAL] Let me double check.
[CUSTOMER][NEGATIVE] Yeah, this will be my 3rd attempt trying to get that over there. It was 13 pages.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And you said it's at the 114?
[CUSTOMER][NEUTRAL] 114. I'm showing that it was confirmed.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, I
[CUSTOMER][NEUTRAL] It was confirmed.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I do not see where that is on either policy.
[CUSTOMER][NEUTRAL] This is all
[CUSTOMER][NEUTRAL] This is so odd. I'm like, what is going on? Like.
[CUSTOMER][NEUTRAL] It shows here confirmation.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 14.
[CUSTOMER][NEUTRAL] Because this is my 2nd attempt trying to get this over here.
[CUSTOMER][NEUTRAL] And I speak with the representative, and they give me the number, and I fax it over.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yep, it shows that it was confirmed to have been received.
[CUSTOMER][NEUTRAL] At [PII]
[CUSTOMER][NEUTRAL] EST.
[AGENT][NEUTRAL] They told you that or that's what your confirmation says?
[CUSTOMER][NEGATIVE] Yeah, I received that's my confirmation. No one told me that.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh, OK. Cause sometimes, you know, you may get that, but it doesn't fully come through.
[AGENT][NEUTRAL] And it would be on her profile if we had actually had received it.
[CUSTOMER][NEGATIVE] No confirmation.
[CUSTOMER][NEUTRAL] Yeah. And again, this is my, um, and then on [PII].
[CUSTOMER][NEUTRAL] I faxed the same information over.
[CUSTOMER][NEUTRAL] And I got a confirmation. I'm looking here.
[CUSTOMER][NEUTRAL] Yep, it says [PII], it was confirmed to have been received.
[CUSTOMER][NEUTRAL] At [PII].
[CUSTOMER][NEUTRAL] 4:35.
[CUSTOMER][NEUTRAL] Yeah, 4:35.
[CUSTOMER][NEUTRAL] p.m.
[CUSTOMER][NEUTRAL] 13 pages.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And your reference, OK, because you've given me two different policy numbers.
[AGENT][NEUTRAL] So, which policy number are you referencing on these faxes that you're sending cause that makes a difference.
[CUSTOMER][NEUTRAL] I, I'm
[CUSTOMER][NEUTRAL] I'm only referencing the 704 because when the claim came back it.
[AGENT][NEUTRAL] So you a
[AGENT][NEUTRAL] OK, because you initially gave me 705.
[CUSTOMER][NEUTRAL] Well let me explain this to you. Um, when this was entered in our system it entered in at 705, however, we received the EOB.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, back in December, on [PII] requesting the pathology report, so on the EOB it referenced the ID number 704 ending in 704. So therefore on [PII] as well as on 114, when I faxed the pathology report and I referenced the policy number ending in 704, which is on the actual EOB.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] 705 is out the window.
[CUSTOMER][NEUTRAL] It's, it's no longer used here in our system because the EOB came back on 704.
[AGENT][NEUTRAL] OK, so let's see.
[CUSTOMER][NEUTRAL] Is there a supervisor I can send this information to? Because this is.
[AGENT][NEUTRAL] What I'm gonna do is I'm gonna, if, if you said that you, I'm gonna send you, I'm gonna just transfer you over, [PII], to one of the examiners so they can cross reference and look at the information that was received since you have sent it multiple times to verify because I can.
[CUSTOMER][NEGATIVE] Two failed attempts.
[AGENT][NEUTRAL] Let me take a look at something on this one policy.
[AGENT][NEUTRAL] So it all should be under her cancer policy is what you're stating. Is that correct?
[CUSTOMER][NEUTRAL] That's what it that I'm going by what the EOB came and that's what I do. I went by the EOB policy number.
[AGENT][NEUTRAL] Uh-huh. Sure. OK. All right, so yes, ma'am. What I'll do is I'll connect you over, explain to them that you have sent that information multiple times, see if they can look at this information since we have received things on both of these policies and you initially had her supplemental medical policy number instead of her group cancer.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Policy.
[CUSTOMER][NEUTRAL] That is what was entered. So, and can I get your name, please?
[AGENT][NEUTRAL] Yes, my name, again, my name is [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I guess I will um speak with an examiner to see if they can find the medical records because right now it's a possibility we have created like violated HIPAA on this patient because someone has to have a medical records and the fax number that I was presented was the one that I sent it to by a representative on [PII] on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And again verify that fax number with me one more time, please, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that is the correct number. I just wanted to re verify it one more time with you. Let me look at one additional.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Maybe it may be hung up in imaging, you know, I'm not sure.
[AGENT][NEGATIVE] Oh, it wouldn't be hung up. Yeah, it shouldn't be hung up. No. If I, if sent submitted it that many times, it would not still be in imaging. It shouldn't be.
[AGENT][NEUTRAL] So give me just a second.
[AGENT][NEUTRAL] It's just taking a moment, [PII], to load what I'm trying to look at.
[CUSTOMER][POSITIVE] Oh, take your time.
[AGENT][POSITIVE] Thank you for your patience.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me get that up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So, yes, I, I cannot locate it. [PII]. I'm sorry. I just, I'm not um
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's not your fault. It's, it's somewhere. Um,
[AGENT][NEUTRAL] Look at one more. I'm just.
[CUSTOMER][NEUTRAL] So maybe we can um
[CUSTOMER][NEUTRAL] I guess we have to speak with the representative of examiner or someone to assist us on why this is occurring.
[CUSTOMER][NEGATIVE] Cause I have confirmation on my side that it was received. It's a glitch somewhere.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Alright, let me just look one more, one more way, and then this will be, I will be at the end of what I, I know to do. So one second please, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII] is the day of service.
[CUSTOMER][NEUTRAL] Let me see you put it back on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] OK, I may have found something here, [PII].
[AGENT][NEUTRAL] OK, so [PII], it looks like what has happened is that this claim was also processed.
[AGENT][NEUTRAL] With the insured submission.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so
[AGENT][NEUTRAL] The benefits were paid to the insured.
[AGENT][NEUTRAL] We received complete information from her.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Before we received the other requested information from the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we should contact the member?
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, but the mystery has been solved as far as
[CUSTOMER][NEUTRAL] Alright, I'll do so.
[CUSTOMER][POSITIVE] I'm so glad that mystery have been resolved. OK. And can you tell me what, what date that was?
[AGENT][NEUTRAL] Yes, but that is.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] It was the end of December.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] But we can be correct on what we're saying. OK.
[CUSTOMER][NEUTRAL] Alright, and your name again is [PII]. Do I need a call reference number for this conversation?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] You would, you would use my if you need one, you would use my name along with today's date.
[AGENT][NEUTRAL] And in the future you could um if we've processed a claim [PII], somebody may have already given you our website but we do have a portal that if you ever need a copy of an explanation of benefits you can actually go to the portal which the website for that is secured. Apublic.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] No, this is my first time experiencing this um insurance because I work with Blue Cross and Blue Shield. I am the rep for Blue. I'm just helping out here. OK. All right, thank you kindly, [PII], and you enjoy the rest of your work day and your work and take care. Stay safe out there. Thank you kindly. Uh-huh. Same to you, dear. Bye-bye. Same to you. Bye-bye. Goodbye.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Well, you
[AGENT][POSITIVE] I hope, yes, ma'am, you too. Have a blessed day. Uh-huh. Bye-bye.