AccountId: 011433970860
ContactId: 15632649-7494-408f-a962-135b07d60c19
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 700419 ms
Total Talk Time (AGENT): 161751 ms
Total Talk Time (CUSTOMER): 219386 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=-1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/15632649-7494-408f-a962-135b07d60c19_20250616T16:31_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII]. I'm reaching out because we've been going on this constantly long
[CUSTOMER][NEUTRAL] dispute about why there's some wonky things going on with reimbursement claims.
[CUSTOMER][NEGATIVE] And I just got another notification that the claims were rejected, which makes no sense. So I was hoping you could pull it up and then I can explain what's been going on and then you kind of tell me what's going on in case I need to call and figure out why, again, it's not being accepted.
[AGENT][NEUTRAL] OK, I'm so sorry, um, what, what is your policy number?
[CUSTOMER][NEUTRAL] It is 01894727.
[CUSTOMER][NEUTRAL] So, generalistically, what's going on is my daughter was born on [PII], um,
[CUSTOMER][NEUTRAL] And a pediatrics group came in and we were billed the [PII], the [PII], and the [PII].
[CUSTOMER][NEGATIVE] So I keep having to argue with them to submit the claims appropriately to you guys. The [PII] was fully covered, but the [PII] and the [PII] weren't sent in the same way. So it was not covered, which makes no sense. Why would you pay for the 3rd day, but not the 1st 2 days. And so I went back to regional pediatrics and I said, you know, you sent these in funny. So then they sent them again and didn't even build Blue Cross Blue Shield, which is our primary insurance.
[CUSTOMER][NEGATIVE] And then after the claims already had a portion of them paid, now it's like they're reversing again and not paying anything. It's very messed up. It's really wonky and I can't seem to figure out what in the heck is going on.
[AGENT][NEUTRAL] Oh, OK, I'm sorry. Now what is your date of birth? Let's start with the verification process, Miss [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] You're fine. My, I just wanted to give you that background before it got confusing, but my birthday is [PII], and this is about the claims for [PII]. She's a dependent.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Correct, and what is your mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and your callback number if we are disconnected please.
[CUSTOMER][NEUTRAL] My number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, thank you very much. Now let me get to your dependent daughter.
[AGENT][NEUTRAL] Her date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I have her pulled up.
[AGENT][NEUTRAL] OK, I see what you call back in May.
[AGENT][NEUTRAL] This is for inpatient for.
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] Patient is OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] We paid
[AGENT][NEUTRAL] OK, so there's one's available. OK, now, OK, got that done for you.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so it's showing that we received some claims that were denied as duplicate.
[AGENT][NEUTRAL] And you're getting a bill from the is it facility?
[CUSTOMER][NEUTRAL] Ah, did not duplicate.
[AGENT][NEUTRAL] Yes ma'am, it was there were 3 claims that were denied as duplicate. I can get those dates for you, um, just bear with me, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let me ask, they
[AGENT][NEUTRAL] OK, so that was.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did anything get so what I saw was for whatever reason ATO covered the cost of the [PII].
[CUSTOMER][NEGATIVE] But not the [PII] and the [PII], which makes positively no sense that you would pay the [PII], but not the [PII] and [PII]. So when they resend those to you guys, they very stupidly took Blue Cross Blue Shield off. So they got rejected because obviously, you guys don't pay for procuring claims, you know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So then I told I called Regional feeds again and I said, what are you all doing? What are you sending? Why are you're not sending it appropriately because the person I spoke with at APL said that they were submitting the claims wrong. So they're getting rejected as duplicates and it's almost like what you were paying got canceled and now nothing's being paid. So what is, can you tell me what's being paid on those?
[AGENT][NEUTRAL] OK, so for, for [PII], we have paid 1012, and that was for um of course inpatient, that was for Miss [PII], so we paid the [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the build amount, the bill amount was.
[CUSTOMER][NEUTRAL] So you pay for the whole 12?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] No, I, no, well, I'm just going back to over what we're what we paid for just to go over to let you know, so, um, give me one second and go back, so we paid um.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] $67.14. Um, that was from Miss [PII].
[AGENT][NEUTRAL] Nurse practitioner.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's for the 12th.
[AGENT][NEUTRAL] And the total charge that they submitted to us.
[AGENT][NEUTRAL] Was $125.
[AGENT][NEUTRAL] OK, so let me write this down for my.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Benefited here 6714.
[CUSTOMER][NEUTRAL] And can you tell me why the whole amount was it covered.
[CUSTOMER][NEGATIVE] That's confusing to me because it's a deductible.
[CUSTOMER][NEGATIVE] Co-pay, so why I've never seen you guys just pay a piece of it.
[AGENT][NEUTRAL] Uh, the 6714, OK, give me one second to pull up the claim.
[AGENT][POSITIVE] And thank you for your patience.
[AGENT][NEUTRAL] That's coming up. So I'm waiting for the claim actual claims come up so I can look at the claim.
[AGENT][NEUTRAL] Well, that is
[AGENT][NEUTRAL] Happening OK 1012.
[AGENT][NEUTRAL] It's gone back over.
[AGENT][POSITIVE] And I apologize for the silence. I'm just waiting for this to come up, OK.
[CUSTOMER][NEUTRAL] You're fine. Take your time. It's been such a confusing thing. It's not a big deal. I just wanna understand so in the future I know what to expect.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Almost, almost populated.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, 125.
[AGENT][NEUTRAL] And I apologize again, it's, it's slow, um, the claim just.
[CUSTOMER][NEUTRAL] You're fine.
[AGENT][NEUTRAL] Populate. I'm waiting for the second image to.
[CUSTOMER][NEUTRAL] It is fine. I
[CUSTOMER][POSITIVE] I would love for this to be the last time I have to call you guys anyway, so we'll just figure it out in this round and take your time and then we'll, we'll be good.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] OK.