AccountId: 011433970860
ContactId: 373f0397-e56a-40cc-80ee-471145f857c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 520467 ms
Total Talk Time (AGENT): 137840 ms
Total Talk Time (CUSTOMER): 286539 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/373f0397-e56a-40cc-80ee-471145f857c8_20250124T14:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm with Wake Forest Chiropractic. I'm calling about a patient um whose date of service, um, that never paid on his gap. What do you need from me? His ID number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright, it's 02455527 [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] Well, I'm working remotely right now on [PII], but I can give you our office number as well.
[AGENT][NEUTRAL] That is fine. I just need it in case the line gets disconnected, and thank you for you're welcome and thank you for verifying that information. Do you have a data service for claim number?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I do. I've got one for 70, I mean, excuse me, 70, 25, 24. It was uh an exam that the balance never got paid on, um.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] $725 for 99203. Looks like it was $180.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] It wasn't allowed from United Healthcare was 55.
[AGENT][NEUTRAL] OK, so under this plan, office visits are not covered.
[CUSTOMER][NEUTRAL] Well, let me explain. Um, United Healthcare only pays $55 no matter what we do. And so they write off all the other services.
[CUSTOMER][NEUTRAL] So we didn't just do an exam. We did an adjustment and therapy, but United Healthcare writes us off because their contractual is only $55 and they applied it to the exam versus the other two charges. So,
[CUSTOMER][NEUTRAL] I don't know how you would do that, but you can see.
[AGENT][NEUTRAL] And it
[CUSTOMER][NEUTRAL] On um the allowed amount, they allowed 55 and just applied it to the exam. So it's not really.
[CUSTOMER][NEUTRAL] They did more than just the exam, I guess it's my point.
[AGENT][NEUTRAL] Yes, ma'am, and I understand that part of it, but this policy follows primary, so it will pick up the copays, the co-insurance, and or deductibles on benefits that are covered under the plan. So if they would have applied that $55 to the other treatment lines, then this claim would have processed the co-pays coinsurance or deductible.
[CUSTOMER][NEUTRAL] So the patient's gonna be responsible for the 55.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][MIXED] OK, that's kind of silly, but all right, um, and then.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Date of service [PII].
[CUSTOMER][NEUTRAL] $30.
[CUSTOMER][NEUTRAL] That have been paid, they allowed 55, United Healthcare paid 25%, and the patient paid 30.
[AGENT][NEUTRAL] OK, on [PII].
[CUSTOMER][NEUTRAL] Well, Payson didn't pay 30, but it was Payson.
[CUSTOMER][NEUTRAL] Portion was 30.
[AGENT][NEUTRAL] On this one it processed under claim number 3500181. It paid a benefit amount of $30 on online 98941.
[CUSTOMER][NEGATIVE] Um, when did that pay? Because I don't believe we ever received that payment.
[AGENT][NEUTRAL] This one processed on [PII].
[AGENT][NEUTRAL] And let me see where it went to.
[CUSTOMER][NEUTRAL] Can you tell us it was cash while you're looking?
[AGENT][NEUTRAL] Like
[AGENT][NEUTRAL] I would have to send it over to the finance department to verify that.
[AGENT][NEUTRAL] It went to [PII].
[AGENT][NEUTRAL] Uh, let me pull it up.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] Um, I bet you it got lost. We have a lot of mail that gets lost.
[CUSTOMER][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Correct, hold on one second.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm just looking for check numbers.
[CUSTOMER][NEUTRAL] Yeah, I don't
[CUSTOMER][NEUTRAL] Can you put a price on that one, please?
[AGENT][NEUTRAL] Yes, ma'am, and it's check number 1871276.
[CUSTOMER][NEUTRAL] 127 trying to look at these.
[CUSTOMER][NEUTRAL] They must say y'all, hang on.
[CUSTOMER][NEUTRAL] And that's weird.
[CUSTOMER][NEUTRAL] Do y'all? Um.
[CUSTOMER][NEUTRAL] Hold on a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know what? Hold on one second.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And then 7.
[CUSTOMER][NEUTRAL] OK, 2 of those was our front desk.
[CUSTOMER][NEUTRAL] Um, problem. They scan the checks, but they never routed the payment because that's what I do. I went in the patient's chart and started searching before I had you put any more work into that and they actually
[CUSTOMER][NEUTRAL] Do y'all don't happen to send a.
[CUSTOMER][NEUTRAL] You know how some um companies send a.
[CUSTOMER][NEUTRAL] The um explanation.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Showing the copy of the check, but the check's not enclosed with it. It comes in a separate, y'all don't do that, do you?
[AGENT][NEUTRAL] It comes with it. Let me see how this one came.
[CUSTOMER][NEUTRAL] Because I have two of those. I have one that says check number 1871277 for the 731.
[CUSTOMER][NEUTRAL] And I have, I just don't understand why we weren't out financially, um, if the, if she really got these checks. And then 187, yeah, they're 126. I just wanna make sure we got the actual check.
[AGENT][NEUTRAL] Yes, because on this one, you will see the EOB.
[AGENT][NEUTRAL] It will give you all the information with the check number and then the check will come, but they all should be in the same envelope. They're not separated.
[CUSTOMER][POSITIVE] OK, alright, well that's all I needed to hear because you're exactly right, those two were.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Received hold on let me make.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know what happened, but that's gonna be a question for my staff, for the staff, not, not you. So I'm gonna print this for them and see where the heck those checks are.
[CUSTOMER][NEUTRAL] Um, uh.
[AGENT][NEUTRAL] So, would you like me to send it over to finance?
[CUSTOMER][NEGATIVE] It's probably got posted but it did not um.
[CUSTOMER][NEUTRAL] Get routed to me is probably all that happened on that. So I'm gonna.
[CUSTOMER][NEUTRAL] Print these, so they've got them. But the other, definitely we did not get, so the patient will be responsible for those.
[CUSTOMER][NEUTRAL] But I'll do some research and call back if I have any more questions.
[AGENT][POSITIVE] OK, sir. Well, thank you for calling American Public Life. Have a great weekend.
[CUSTOMER][POSITIVE] Thanks. I appreciate it. It's a clerical error. All right. Thank you. Bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.