AccountId: 011433970860
ContactId: 4217c90e-633a-44f3-8231-d56fba6e2f9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 797099 ms
Total Talk Time (AGENT): 348168 ms
Total Talk Time (CUSTOMER): 227000 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/4217c90e-633a-44f3-8231-d56fba6e2f9d_20250124T18:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, can you look up my policy number?
[AGENT][NEUTRAL] Yes sir, um, can I get your name and your call back number?
[AGENT][NEUTRAL] With your policy.
[CUSTOMER][NEUTRAL] J J
[CUSTOMER][NEUTRAL] [PII] callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you sir and then what is your policy number?
[CUSTOMER][NEUTRAL] OK, would that be the same thing as a payer ID?
[AGENT][NEUTRAL] No, sir, that's um that's our number. It may say uh inpatient or outpatient certificate number.
[CUSTOMER][POSITIVE] OK, impatient.
[CUSTOMER][NEUTRAL] Uh, OK, certificate number is um.
[CUSTOMER][NEUTRAL] It the outpatient certificate number is 202505666.
[CUSTOMER][NEUTRAL] M as in Mike
[CUSTOMER][NEUTRAL] L as in Lima.
[CUSTOMER][NEUTRAL] 8.
[AGENT][NEUTRAL] OK, thank you, sir, let me look that policy up for us real quick.
[AGENT][NEUTRAL] OK [PII], I have your policy pulled up. Can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] 13
[CUSTOMER][NEUTRAL] Uh, address [PII].
[CUSTOMER][NEUTRAL] Email
[CUSTOMER][NEUTRAL] Email is um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then the phone number you gave me to call you back on is that your is that your cell phone address?
[AGENT][NEUTRAL] Your cell phone number? I'm sorry.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you for verifying your policy for me, sir.
[AGENT][NEUTRAL] How can I help you with your policy today?
[CUSTOMER][NEUTRAL] OK, I have um.
[CUSTOMER][NEUTRAL] After some claims that are supposed to be submitted by Doctor [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does it show that the claims were paid or does it show it's outstanding?
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] OK, let me look, uh, do you know when the claims were reported?
[CUSTOMER][NEUTRAL] This is, this has been going on for a whole year, not 2024.
[CUSTOMER][NEUTRAL] I mean, I, I'm just, I'm being, I'm being aware, I'm being informed about it now, but this I'm looking at [PII], the whole year.
[AGENT][NEUTRAL] OK. I
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me look real quick, sir, um, we received a claim on [PII] and paid it and that was for um.
[AGENT][NEUTRAL] Dermatology Group of Florida.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And we paid $60.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And then we also have another claim that we received uh let me look at it, sir.
[AGENT][NEUTRAL] We received that claim on [PII] for the dermatology group of Florida. Um, let me look and see what the remark is. There's a remark on that claim. Let me see what it says.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] It says that the procedure code submitted on the claim is not a listed procedure code in the ICD 9.
[AGENT][NEUTRAL] Manual please submit with a valid ICD-9 code.
[AGENT][NEUTRAL] So you can get that from the, the office, the doctor's office, let them know that the procedure code was not valid and they need to submit it with a good procedure code.
[CUSTOMER][NEUTRAL] What day was that for?
[AGENT][NEUTRAL] That claim was for
[AGENT][NEUTRAL] Let me look for you real quick sir.
[AGENT][NEUTRAL] That claim was for [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and what else? What else?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] That's it. That's those are the only two claims that I show on file for you.
[CUSTOMER][NEUTRAL] There's 2 claims for the whole year?
[AGENT][NEUTRAL] Yes, just to
[AGENT][NEUTRAL] Yes sir, for [PII].
[CUSTOMER][NEUTRAL] So, uh, so only two claims because I made, I did more visits.
[CUSTOMER][NEGATIVE] In 22 office visits, that that's why I'm asking you. This should have been, there should have been more claims.
[AGENT][NEUTRAL] No sir, I only show the 2, so you'll just need to let them know that the other claims for your office visits need to be submitted to us.
[CUSTOMER][NEUTRAL] OK, so the one that was submitted in, uh, I think you said it was in March, was it March?
[CUSTOMER][NEUTRAL] What was the other, what was the other claim?
[AGENT][NEUTRAL] Let me look for you, sir.
[AGENT][NEUTRAL] Let me look for you sir.
[AGENT][NEUTRAL] Because that was for uh date of service was [PII].
[AGENT][NEUTRAL] And that was the one that was paid.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Yes, and that was the one that was paid $60.
[CUSTOMER][NEUTRAL] OK, so, so I'm if I'm understanding correctly for [PII] there's only two claims submitted.
[CUSTOMER][NEGATIVE] One of [PII] that was paid and then one was submitted uh [PII] and the procedure code was not correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] Can you, can you see if there's there was any in [PII]?
[AGENT][NEUTRAL] I do not see any for [PII]. Let me see if you had a different policy in [PII].
