AccountId: 011433970860
ContactId: 22205bcf-664e-4d9e-9621-83f364a4e974
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 772679 ms
Total Talk Time (AGENT): 253459 ms
Total Talk Time (CUSTOMER): 287253 ms
Interruptions: 13
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/22205bcf-664e-4d9e-9621-83f364a4e974_20250414T14:08_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][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.
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] It's on policy number 251.
[CUSTOMER][NEUTRAL] 1363.
[CUSTOMER][NEUTRAL] And it is for claim 358.
[CUSTOMER][NEUTRAL] 5466.
[CUSTOMER][NEUTRAL] And she is stating that she believes that we paid for the primary paid and not the responsibility.
[AGENT][NEUTRAL] OK, let me just.
[CUSTOMER][NEUTRAL] Can you help her with that for a little further research?
[AGENT][POSITIVE] Yes, let me go ahead and pull this information up and then I'll take it and then I can help her out.
[CUSTOMER][POSITIVE] Absolutely, no problem. I get it.
[CUSTOMER][NEUTRAL] Always try to give you time to get everything pulled up.
[CUSTOMER][NEUTRAL] And I told her that I would let her know what was going on so she didn't have to repeat it.
[CUSTOMER][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?
[CUSTOMER][NEGATIVE] It's been so long since I've done claims.
[AGENT][NEUTRAL] Well, so
[AGENT][NEUTRAL] For the MetLink, it pays the copays and deductibles, so it only pays.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Like that that paid amount.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So I'm trying to see what other amount she thinks that we should be paying. Um, let me see.
[AGENT][NEUTRAL] OK, and what I'm sorry, what was the provider's name?
[CUSTOMER][NEUTRAL] [PII] and I've got her callback number if needed.
[AGENT][NEUTRAL] OK, yes, please.
[CUSTOMER][NEUTRAL] Her callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK great thank you I'm ready for her.
[CUSTOMER][POSITIVE] Alright, let me get her on the line. Thank you, [PII]. I hope you have a wonderful day. One moment.
[AGENT][POSITIVE] Alright thanks you too.
[CUSTOMER][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? OK, great thank you and thank you for calling APL. I hope you have a wonderful day. You too, thank you.
[CUSTOMER][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][POSITIVE] OK, thank you for holding this is [PII].
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Uh, yes, um, you say you're calling from the provider's office, [PII], and you had a question regarding, uh, a, a paid claim.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right, right. Did she explain to you how they pay us?
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] I'm sorry that you had a question regarding the amount that was that was processed.
[CUSTOMER][NEUTRAL] Correct, right, so did she explain to you that they pay less for the, for the, for the claim?
[CUSTOMER][POSITIVE] Correct.
[AGENT][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?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Right, but the claim, like if you look at the date of service of [PII], you can compare it, how you guys paid it 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] I see.
[AGENT][NEUTRAL] OK, so you're saying that you are comparing it to a different claim?
[AGENT][NEUTRAL] The amount
[CUSTOMER][NEUTRAL] 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 [PII]. The primary paid 7582, so American was supposed to be paying 324, 18.
[CUSTOMER][NEUTRAL] And they only pay 7582. OK, but if you look at the other other claims, right, but if you look at all the other claims, they have all paid.
[AGENT][NEUTRAL] Correct, so it looks like the 324818 was the adjustment amount. It's on 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 the copays and deductibles.
[AGENT][NEUTRAL] Um, on that off of the EOB.
[AGENT][NEUTRAL] OK, so what date of service were you?
[CUSTOMER][NEUTRAL] [PII]? [PII]. OK.
[AGENT][NEUTRAL] I'm sorry, [PII]?
[AGENT][NEUTRAL] OK, let me take a look at that one. Bear with me just a moment.
[CUSTOMER][NEGATIVE] But you guys see what ended up paying exactly what the primary paid. It doesn't make sense.
[AGENT][NEUTRAL] Oh sure, well, bear with me just a moment. I'll take a look at that previous claim for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, do you mind if I put you on hold for just a quick second, [PII]?
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Good morning [PII] how are you doing?
[AGENT][NEUTRAL] I'm good. I think I have a problem though. I need your help.
[AGENT][NEUTRAL] OK. Can you see my screen?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so I have a provider on the other line and she's calling regarding this claim that we paid um 7582 on.
[AGENT][NEUTRAL] And from what I'm looking at,
[AGENT][NEUTRAL] That looks like the correct amount we should have paid, is that right?
[AGENT][NEUTRAL] OK, what?
[AGENT][NEUTRAL] So what amount should we have paid?
[AGENT][NEUTRAL] Uh
[AGENT][NEGATIVE] No, she's saying we underpaid it because and then I'm going through because we have paid the look at the previous claims, we have been paying this amount, the adjustment on several claims and that's why she's calling because she's like you guys paid this 300 da da da all these other times because he looked.
[AGENT][POSITIVE] We, we, we've paid that amount we've been receiving this EOB, that same EOB and we've paid this amount several times.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. Uh
[AGENT][NEUTRAL] I just, I can, I'm just not really sure what the amount we should, like you said, we should, I guess we see a more detailed EOB.
[AGENT][NEUTRAL] But was that the correct amount or or are they both?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Is this
[AGENT][NEUTRAL] OK, so that was actually correct, but that this one we, we did underpay.
[AGENT][NEUTRAL] OK, OK, well I'll let her know that that will.
[AGENT][NEUTRAL] Yeah, OK, cause I just, I just didn't, I just wasn't sure cause I didn't see, you know, like it's like the copay deductible or whatever, so, I mean, me looking at it.
[AGENT][NEUTRAL] Oh, cause for me the adjustment amount just means what was like written off, so that's what was kind of confusing to me, but.
[AGENT][NEUTRAL] Right, and it says patient responsibility.
[AGENT][NEUTRAL] Or co-insurance. Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] But it's like which amount is it referring to though, you know?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I just need to send auto like an error thing to reprocess?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty, thank you, ma'am.
[AGENT][POSITIVE] Thanks bye bye.
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] Uh, thank you for holding, [PII]. Are you still there?
[AGENT][NEUTRAL] OK, yes, so I did review that discrepancy with that last claim for [PII], so I will go ahead and have that re-reviewed and the additional um benefit will be released, OK?
[CUSTOMER][NEUTRAL] OK, so we got it straight out. OK, perfect. Um, is there like a reference number for this call?
[AGENT][NEUTRAL] Um, no, we don't have reference numbers, but you're free to use my name and today's date.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, what is your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] OK, so it was a mistake. You saw that, right?
[AGENT][NEUTRAL] Yes ma'am, there was a discrepancy with that claim, so we will go ahead and have it reprocessed and it will be released today.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much.
[AGENT][NEUTRAL] Uh sure, was there anything else I could do to help you today?
[CUSTOMER][NEUTRAL] She's
[CUSTOMER][POSITIVE] That's all. Thank you so much.
[AGENT][POSITIVE] Thanks for calling APL. You have a good day.
[CUSTOMER][POSITIVE] Bye-bye. Thanks. Bye. Bye-bye too.