AccountId: 011433970860
ContactId: 2d52381b-33fe-4840-ab3f-3874b7203496
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 658929 ms
Total Talk Time (AGENT): 159805 ms
Total Talk Time (CUSTOMER): 378986 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/2d52381b-33fe-4840-ab3f-3874b7203496_20250325T14:25_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. My name is [PII]. I am calling on behalf of Baptist Medical Center in [PII], and I think I understand a claim payment, but I do need some help on this patient's information.
[AGENT][NEUTRAL] OK, [PII], I can help you in reviewing that claim. Um, can I get a good callback number for you?
[CUSTOMER][NEUTRAL] Sure, my direct line is [PII].
[AGENT][POSITIVE] OK, thank you, [PII].
[AGENT][NEUTRAL] Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] The ID number that we have for the patient is D as in Delta 43,302,090.
[AGENT][NEUTRAL] And you said you do have a claim on file that we've processed, is that correct?
[CUSTOMER][NEUTRAL] Yes, but I do not have the claim number uh because I see a payment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] What was the patient name?
[CUSTOMER][NEUTRAL] Oh excuse me, I sat here all this time without a tickle in my throat. Now when I gotta talk, I got a tickle. Let's see, date of birth is [PII]. Isn't that the way patient's date of birth is [PII].
[AGENT][NEUTRAL] Oh you're fine.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] And what was the name?
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Or [PII], I guess in some spots we have him [PII] and some we have him [PII], so it's the way the, the bill went was just S T E V E.
[AGENT][NEUTRAL] I'm pulling that up. My system is running a little slow. Bear with me.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Do you have, I'm having a little trouble finding in the system. Do you have a social social by chance?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I don't, um.
[CUSTOMER][NEGATIVE] Let me see, I don't think I do. And of course by the time this gets to me, you know, 800 people have been through it and they only send you what, you know, what the, you know what, yeah, I'm the, I'm the last ditch effort here. Let's see here. Oh, and I'm locked out of the account by someone else. Um, I don't see his social security number. um, I.
[AGENT][NEUTRAL] I get it.
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Uh, I'll tell you what I am looking at. I'm looking at an ID card that says 90 degree benefits for medical claim submissions submit to 90 degree benefits. So when I called the number on the ID card, and then gave me only some choices, and one of the choices was to select APL and I had seen something about APL on an on an EOB um.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] But his APL card that we have on file.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Refs me back to.
[AGENT][NEUTRAL] 90 degree.
[CUSTOMER][NEUTRAL] Um, I, I, I don't know. [PII], um, yeah, I don't know that it's 90 degree because it says submit claims to attention IMA Inc [PII], but it gives that same address.
[CUSTOMER][NEUTRAL] That's on his other ID card, his ninety-degree ID card. So,
[AGENT][NEUTRAL] Let's try that cert, uh, does it have a policy cert number on it? Let me try that one more time.
[CUSTOMER][NEUTRAL] I guess that.
[CUSTOMER][NEUTRAL] Um, a policy cert number.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Certification.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm wondering, let's see.
[CUSTOMER][NEUTRAL] So I'm just, to be honest, I'm just trying to figure it out in my head how he's because he's got MetLife vision and I believe he has multiplan physician only network from what I can tell he's got.
[AGENT][NEUTRAL] Yes, yeah.
[CUSTOMER][NEUTRAL] Uh, he, he's got dental, he's got an RX through elixir. Um, his member says is his ID card mentions Oxford, and I believe that's probably the employer group Oxford Global Resources because the APL card says Oxford Global Resources, but the card that has 90 degree just says Oxford.
[AGENT][NEUTRAL] OK, I think I found them. Hold on one moment.
[CUSTOMER][POSITIVE] OK, good.
[AGENT][NEUTRAL] He's got several different policies, so let me see which one we're looking at.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] And if it helps his data service was at [PII].
[AGENT][NEUTRAL] OK, 910 [PII] 2024, OK.
[CUSTOMER][POSITIVE] Yes, I am so sorry to do this to you on a Tuesday morning.
[AGENT][NEGATIVE] Jot that down.