[AGENT][NEUTRAL] OK, we're getting somewhere now. So the policy number you gave me, that is, those are the two claims that were submitted on that policy number on your old policy number 01659147.
[AGENT][NEUTRAL] We have more claims for [PII].
[AGENT][NEUTRAL] And we also have claims for [PII].
[CUSTOMER][NEUTRAL] OK, why would we not, why were they not being, why we not, why were they not pay?
[AGENT][NEUTRAL] So the ones that weren't paid, let me give them to you.
[AGENT][NEUTRAL] Claim was for.
[AGENT][NEUTRAL] Data service [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You just told me that was paid.
[AGENT][NEUTRAL] Yes, that was paid on the 2nd policy, the first original policy that you gave me.
[AGENT][NEUTRAL] I'm just looking to see.
[AGENT][NEUTRAL] OK, on data service of [PII].
[AGENT][NEUTRAL] But it
[AGENT][NEUTRAL] Submitted until [PII].
[AGENT][NEGATIVE] This one was denied.
[AGENT][NEUTRAL] Because benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing the benefits were paid. That was for your date of service.
[AGENT][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] By the dermatology group.
[CUSTOMER][NEUTRAL] OK, but I don't understand because that I just spoke to Aetna and they said that all the claims are paid.
[CUSTOMER][NEUTRAL] Which is my primary.
[CUSTOMER][NEUTRAL] I asked them, I asked them 200, I asked him if there was any outstanding claims in [PII]. They said, uh, there's no, there's no existing in [PII] and in [PII] was just processed now, so.
[AGENT][NEUTRAL] OK, so for the one for [PII].
[CUSTOMER][NEUTRAL] What do they need?
[AGENT][NEUTRAL] The one for [PII].
[AGENT][NEUTRAL] OK, so what I'm gonna
[CUSTOMER][NEUTRAL] Well, that I.
[AGENT][NEUTRAL] The one for [PII] is the one that.
[AGENT][NEUTRAL] We needed a good diagnosis code that the CDT code was not correct.
[CUSTOMER][NEUTRAL] OK, well, I'm sorry, what, what day was that?
[CUSTOMER][POSITIVE] Good
[AGENT][NEUTRAL] That was the first one that I gave you on the first policy number.
[CUSTOMER][NEUTRAL] OK, you gave me 2, you gave me 2 on the first policy number.
[AGENT][NEGATIVE] Yes, it'll be the one that was, it's gonna be the one that was not paid.
[CUSTOMER][NEGATIVE] One was paid and one was not.
[CUSTOMER][NEUTRAL] OK, that one shows the net done [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Is that the one that you guys had not paid [PII]?
[AGENT][NEUTRAL] Right, that's the
[AGENT][NEUTRAL] That we need the good diagnosis code for.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Oh wait, that, that was from you. That was from you. OK, that was the one that you need. OK, is there any outstanding in [PII]?
[AGENT][NEUTRAL] Let me look and see for you, sir.
[CUSTOMER][NEUTRAL] The reason why I'm asking this is because I'm having issues with the billing company.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEGATIVE] Now they, now they don't answer my calls. It's, it's frustrating because this is going a whole year and now I'm I need treatment.
[AGENT][NEGATIVE] Oh, no.
[AGENT][NEUTRAL] OK. I've got um.
[CUSTOMER][NEGATIVE] So I'm dealing, I'm dealing with some incompetent people in billing department and uh and every time you call their, their phone number you you get a, you don't even get somebody answering it's it's a, it's a it's a phone message.
[CUSTOMER][NEGATIVE] Ridiculous
[AGENT][NEUTRAL] OK, so
[AGENT][NEGATIVE] What you'll need to do is to go to them and ask them what dates of service are not paid for, get a list of the date of services that was not paid.
[AGENT][NEUTRAL] And then when you call back with us, give us the the dates of service that were not paid and we can look up and see.
[AGENT][NEGATIVE] Why they weren't paid or if they were even sent to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEGATIVE] OK, let me, let me, let me see if I can get them on the phone. It's ridiculous. I can't even get them to answer the phones now.
[CUSTOMER][NEUTRAL] Um, but for for just so you know, Aetna, I just spoke to Edna because I'm having the same issue. Edna said that they resubmitted their, their claims. The billing company resubmitted the claims, and Edna supposedly processed all the claims, so there's nothing outstanding with Aetna. So that's why I was calling you.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, APL to verify there's any outstanding claims that were not paid because they're denying me treatment.
[CUSTOMER][NEGATIVE] But now you can't get him on the phone.
[AGENT][NEUTRAL] Right, I do.
[AGENT][NEUTRAL] Right, I understand. If you can get with your, uh, with the dermatology group of Florida and ask them for a list of the dates of service that were not paid.
[AGENT][NEGATIVE] Then call us and let us know and we can look them up and see why they weren't paid or if we even received a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, miss.
[AGENT][POSITIVE] You're so very welcome. I hope you have a good rest of your weekend and we appreciate you calling APL. You take care [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][POSITIVE] You're welcome