AccountId: 011433970860
ContactId: 2c8a7744-8244-4bbd-b1cb-849129551bef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2915030 ms
Total Talk Time (AGENT): 804194 ms
Total Talk Time (CUSTOMER): 1113435 ms
Interruptions: 9
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/2c8a7744-8244-4bbd-b1cb-849129551bef_20250411T15:26_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes and uh my uh.
[CUSTOMER][NEUTRAL] Number is 02505681ML8.
[AGENT][NEUTRAL] OK, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh [PII].
[AGENT][NEUTRAL] And your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that and all and um was there, I'm sorry, and how may I assist you today?
[CUSTOMER][NEUTRAL] OK, I did a surgery almost like 10 or 11 months ago. I think, I think it was May of last year, and I had a deductible like $6000 and it was supposed to go through you through you guys and uh the hospital has been sending us that they've been sending it to you guys. Have you guys received it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the um data service there, May, what day in May?
[CUSTOMER][NEUTRAL] I think it's [PII].
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So we have 2 claims here. Let me get them. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All identity.
[AGENT][NEUTRAL] 649, excuse me, 649.
[AGENT][NEUTRAL] OK, so we received two claims for [PII]. 1 of the claims was received from the provider, one was received from you, um,
[AGENT][NEUTRAL] The what we paid to both. The one that was received to the from the provider, we paid $60.
[AGENT][NEUTRAL] And the one that was received from um you all as the insured.
[AGENT][NEUTRAL] We paid $43.38 which is what they billed us for.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] There's also claims here on the [PII]. Would that, I don't see anything total of 6000.
[AGENT][NEUTRAL] But what they built, oh, here it is, 6500, actually this is $65,782.
[CUSTOMER][NEUTRAL] There's a
[CUSTOMER][NEUTRAL] That's probably the operation. I, uh, my insurance covers.
[CUSTOMER][NEUTRAL] Uh, and, and that cover, uh, I don't know, I guess, uh, whatever it is, I, and it was only a deductible of $6000 that that you guys were supposed to pay.
[CUSTOMER][NEUTRAL] Not that amount.
[AGENT][NEGATIVE] OK, so I don't know if we paid what they billed us for. So they billed us for $43 and that's what we paid. I don't see, I mean, I can look for other dates, but I don't see.
[CUSTOMER][NEUTRAL] It it it's, it's a hospital bill, it's a hospital bill.
[AGENT][NEUTRAL] I understand, but our, our claims are by dates of service. So I mean there's some, there's something here from [PII] I can look at for you, but either way, your calendar.
[CUSTOMER][NEUTRAL] That's where I did the surgery.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your um calendar year max for your inpatient was 7900. So you definitely had enough for the
[AGENT][NEUTRAL] 6000.
[CUSTOMER][NEUTRAL] For the 6000.
[CUSTOMER][NEUTRAL] Is there anything for outpatient? You got anything there for outpatient? I mean.
[AGENT][NEUTRAL] Mhm. There's outpatient claims also.
[CUSTOMER][NEUTRAL] I'll I'll.
[AGENT][NEUTRAL] The easiest thing to do, do you have a bill there or like what paperwork do you have?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, we, no, we, we haven't had a bill yet.
[AGENT][POSITIVE] OK, that's good. So,
[CUSTOMER][NEGATIVE] From the we, we haven't had a bill from the hospital. The hospital says that I owe like 6000 something that it's been sent to you guys, but we're still, it's been like that for months.
[AGENT][NEUTRAL] OK, cause the only thing.
[AGENT][NEUTRAL] We paid everything unless it was a duplicate when it and then it was denied as a duplicate. So we're kind of in the blind because we don't have exact, um, the easiest thing to do is going to be to ask them the data service and the total bills. Um, is there a number maybe I can give them a call so we can do this now?
[CUSTOMER][NEUTRAL] Yes, yes, hold on one second.
[CUSTOMER][NEUTRAL] The phone number is [PII].
[CUSTOMER][NEUTRAL] 974.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the account number is [PII].
[CUSTOMER][NEUTRAL] [PII]. Yes I can. That's for [PII]. Do you have anything for um [PII] of service?