[AGENT][POSITIVE] No, you're fine. No worries, no worries, here to help.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And I've got a group number.
[AGENT][NEUTRAL] OK, what's that?
[CUSTOMER][NEUTRAL] 9433.
[AGENT][NEUTRAL] OK, let's see what we have.
[AGENT][POSITIVE] I think we're getting somewhere now let's see.
[AGENT][NEUTRAL] I just, he has several policies. I'm trying to figure out which one we're gonna be looking at. What kind of claim was it? Was it like an outpatient hospital or?
[CUSTOMER][NEUTRAL] No, it was inpatient hospital and it was.
[CUSTOMER][NEUTRAL] $294,000.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Um, let's see, so.
[AGENT][NEUTRAL] Let me see if it's on this. She's got a hospital indemnity policy. Let me see if I've got anything on it.
[CUSTOMER][NEUTRAL] So I assume from what I could see that we got a $2300 payment on this claim from APL for $2300 and it's a limited liability plan correct? They only pay certain things at a certain dollar amount and once that's gone it's gone. I mean it doesn't look like it pays impatient at all from what I can tell.
[AGENT][NEUTRAL] Yeah, it looks I think I found a claim let me pull it up um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah, I found it. OK, so yes, we paid the $2300. It is a hospital indemnity plan, so it only pays up to a certain dollar amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, based on what's submitted, so.
[CUSTOMER][NEUTRAL] Right, and that's OK. OK.
[CUSTOMER][NEUTRAL] OK, so it looks like they allowed $800 for the room, which would have been $100 a day. Um, OK, so just so you can confirm for me just because I need this straight in my head.
[CUSTOMER][NEUTRAL] APL is the limited liability plan, but it is what do I wanna say um you fit into this as you administer this plan for APL correct?
[AGENT][NEUTRAL] Yeah, we are APL, yeah, and then so and then IMA, the 90 degree and IMA they actually claims go through them to process. We're kind of like the TPA to tell you how the claims processed and send out the EOBs, etc.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, OK, OK, OK, so you're adminis you, you're the administrator you administer the plan. APL actually pays the claim on a limited basis. They have, um, a physicians only network through multiplan, so the most that we're gonna get out of any of this is the $2300 that we got.
[AGENT][POSITIVE] That is correct. It's the maximum that's been paid, yes, for this plan. It's, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, OK, OK, I think I understood it. I, I, I just needed to hear it and I just needed someone to hear say it to me so that I can report back to the powers that be and say hey.
[AGENT][POSITIVE] Totally understand.
[CUSTOMER][NEGATIVE] I'm not making this up.
[CUSTOMER][NEUTRAL] I confirmed this with a voice.
[AGENT][POSITIVE] Exactly it's a real, I'm a real person.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] So, OK, that helps and he is the employee correct and the subscriber.
[AGENT][NEUTRAL] He is.
[AGENT][NEUTRAL] Yeah, he is. Mhm.
[CUSTOMER][NEUTRAL] OK, OK, OK, not a spouse, right, well, that's not what I wanted to hear on a $300,000 claim because I don't know how that's gonna get paid at this point, but it is what it is, and he had what he had and his employer group is the global resources or the Oxford Global Resources is the employer group correct?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, that's correct. Uh-huh.
[CUSTOMER][NEUTRAL] Yeah. OK, and the plan sponsor, right, the only thing I could use at this point, and I'm so sorry to have bothered you, do you have a reference number you can share with me? OK.
[AGENT][NEUTRAL] No, it's fine.
[AGENT][NEUTRAL] Um, it's just my first name, last initial, so it's [PII] as [PII], last initial, and then today's date.
[AGENT][NEUTRAL] And [PII], is there anything else I can help with?
[CUSTOMER][NEUTRAL] All right, [PII] you have.
[CUSTOMER][POSITIVE] No, you've been wonderful to work with. I appreciate all that you did for me. It has been delightful.
[AGENT][POSITIVE] Absolutely glad to help and just don't don't hesitate to reach out if you got any more questions.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you so much have a good day.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day too.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.