AccountId: 011433970860
ContactId: 252587cf-d202-436b-89fe-77f03ffd33b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1135209 ms
Total Talk Time (AGENT): 356251 ms
Total Talk Time (CUSTOMER): 350517 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/252587cf-d202-436b-89fe-77f03ffd33b5_20250207T15:25_UTC.wav
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[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, I'm calling from provider's office. Um, I was, I had a couple of questions. Um, we received, so we sent a claim out for a patient for a hospital claim.
[CUSTOMER][NEUTRAL] And we received a letter stating um
[CUSTOMER][NEUTRAL] That the benefits needed to be verified before processing.
[CUSTOMER][NEUTRAL] From American Public Life and I called.
[CUSTOMER][NEUTRAL] Then if it's in a car and they said to call 9 degrees.
[AGENT][NEUTRAL] OK. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, D as in David, 43728955.
[AGENT][NEUTRAL] Can you give me your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], what's a good uh callback number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and um who was the claim processed by 90 Degree or American Public Life?
[CUSTOMER][NEUTRAL] They said that 90 degrees.
[AGENT][NEUTRAL] OK, do you have a claim number?
[CUSTOMER][NEUTRAL] No, I was calling you to get that information.
[AGENT][NEUTRAL] OK, well, you're speaking with American Public Live, so it's two different companies, APL and 90 Degree, so I'm trying to figure out what's going on here, um, spell the patient's first and last name for me.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, [PII] is [PII]
[CUSTOMER][NEUTRAL] They gave me this number for 90 degrees.
[AGENT][NEUTRAL] Yeah, you may have selected the incorrect option. What option did you choose?
[CUSTOMER][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] Uh, it says something about hospital indemnity plan.
[AGENT][NEUTRAL] Right, and so that brought you to American Public Life, but let me search by the name and see if I can locate this member.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And it is a medical claim, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And do you have a data service for the claim?
[CUSTOMER][NEUTRAL] 1015, 2024.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, thank you for holding. I think I've located the policy number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's his date of birth? [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Um, uh, [PII].
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the total charge?
[CUSTOMER][NEUTRAL] $17,939.65.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And would this be the hospital charge?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, so is it from the [PII] through the [PII]?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim would have been processed by American Public Life, which is who you're speaking with, is that Piedmont Newman Hospital?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And so.
[AGENT][NEUTRAL] I show that we processed the claim on [PII].
[AGENT][NEUTRAL] And there was no payment made on this claim, let me see why.
[AGENT][NEUTRAL] It says
[AGENT][NEUTRAL] Our records indicate that premium for this service date.
[AGENT][NEUTRAL] Was not received therefore no benefits are payable so it looks as though this patient was not eligible at the time of the date of service.
[CUSTOMER][NEUTRAL] My guy I just talked to said it was active on the data server.
[AGENT][NEUTRAL] The policy is active.
[AGENT][NEUTRAL] But for those for the specific dates in question, the patient was not eligible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So the policy was active but not eligible for the services on that data service.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy is currently active and so the reason why the claim could not be paid because the dates of service of your claim at that time between the [PII], he was not eligible for those dates.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what is the claim number for that?
[AGENT][NEUTRAL] It's 352.
[AGENT][NEUTRAL] 4471.
[AGENT][NEUTRAL] And the patient should have received the explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the letter that we got.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I just want to make sure. So it says on here we are waiting information to confirm eligibility.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We are, yeah, OK, so.
[AGENT][NEUTRAL] What does it read specifically?
[CUSTOMER][NEUTRAL] It says, we are waiting information to confirm eligibility from benefits in a card. Upon receipt of this information, we will continue processing your claim. If you have any questions, please call benefits and a card and their number.
[AGENT][NEUTRAL] OK, and we received response.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Go. Is this the EOB stating it was, it was denied, or is there another EOB that states that?
[AGENT][NEUTRAL] No, that's the, you know, that's the initial claim that was processed and just let it so that that that EOB is just stating that we were basically the claim was in a pending status waiting to confirm eligibility. We did receive a response and we was informed that the patient was not eligible for this particular date of service. So then a second explanation of benefits was mailed, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And it should be reflected on the claim number that I provided.
[CUSTOMER][NEUTRAL] OK. I did not get that EOB. Could you fax or email that to me?
[AGENT][NEUTRAL] What's the billing address? It was sent to the same address as the one you just read.
[CUSTOMER][NEUTRAL] Um, it should be [PII].
[AGENT][NEUTRAL] Mhm, what I can do is show you how to create an online account and you can download it from the website because it this one was mailed as well.
[AGENT][NEUTRAL] It would have been mailed on [PII] to that address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is this a um.
[CUSTOMER][NEUTRAL] Is this for the American public life portal?
[AGENT][NEUTRAL] American American public life, yes, yes.
[CUSTOMER][NEUTRAL] I think I have an account. Let me, let me see if I can get on there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] You could help me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEGATIVE] Password is expired unless reset.
[CUSTOMER][NEUTRAL] Let me reset this. Sorry. Thank you for helping me. This, I've been so confused about, there's so many different people to talk to for this one thing.
[AGENT][POSITIVE] No worries.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Come on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I am in the portal.
[CUSTOMER][NEUTRAL] So just can I just search for the claim and it should pop up?
[CUSTOMER][NEUTRAL] No claims, he says.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] There's a quick search where you can enter the patient's first name, their date of birth, and then the claim number that I gave you, and it should populate the ELB.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So when I do the um claim number, and it says 352-447-1.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, when I do that.
[CUSTOMER][NEUTRAL] It says there are no claims to display.