[AGENT][NEUTRAL] [PII], let me see, hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because another day they gave me was [PII] maybe that's.
[AGENT][NEUTRAL] Yes, hold on, let me see now, this is a bigger bill. Hold on one moment, 59.
[AGENT][NEUTRAL] OK, so for this one, they sent it to us 3 times. Let me see the first one that they sent in. Hold on 1 2nd.
[AGENT][NEUTRAL] 059.
[AGENT][NEUTRAL] OK, so they sent this to us, um, we received it. Hold on one second.
[AGENT][NEUTRAL] Let me look at the original because that was the first one. What was that denied for?
[AGENT][NEUTRAL] Hold on one moment, I'm just trying to get everything in one place.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][POSITIVE] No problem. I just wanna see if we could take care of this.
[AGENT][NEGATIVE] OK, so the first time we received it, we denied it requesting the explanation of benefits from primary. They sent it in again.
[CUSTOMER][NEUTRAL] So OK.
[AGENT][NEUTRAL] And what happened then? Hold on one moment.
[AGENT][NEGATIVE] They sent us the wrong explanation of benefits. The explanation of benefits that they sent in didn't match what they were claiming. So then they sent it again, but they sent the same explanation of benefits, so it was denied as a duplicate. So it's not that we're not paying, we're asking for additional information and they're not giving it to us. So, the reason we're asking for the explanation of benefits is so that we can see everything that was charged, what you paid.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And what, what primary pay and what they owe. So that's how we're able to reimburse you for the co-pay or pay them if something else is owed. That's why we're asking for that.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Because, because, because when we talk to them there's, there's a bill of $6000 something dollars and, you know, I, you know, I think the first bill was like $200 and something dollars00 dollars and then they, the, uh, the insurance paid $50,000 and then it was only left with the co-payment of $6000 or $6000 something. Is there a, a, a way that you could talk to them?
[CUSTOMER][NEUTRAL] With this the information that I'm giving you to see if you if they could give it to you right or.
[AGENT][NEUTRAL] Mhm. Yeah, um, so what you're explaining is exactly what why we're asking for the explanation of benefits, um, but I can talk to them and
[AGENT][NEUTRAL] I mean, I guess just explain what we're asking for, but yes, that's exactly why we're asking for the explanation of benefits, so we know what to pay out and to who.
[CUSTOMER][NEUTRAL] OK, and then the the number that we gave you was [PII] and the account number is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, OK, um, do you mind if I place you on just a brief hold so I can call on the other line?
[CUSTOMER][POSITIVE] No, no, no, perfect, cool, perfect. Thank you.
[AGENT][NEUTRAL] OK, hold on one moment. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you for calling. Your call will be recorded. Continu [PII].
[CUSTOMER][POSITIVE] Thank you for calling the customer service department. I'm your new virtual assistant here to help you with tasks like making a payment, checking a balance, or requesting a statement. How can I help you today?
[AGENT][NEUTRAL] Billing
[CUSTOMER][NEUTRAL] Sure, I can help you with billing. What would you like to do? You can say things like make a payment, account balance, or statement.
[AGENT][NEUTRAL] Representative.
[CUSTOMER][NEUTRAL] I'm happy to connect you to an agent, but I need some additional information. Sure, I can help you with billing. What would you like to do? You can say things like make a payment, account balance, or statement.
[AGENT][NEUTRAL] Questions about billing.
[CUSTOMER][NEUTRAL] Please choose from the following options to make a payment, press or say 1. To check your balance, press or say 2. To request a copy of a billing statement, press or say 3. To request an itemization of hospital charges, press or say 4. To review a charge, press or say 5.
[AGENT][NEUTRAL] Representative
[CUSTOMER][NEUTRAL] I'm sorry, I'm still not sure what you're looking for. Please wait while I connect you to an agent.
[CUSTOMER][NEUTRAL] Your current estimated wait time is less than 5 minutes.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] All of our agents are currently assisting other callers. Please remain on the line and we will answer your call as soon as possible.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] All of our agents are currently assisting other callers. Please remain on the line, and we will answer your call as soon as possible.
