AccountId: 011433970860
ContactId: 17ebc809-3f43-449f-b77e-00cbc1a1c786
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 533679 ms
Total Talk Time (AGENT): 169915 ms
Total Talk Time (CUSTOMER): 335598 ms
Interruptions: 13
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/17ebc809-3f43-449f-b77e-00cbc1a1c786_20250414T14:04_UTC.wav
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[AGENT][NEUTRAL] Well yes let me I'm [PII].
[CUSTOMER][NEUTRAL] I don't think I'm Yes, I'm calling regarding a claim status, please.
[AGENT][POSITIVE] Oh it would be my pleasure to assist you with claim status. May I ask your name?
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Oh yeah, call us, uh, what is the callback number, please?
[CUSTOMER][NEUTRAL] like me
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That is [PII] MLH.
[AGENT][POSITIVE] Thank you. And the policy number for the patient, please.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] It's for [PII] [PII].
[AGENT][NEUTRAL] All right, thank you, and I can help you with that claim status. What is the data service?
[CUSTOMER][NEUTRAL] It's for, I'll tell you right now, give me one sec 225, 2025.
[CUSTOMER][NEUTRAL] You guys are the supplemental, but I, 0 400.
[AGENT][NEUTRAL] And the bill amount, please.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] I believe you guys paid it in error because you guys paid exactly the same amount that the primary paid and we usually don't get that amount we get more.
[AGENT][NEUTRAL] OK, and what is the name of the provider and the total, you said the total bill amount was?
[CUSTOMER][NEGATIVE] Like, no.
[CUSTOMER][NEUTRAL] 100 and it's for [PII].
[AGENT][NEUTRAL] 400
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Let me just get that pulled up real quick one moment please.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Bear with me just one second. I'm checking on that for you. And y'all received that 7582 payment?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, so let me see something. If you look at the previous claims like we received like 3 24 18 so.
[CUSTOMER][NEUTRAL] on.
[CUSTOMER][NEUTRAL] Oh, that's the.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What I'm going to do.
[AGENT][NEUTRAL] Because I'm gonna send this back to our claims department.
[AGENT][NEUTRAL] To review and reprocess.
[CUSTOMER][POSITIVE] OK, perfect. You saw the previous claims, right?
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] because of
[AGENT][NEUTRAL] Well, I would just looked at the EOB that we had um on that claim.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] They just, it was just an error and we're gonna get that corrected.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now it could take up to 7 to 10 business days.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] I'll tell you, I'll tell you what, if you don't mind, can you hang, let me get you to that claims adjuster and let them review because I don't know if they're gonna wanna ask.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Let.
[AGENT][NEUTRAL] Um, just pay the difference or what, do you mind holding just one moment?
[CUSTOMER][NEUTRAL] Yeah, are you gonna be on the line too, or do I have to repeat everything?
[AGENT][NEUTRAL] No, I'm gonna let her know. You don't have to repeat everything.
[CUSTOMER][POSITIVE] OK. OK. OK, great. Thanks. Thank you, thank you.
[AGENT][POSITIVE] I'll take care of that for you. Thank you [PII]. One moment please.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh that's.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], it's [PII]. Happy Monday. I have a provider on the line calling in regarding to regards to a claim that they're expecting a different amount.
[CUSTOMER][POSITIVE] Good morning.
[AGENT][NEUTRAL] It's on policy number 251.
[AGENT][NEUTRAL] 1363.
[AGENT][NEUTRAL] And it is for claim 358.
[AGENT][NEUTRAL] 5466.
[AGENT][NEUTRAL] And she is stating that she believes that we paid for the primary paid and not the responsibility.
[AGENT][NEUTRAL] Can you help her with that for a little further research?
[CUSTOMER][NEUTRAL] OK, let me check.
[CUSTOMER][POSITIVE] Yes, let me go ahead and pull this information up and then I'll take it and then I can help her out.
[AGENT][POSITIVE] Absolutely. No problem. I get it.
[AGENT][NEUTRAL] Always try to give you time to get everything pulled up.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And I told her that I would let her know what was going on so she didn't have to repeat it.
[AGENT][NEUTRAL] And I wasn't sure because we pay part of it, would y'all just do an additional payment on it or how would that work?
[AGENT][NEGATIVE] It's been so long since I've done claims.
[CUSTOMER][NEUTRAL] Well, so,
[CUSTOMER][NEUTRAL] For the MetLink, it pays the co-pays and deductibles, so it only pays.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like that that paid amount?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I'm trying to see what other amount she thinks that we should be paying. Um, let me see.
[CUSTOMER][NEUTRAL] OK, and what I'm sorry, what was the provider's name?
[AGENT][NEUTRAL] [PII] and I've got her callback number if needed.
[CUSTOMER][NEUTRAL] OK, yes, please.
[AGENT][NEUTRAL] Her callback number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK great thank you I'm ready for her.
[AGENT][POSITIVE] All right, let me get her on the line. Thank you, [PII]. I hope you have a wonderful day. One moment.
[CUSTOMER][POSITIVE] Thanks. You too.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] [PII], thank you for your patience. I have [PII] on the line. She's going to assist you further and she is looking at that claim now, OK?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, great. Thank you.
[AGENT][POSITIVE] And thank you for calling [PII]. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][POSITIVE] Right, right, thank you for holding, this is [PII].
[CUSTOMER][NEUTRAL] Hi, uh, yes, um, you're so you're calling from the provider's office, [PII], and you had a question regarding the, uh, a paid claim, right, right, did she explain to you how they pay us?
[CUSTOMER][NEUTRAL] I'm sorry that you had a question regarding the amount that was that was processed. Correct, right, so did she explain to you that they paid less for the for the for the claim?
[CUSTOMER][NEUTRAL] So regarding the EOB that that we received, we see that there was a build amount of $400 and then there was an adjustment of $324.18 and it looks like the the patient responsibility left over was $75.82. Is that correct? Right, but the claim, like if you look at the date of service of [PII], you can compare it, how you guys paid it.
[CUSTOMER][NEUTRAL] For 225, you guys ended up paying the same amount that the primary insurance paid.
[CUSTOMER][NEGATIVE] So that looks like it's an error.
[CUSTOMER][NEUTRAL] OK, so you're saying that you are comparing it to a different claim, the amount? OK, so I don't, I'm not sure the the lady explained to you the situation so this claim was underpaid by by American Public Life to 25 2025, the primary paid 7582, so American was supposed to be paying 324, 18.
[CUSTOMER][NEUTRAL] And they only pay 7582. Correct, so it looks like the 324818 was the adjustment amount. It's only the EOB that we received that doesn't look like it that was covered by insurance, that's showing as the adjusted amount under this policy, it pays the co-pays and deductibles, um, on that off of the claims.
[CUSTOMER][NEUTRAL] Right, but if you look at all your data.
[CUSTOMER][NEUTRAL] 26 2