[AGENT][NEUTRAL] OK, what tax ID number did you enter?
[AGENT][NEUTRAL] What provider tax ID number did you enter?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I don't know what's on my account actually.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, it's so if if you do billing or claim statuses for different providers, of course they each will have a different tax identification number. I bet that's why it's not pulling up, so you, I don't know if you have to create an account for this particular tax ID.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I may have to create a new one. Well, let me.
[AGENT][NEUTRAL] The account that you're in now, is it already created?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it could be.
[CUSTOMER][NEUTRAL] So I don't know what tax ID I used.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, let me.
[CUSTOMER][NEUTRAL] I'll try to, so it says to register use a patient account number.
[AGENT][NEUTRAL] So that's the patient account number that's on your claim. So that's a hospital bill, so it's gonna be in the upper right corner. I think it's box 3 may say medical control number.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Or patient account number?
[CUSTOMER][NEGATIVE] Uh, it's not working.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What number?
[CUSTOMER][NEGATIVE] It just keeps saying no user was found.
[AGENT][NEUTRAL] OK, but you have to make sure that you're looking under the tax ID number that the claim is under, so that would be for the hospital.
[AGENT][NEUTRAL] So you may have to go back out and so when you so did you create an account under the hospital's tax ID?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I am trying to create a new account and it's asking for the tax ID and then a patient account number and it's not right it's not pulling up the account number I'm using.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] What tax ID number are you using?
[CUSTOMER][NEUTRAL] [PII]. That's [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, that's what I show and then the patient account number or the medical the mem the um.
[AGENT][NEUTRAL] Control number I think it's in box 3. I'm pulling up the UBO4 form.
[AGENT][NEUTRAL] Give me that number, it's the patient control number in 3A.
[CUSTOMER][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] You claim.
[CUSTOMER][NEUTRAL] Yeah, I mean that's what I put the E.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The E number
[CUSTOMER][NEUTRAL] E 1089.
[AGENT][NEUTRAL] Can you say that out loud for me? Mhm.
[CUSTOMER][NEUTRAL] So 108995923801.
[AGENT][NEUTRAL] Um, it's actually 800. I think each time when you're in when you open the claim it'll change that last number.
[AGENT][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Ah, there, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, let me, it works, so let me try to create this account.
[CUSTOMER][NEUTRAL] Wish you could do more than one tax ID.
[AGENT][NEUTRAL] I know it I know it so like if you had several patients with the same tax ID number you could stay in that one file, but if it's a different tax ID or a different doctor or hospital, you have to register under their tax ID number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Oh, that's aggravating.
[CUSTOMER][NEUTRAL] Not your fault.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK, all right, I.
[CUSTOMER][POSITIVE] Got it. Perfect. OK, let me search for the patient now that I got that. OK.
[CUSTOMER][NEUTRAL] Oh goodness, this is, I know you have things you gotta do. I'm sorry.
[AGENT][NEUTRAL] No, you're fine. You're fine.
[CUSTOMER][NEUTRAL] Searching, please pull up. There it goes.
[AGENT][POSITIVE] Yay
[CUSTOMER][NEUTRAL] Come on, come on, come on.
[CUSTOMER][NEGATIVE] I have to write down all these accounts.
[AGENT][NEUTRAL] Mhm. Right.
[CUSTOMER][NEUTRAL] Alright, so.
[AGENT][NEUTRAL] And the remarks should be on page 2 or the back.
[CUSTOMER][NEUTRAL] OK, so from what it's showing me it's saying the EOB still says we're waiting confirmation for eligibility.
[AGENT][NEUTRAL] But what claim number did you, did you, um, are you looking at?
[CUSTOMER][NEUTRAL] 352-447-1
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][NEUTRAL] Yeah, that's the claim number.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Yeah, so what I'm showing it indicates that our records indicate that premium for this date of service was not received therefore no benefits are payable.
[AGENT][NEUTRAL] So you could be you you're looking at probably the initial.
[AGENT][NEUTRAL] Claim that was processed?
[CUSTOMER][NEUTRAL] Yeah, that's the little one it's pollen.
[CUSTOMER][NEUTRAL] Let me see if I just searched the actual patient and see if it pulls up any different ones.
[AGENT][NEUTRAL] Yeah, you're gonna have to put the patient's first name in there, the patient's first name, their date of birth, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Last four digits of your social, so [PII].
[CUSTOMER][NEUTRAL] The account number.
[CUSTOMER][NEUTRAL] And they're just
[CUSTOMER][NEUTRAL] See what this
[CUSTOMER][NEUTRAL] Same thing.
[CUSTOMER][NEUTRAL] Yeah, I need something that says like.
[CUSTOMER][NEUTRAL] And you know that what you said it wasn't covered.
[AGENT][NEUTRAL] Yeah, I'll fax it to you. I don't know why you can't retrieve it because it was reissued um, give me, give me your fax number.
[CUSTOMER][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, to your attention.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] OK, so I'll get that to you, um, allow at least 24 hours to receive that. It could be before then, but allow at least that time, OK, [PII]?
[CUSTOMER][POSITIVE] OK, thank you so much. I appreciate all your help.
[AGENT][POSITIVE] Oh, you're welcome. No problem. Anything else?
[CUSTOMER][NEUTRAL] Uh, what was your name and can I get a reference number?
[AGENT][NEUTRAL] It's you'll use my name in today's date is your reference T O N Y A and then first initial last name is [PII] as [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty. Thank you so much.
[AGENT][POSITIVE] All righty, thank you.
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] Bye bye.