[CUSTOMER][POSITIVE] Thank you for calling the customer service department. My name is [PII] on a recorded line to better assist you. May I have your account number, please?
[AGENT][NEUTRAL] Hi [PII], the account number is 31011973.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you and are you the patient?
[AGENT][NEUTRAL] No, the patient's on the line. I'm calling from their insurance company.
[CUSTOMER][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] OK. May I have your name, please?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] Thank you, can you verify your address and your date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII] [PII].
[CUSTOMER][NEUTRAL] Thank you. And what is the state for the address?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] What is the state?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you. I have your phone number [PII].
[CUSTOMER][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] I have an email [PII], yes.
[CUSTOMER][POSITIVE] Thank you and how may I help you?
[CUSTOMER][NEUTRAL] Yes, I, I had a surgery there.
[CUSTOMER][NEUTRAL] OK, and uh there was a bill that that's still there and this uh.
[CUSTOMER][NEUTRAL] The lady that's helping me out, it's another insurance APL can and uh she's gonna explain you what she needs from you guys to pay the remainder.
[CUSTOMER][POSITIVE] OK, um, I can answer any questions.
[CUSTOMER][NEUTRAL] About this account to you Mr. [PII], um, if she needs more in to provide more information about the insurance, I'm gonna need to transfer you to the insurance department and they can further assist you.
[AGENT][NEUTRAL] Hold on. So you can assist us with billing questions because I'm from the insurance company?
[CUSTOMER][NEUTRAL] Uh, what I'm saying is that I can answer any questions from the patient, but if you need to provide any information about the claim or insurance, I'm gonna need to transfer you to that department.
[AGENT][NEGATIVE] So are you saying you're not going to speak to me? What, what are you saying?
[CUSTOMER][NEUTRAL] It it
[AGENT][NEUTRAL] Because we have questions so that we can try to get this claim paid. So he asked me to give y'all a call.
[CUSTOMER][NEUTRAL] Yes, like, like I said.
[CUSTOMER][NEUTRAL] Yeah, because this is.
[CUSTOMER][NEUTRAL] Right, right, because this has been, this has been going almost, it's gonna be a year already and we're trying, OK, let me just go, uh, what's, what's the bill there? The bill there, what's the uh, the remaining of the bill.
[AGENT][NEUTRAL] Uh, asking for the data service for the bill that has the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, co-pay of $6000. What data services that ask him that since he can't speak to me.
[CUSTOMER][NEUTRAL] OK, on, on, on May on [PII] of last year I did a surgery there. that's, that's what you have?
[CUSTOMER][NEUTRAL] That is correct. It's date of service [PII] at HCA Florida Kendal Hospital.
[CUSTOMER][NEUTRAL] OK, it shows that the information was sent to yours.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] The information was sent to my secondary insurers to APL correct?
[CUSTOMER][NEUTRAL] It showed that it was sent to American public life.
[AGENT][NEUTRAL] On what they
[CUSTOMER][NEUTRAL] Um, they haven't sent any.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] What date?
[CUSTOMER][NEUTRAL] The claim was submitted on [PII].
[AGENT][NEUTRAL] And it's for data service, [PII]?
[CUSTOMER][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it the expla uh uh well I guess what we're having problem here is just with the explanation.
[CUSTOMER][NEUTRAL] Of the billing?
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][POSITIVE] uh uh thank you for helping us, OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So are you saying you can't speak to me, so I need to tell the patient what to ask you?
[CUSTOMER][NEUTRAL] Right. No, man, like I said.
[CUSTOMER][POSITIVE] I'll be more than happy and this is how.
[CUSTOMER][NEUTRAL] I'm following the hospital guidelines.
[CUSTOMER][NEUTRAL] There is a dedicated line that helps the insurance company regarding any questions that they have about about an account. I'm providing the information because the patient is asking me, but if you have questions or you need to provide any information that's.
[CUSTOMER][NEUTRAL] With the insurance department.
[CUSTOMER][NEUTRAL] OK, and then
[CUSTOMER][NEGATIVE] Apparently the problem that we're having is.
[AGENT][NEUTRAL] I just need to know if, hold on, I just need to know if I'm able to ask questions because I'm just trying to get to the bottom of this. We have a claim here, I need to know the total bill of the claim that you sent in for [PII], so I can know if this is the right bill. Can you help me with that?
[CUSTOMER][POSITIVE] I, I, I'm gonna transfer you with the insurance department and they're gonna answer any questions that you have.
[AGENT][NEUTRAL] But it's not insurance, it's billing. Are you billing?
[CUSTOMER][NEUTRAL] I'm billing
[AGENT][NEUTRAL] So you can speak as long as he asks you.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Right, I don't, I don't answer any questions.
[AGENT][NEUTRAL] OK, so Mr. [PII].
[CUSTOMER][NEUTRAL] Right, yes, what?
[AGENT][NEUTRAL] Mr. [PII], can you ask him for the total bill of the claim that was sent in on [PII]?
[CUSTOMER][NEUTRAL] Yeah, can you please tell me the total bill for [PII]?
[CUSTOMER][NEUTRAL] $6,652.38.
[CUSTOMER][NEUTRAL] OK, can you 6000?
[CUSTOMER][NEUTRAL] $6,652.38.
[CUSTOMER][NEUTRAL] 38 cents.
[AGENT][NEUTRAL] OK, so we have a claim here that was received from the provider. The date of service is [PII], but it has a total bill of $1,699. So, and we paid on that claim. So the claim that total $6,652.38 where was that sent to?
[CUSTOMER][NEUTRAL] Again, ma'am.
[AGENT][NEUTRAL] Go ahead and transfer me to the insurance line.
[CUSTOMER][NEUTRAL] Any other questions that you have?
[AGENT][NEUTRAL] Because we need to get a resolution on this.
[CUSTOMER][POSITIVE] Thanks for
[CUSTOMER][NEUTRAL] Yeah, well, because what we're trying to do is pay the bill and, and apparently, you know, the easiest that we get all these things done it's gonna get paid.
[AGENT][NEUTRAL] Right, and if you can't help us, then just go ahead and get us to insurance because I don't want him to have to keep going through this over and over. So I can just talk to insurance and ask them direct questions, but I don't understand why I need to talk to insurance and his billing questions.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Ma'am, because I, I, I'm sorry, this is.
[AGENT][NEUTRAL] That's fine. Just go ahead and get us the insurance.
[CUSTOMER][NEUTRAL] The way that the hospital stay.
[CUSTOMER][POSITIVE] Thank you for calling. Have a good day.
[AGENT][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Your current estimated wait time is more than 5 minutes. No, no problem, no problem. At least, at least uh we're gonna get.
[AGENT][POSITIVE] I'm sorry about that, Mr. [PII].
[AGENT][NEGATIVE] I don't understand.
[CUSTOMER][POSITIVE] At least now we're gonna get through this.
[AGENT][POSITIVE] Yes, I'm definitely going to get you a resolution.
[CUSTOMER][NEGATIVE] Because I haven't, I haven't received it.
[CUSTOMER][NEGATIVE] I haven't received a bill. It's just that I know it's like 6000 something and apparently now he's saying it, you know.
[AGENT][NEUTRAL] Right, and if that's it, so there's a difference between what I was trying to get to understand is this $6000 he's saying it's a total bill, but
[AGENT][NEUTRAL] To us it's a like uh what how it was explained was it was a co-pay, so that's what I was trying to understand.
[AGENT][NEUTRAL] If this is the total bill for sure or if this is truly a co-pay, but I
[CUSTOMER][POSITIVE] Great.
[AGENT][NEGATIVE] Not sure what insurance is gonna be able to tell me about what billing did. That doesn't make sense.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Because I think the bill was, the bill was like $200 something dollars, OK? It it was surgery that I did, but I apparently my first insurance only paid like. All of our agents are currently assisting other callers. Please remain on the line and we will answer your call as soon as possible.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If you are a patient, patient advocate, or provider, please call [PII]. All other callers, please continue to hold. All callers must have the patient name and patient date of birth along with the facility name or account number. If you do not have this information, please obtain the information and call us back. Yeah. Yeah.
[AGENT][NEUTRAL] Usually, like if you weren't on the phone, then yes, I would have to speak to insurance because I'm an insurance company, but you're on the phone, so he should have been able to help us.
[CUSTOMER][NEUTRAL] I can't believe you.
[AGENT][NEUTRAL] Because the insurance department can't really do anything, they just work on the bills that billing gave them, so I'm really going in a circle, but I'm gonna see how this works.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Long as you get your resolution, that's my only concern.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] All of our agents are currently assisting other callers. Please remain on the line, and we will answer your call as soon as possible. If you are a patient, patient advocate, or provider, please call [PII]. All other callers, please continue to hold. All callers must have the patient name and patient date of birth along with the facility name or account number. If you do not have this information, please obtain the information and call us back.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] All of our agents are currently assisting other callers. Please remain on the line, and we will answer your call as soon as possible. If you are a patient, patient advocate, or provider, please call [PII]. All other callers, please continue to hold. All callers must have the patient name and patient date of birth along with the facility name or account number. If you do not have this information, please obtain the information and call us back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All of our agents are currently assisting other callers. Please remain on the line, and we will answer your call as soon as possible. If you are a patient, patient advocate, or provider, please call [PII]. All other callers, please continue to hold. All callers must have the patient name and patient date of birth along with the facility name or account number. If you do not have this information, please obtain the information and call us back.
[CUSTOMER][NEUTRAL] All of our agents are currently assisting other callers. Please remain on the line, and we will answer your call as soon as possible. If you are a patient, patient advocate, or provider, please call [PII]. All other callers, please continue to hold. All callers must have the patient name and patient date of birth along with the facility name or account number. If you do not have this information, please obtain the information and call us back.
[AGENT][NEUTRAL] I think
[AGENT][NEUTRAL] This might be why he sent us the insurance.
[CUSTOMER][NEUTRAL] All of our agents are currently assisting other callers. Please remain on the line, and we will answer your call as soon as possible. If you are a patient, patient advocate, or provider, please call [PII]. All other callers, please continue to hold. All callers must have the patient name and patient date of birth along with the facility name or account number. If you do not have this information, please obtain the information and call us back.
[CUSTOMER][NEUTRAL] You're still there?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] All of our agents are currently assisting other callers. Please remain on the line, and we will answer your call as soon as possible. If you are a patient, patient advocate, or provider, please call [PII]. All other callers, please continue to hold. All callers must have the patient name and patient date of birth along with the facility name or account number. If you do not have this information, please obtain the information and call us back.
[AGENT][NEUTRAL] I'm still here.
[AGENT][NEUTRAL] Wait, wait, hold on one second.
[AGENT][NEUTRAL] I can't hear you. I mean, I know you're talking, but I can't hear you over the lady.
[AGENT][NEUTRAL] Hold on one second. OK.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] OK, what did you say?
[CUSTOMER][NEUTRAL] Yeah, apparently the bill was at $213,835 and then here my wife put this is it's been a while, but it says balance to APL was $6,652. That's the figure that he was giving us.
[AGENT][NEUTRAL] $1,652.38.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Correct, correct.
[AGENT][NEUTRAL] That was billed to us, but the total was over 200,000.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Right, OK.
[CUSTOMER][NEGATIVE] Right, apparently my, my primary insurance, you know, you know how they put 2130 and they only pay like 58,000 or something like that.
[CUSTOMER][NEUTRAL] All of our agents are currently assisting other callers. Please remain on the line and we will answer your call as soon as possible. If you are a patient, patient advocate, or provider, please call [PII].
[CUSTOMER][NEUTRAL] [PII]. All other callers, please continue to hold. All callers must have the patient name and patient date of birth along with the facility name or account number. If you do not have this information, please obtain the information and call us back.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] All of our agents are currently assisting other callers. Please remain on the line, and we will answer your call as soon as possible. If you are a patient, patient advocate, or provider, please call [PII]. All other callers, please continue to hold. All callers must have the patient name and patient date of birth along with the facility name or account number. If you do not have this information, please obtain the information and call us back.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] All of our agents are currently assisting other callers. Please remain on the line, and we will answer your call as soon as possible. If you are a patient, patient advocate, or provider, please call [PII]. All other callers, please continue to hold. All callers must have the patient name and patient date of birth along with the facility name or account number. If you do not have this information, please obtain the information and call us back.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] All of our agents are currently assisting other callers. Please remain on the line, and we will answer your call as soon as possible. If you are a patient, patient advocate, or provider, please call [PII]. All other callers, please continue to hold. All callers must have the patient name and patient date of birth along with the facility name or account number. If you do not have this information, please obtain the information and call us back.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, so here's what, um, here's what we can do because I can't um hold long, but here's what we can do. I just looked through your all the claims, um, so we have only received one claim from um the from the provider, I forgot the name of the hospital.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] We've only received one claim.
[CUSTOMER][NEUTRAL] [PII] original?
[AGENT][NEUTRAL] Hold on one second. 649.
[CUSTOMER][NEUTRAL] OK. HC something [PII].
[AGENT][NEUTRAL] Well, it's coming over.
[AGENT][NEUTRAL] It's coming over as hospital medicine services. I'm gonna give you, um, I'm gonna give you all the information. You're gonna have to call them, speak to that line that we spoke with originally, and just give them everything that I'm getting ready to give them, I mean, give you. Basically, either they're gonna have to resubmit the claim or submit the claim because we only have one claim here and it's
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] A total of $1,699. So if this is not the claim,
[CUSTOMER][NEUTRAL] And that's from the
[CUSTOMER][NEUTRAL] This is from that's from them?
[AGENT][NEUTRAL] This is from a hospital.
[CUSTOMER][NEUTRAL] The thousands
[AGENT][NEUTRAL] This is from Hospital medicine services and I'm going to give you their tax ID as well, because sometimes it comes over as a different provider, but if the tax ID is the same, it's the same facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm gonna give you the date we received it, the name of the facility, the tax ID, and the total bills. When you call them, let them know this is what my insurance company has received. If there is a bill that totals the 6,652, they did not, we have not received that.
[AGENT][POSITIVE] There is no timely, um, timely filing limit, so they can file at any time as long as your policy is active, so you don't have to worry about like running out of time or anything.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so the claim number is 351.
[AGENT][NEUTRAL] 7649.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] And on [PII], we paid the provider $708.33.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I just.
[AGENT][NEUTRAL] Before I, when you call them, before I get, before you get into any like numbers or anything, I would just say, um, this is the claim that my insurance company received, it's from Hospital medicine services and then give them this tax ID and once they confirm that that's them, you can proceed. If not, if that tax ID is different, then we don't have anything on file for them, they need to send it in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the tax ID is [PII].
[AGENT][NEUTRAL] 11
[AGENT][NEUTRAL] 66
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, then I'll, I'll call the the the same people we were talking to and give them all this information and that way they could resubmit it or do something about it, right?
[AGENT][NEUTRAL] Right. Once you give them the name, the hospital medicine services, and the tax ID, if they tell you that's not their tax ID, then it stops there. They need to submit the claim. We don't have anything on file from them.
[AGENT][NEUTRAL] If it's the same, then you can go into, well, my um insurance company received this claim on October blah blah blah, and they paid $708.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me ask you a question. You don't have anything received in January of this year for any, any like [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see, hold on one second.
[CUSTOMER][NEUTRAL] For any any kind of claims submitted?
[AGENT][NEUTRAL] Well, I have [PII], we received something.
[CUSTOMER][NEUTRAL] Or [PII].
[CUSTOMER][NEUTRAL] And how, how, how much is that for?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what I'm
[AGENT][NEUTRAL] Now, this one actually says um HCA [PII] Kindle.
[AGENT][NEUTRAL] Um, and this total is
[CUSTOMER][NEUTRAL] Right, and how much is that?
[AGENT][NEUTRAL] $65,782.39.
[CUSTOMER][POSITIVE] And does it have an outstanding.
[CUSTOMER][NEUTRAL] Amount like, or is that the total bill?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So, the 65,000 is the total bill. Let me see what happened with the claim though. Hold on one second.
[AGENT][NEUTRAL] We paid 40, OK. We paid $43.38 for this. So you all submitted a claim and the provider submitted a claim for this, and we paid $43.38 directly to you all for this, this claim.
[CUSTOMER][NEUTRAL] Who you are, huh?
[AGENT][NEUTRAL] You as the patient, yes.
[CUSTOMER][NEUTRAL] You check it for you guys? I don't remember that, but you don't, but so that one, that one, there's no outstanding balance of the 6000.
[CUSTOMER][NEUTRAL] As an outstanding balance for you guys to pay.
[CUSTOMER][NEUTRAL] Because the original bill was 213,835 and they said after Ena paid their portion, the outstanding balance was 6,652.
[CUSTOMER][NEUTRAL] And they had told me.
[AGENT][NEUTRAL] That's what we're missing.
[CUSTOMER][NEGATIVE] Yeah, they had told me they had submitted it on [PII], on [PII] also they said that they had submitted it to y'all and that you guys were missing an explanation of benefits from [PII].
[AGENT][NEUTRAL] That's why
[CUSTOMER][NEUTRAL] I think I submitted that and they were supposed to submit it again and then when I called them this morning they said in January we resubmitted that bill to APL.
[CUSTOMER][NEGATIVE] And it says not received it some other accepted or something through their system.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEGATIVE] When they go through IPL, it shows like you guys don't have it so I don't know who's sending what who's getting what.
[AGENT][NEGATIVE] Yeah, and that's what I was trying to get to when we were on the phone with them, but they won't tell me anything. I was gonna ask them how did they send it, you know, it doesn't make sense that they couldn't talk to me and you all are on the phone with me. Now if it was just me, yes, I have to go through insurance because that's HIPAA, but
[CUSTOMER][NEUTRAL] It's somewhere in the middle.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] I don't know why they, why they did that, but yes, if, if we can confirm where they sent that to, mailing address, PO, um, if they sent it electronically, if they faxed it.
[CUSTOMER][NEUTRAL] And I had even, and I had even, I had verified that they had sent it to the [PII] address.
[AGENT][POSITIVE] Mhm, that's correct. But.
[CUSTOMER][POSITIVE] Is that, is that, that's still a good one, OK, OK.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Um, the only, so the only claim that we received in January is the claim that you as the patient submitted. The other one, because remember I said we only received 21 from you and one from them. So the other one is the one from them that we need confirmation on. If that tax ID is not the same, because like I said, when yours came over, yours says HCA Kindle. This other one doesn't, which is making me think there's no claim on file from the provider because
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's why I want you to check the tax ID with them.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The, the 708 amount, I think that's, that's another type of same surgery but another type of service.
[AGENT][NEUTRAL] Mhm. And sometimes that
[CUSTOMER][NEUTRAL] Um, within that surgery, I think it's.
[CUSTOMER][NEUTRAL] Yeah, I think it's a specific physician that saw him at that same day or within the hospital limits or whatever. So that's OK. The 708 paid is is fine. It's the 6000 that I'm trying to.
[CUSTOMER][NEGATIVE] To get clear because I don't want them coming 2 years later and say, listen, you know, you owe all this and and we've been fighting with them for the whole year about this.
[AGENT][NEUTRAL] Right, so in terms of the $6,652.38 for the for the data service, [PII], we only have those two claims, one from you and one from the other provider. When you call them and you give them the name and that tax ID that I gave you, they can confirm, yes, that's us or no, it's not. If they say no, there's no claim on file here, they need to file it. If they say yes, then you can go into, well, my insurance company received it on blah blah blah and we paid it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] OK, OK, alright, let me, um, let me work on that and see what I can get through them. OK, I appreciate your help. Thank you so much, uh huh.
[AGENT][NEUTRAL] And I'm the only
[AGENT][POSITIVE] You're welcome. Um, I'm the only [PII] here. So if y'all need any help or anything, um, just give us a call. It won't be hard to get to me, and I have notes on your policy as well for you.
[CUSTOMER][NEUTRAL] And you said
[CUSTOMER][NEUTRAL] You said it's [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Your name? OK, OK, alright, let me see what I can um do with them. OK, thank you so much I appreciate your help.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APL. I hope you all have a great weekend.
[CUSTOMER][NEUTRAL] You too dear. You too, bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.