AccountId: 011433970860
ContactId: 4764e4c6-9726-41c1-8462-17a5d9d2bed5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1355699 ms
Total Talk Time (AGENT): 328692 ms
Total Talk Time (CUSTOMER): 216763 ms
Interruptions: 4
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/4764e4c6-9726-41c1-8462-17a5d9d2bed5_20250328T18:10_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. um, I had called, uh, your office a little bit ago, um, and they told me that my claim was denied because they needed a diagnosis code. So I just got off the phone with the, the, um, the hospital, and they said that they submitted everything to you guys with the codes. Um, can I give you my info?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, what's your policy number please?
[CUSTOMER][NEUTRAL] OK, it is, where is that, um.
[CUSTOMER][NEUTRAL] 02280228
[CUSTOMER][NEUTRAL] 1581.
[AGENT][NEUTRAL] Your name and date of birth?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Is this the ER?
[AGENT][NEUTRAL] Claim
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] United, they told me United Healthcare paid their portion, they submitted it to you guys, with all the codes that they sent to them with the diagnosis, the, the um.
[CUSTOMER][NEUTRAL] Everything.
[AGENT][NEGATIVE] I'm not sure we asked them for that. I'm showing we denied it.
[AGENT][NEUTRAL] Because it says.
[AGENT][NEUTRAL] We are not a covered loss.
[AGENT][NEUTRAL] So I'm not showing you have the benefits for treatment in ER.
[AGENT][NEUTRAL] So we didn't ask them for diagnosis.
[AGENT][NEGATIVE] We just, we outright denied it because it was not a covered expense.
[CUSTOMER][NEUTRAL] Why is it not a covered expense that's for um.
[CUSTOMER][NEUTRAL] Isn't that for deductible?
[CUSTOMER][NEGATIVE] And an illness.
[AGENT][NEUTRAL] Let me pull up a hard copy of your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, they did it under the HI policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is that?
[AGENT][NEUTRAL] So you.
[AGENT][NEUTRAL] Had a hospital indemnity policy, but I see now you also have a medlink policy. OK, I need to go under the right policy. The number that you gave me is to your, your, um, hospital indemnity policy that ended [PII]. So when I was looking under there, they did process it on process it under, but they were like, hey, this is not a covered benefit. So now I need to go under your Medlink policy to find the claim.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I suppose.
[CUSTOMER][NEUTRAL] Yeah, so we have both, and it's confusing of what.
[CUSTOMER][NEUTRAL] You know, I mean, we, and, and every time we do go, we did give them both just because.
[AGENT][NEUTRAL] So they have it. OK, I see now. So we do have the diagnosis, but we have it under your HI policy. OK. Just give me a minute so I can.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Figure this out, OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So I need to get the I can't, I wonder if I can.
[AGENT][NEUTRAL] If it'll let me
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] Thank you so much for your patience.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 16
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I'm not sure they ever filed with us.
[AGENT][NEUTRAL] 00, they filed. OK. Uh no, I, I'm getting confused. They filed, but they filed under the.
[CUSTOMER][NEUTRAL] Yeah, they said they
[CUSTOMER][NEUTRAL] No, that's
[AGENT][NEUTRAL] The HI OK.
[CUSTOMER][NEUTRAL] The uh the other one, right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I, I, I, I was looking to see how they filed under the meddling, but OK, it was put under, they just sent it and it was put under. OK, so I, I can process this claim to them and not to you, right?
[CUSTOMER][NEUTRAL] OK, uh, what do you mean to their payment?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, yeah, I mean, you, um, it's Atlantic Health Systems, right? That's who, like you, you know who it has to go to, right?
[AGENT][NEUTRAL] Right, um, United, well, it's AHS Hospital Corp.
[CUSTOMER][NEUTRAL] No, it's not
[CUSTOMER][NEUTRAL] You wanna send it to me and then I'll pay them.
[AGENT][NEUTRAL] OK, so what.
[CUSTOMER][NEGATIVE] Just cause I don't want it to get or have.
[AGENT][NEUTRAL] OK, so let me see who.
[CUSTOMER][NEUTRAL] Or I can give you this bill that they sent.
[AGENT][NEUTRAL] The payment is gonna go, the, the payment will go to, let me see, do we have an assignment?
[CUSTOMER][NEUTRAL] So it's from
[CUSTOMER][NEUTRAL] It well the bill I got was from [PII].
[AGENT][POSITIVE] Yeah, they, we do have an assignment of benefits.
[AGENT][NEUTRAL] We do have an assignment of benefits.
[CUSTOMER][NEUTRAL] To Atlantic Health System.
[AGENT][NEUTRAL] Yeah, that's AHS. I'm assuming that's what AHS means.
[CUSTOMER][NEUTRAL] So that's who will go to the.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][POSITIVE] Yeah, OK. Wonderful, um.
[CUSTOMER][NEUTRAL] Thank you for that. Thank you so much for your help and your patience and um cause this gets really frustrating.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Now let me ask you this, do we have um vision coverage as well?
[AGENT][NEGATIVE] Not with us. We don't do vision.
[CUSTOMER][NEUTRAL] Oh, OK, not at all. OK, alright, so then you'll take care of this claim for me?
[AGENT][POSITIVE] Yes, ma'am. We'll, I'll get it reprocessed today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh great thank you so much.
[AGENT][NEUTRAL] OK, was there anything else I could assist with?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] Thank you for calling APR.
[CUSTOMER][NEUTRAL] Do you, could you see if there's any other?
[CUSTOMER][NEUTRAL] If there were any other claims that were submitted that were denied.
[AGENT][NEUTRAL] Um, yeah, they were denied because.
[AGENT][NEGATIVE] There was no patient responsibility.
[CUSTOMER][NEUTRAL] What do you mean?
[AGENT][NEGATIVE] Meaning on the EOB that we received, either it wasn't covered or the hos or the, the insurance already paid it.
[CUSTOMER][NEGATIVE] Oh, OK, but you can't tell on your end like I was just concerned. I didn't get any other bills. I'm just concerned though if we run into the same issue.
[CUSTOMER][NEUTRAL] You know that it was billed.
[CUSTOMER][NEGATIVE] To the wrong
[CUSTOMER][NEGATIVE] To the wrong one.
[AGENT][NEUTRAL] Um, let me look under your.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] I don't see where this [PII] lab was processed under the medin.
[AGENT][NEUTRAL] Wait, let me see that.
[AGENT][NEUTRAL] Labs.
[AGENT][NEUTRAL] So the the [PII].
[AGENT][NEUTRAL] No, I'm sorry, [PII] labs, um, that provider.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] If you, if you can send in.
[AGENT][NEUTRAL] We have the EOB, but we just need to know.
[AGENT][NEUTRAL] Um, if that was performed.
[AGENT][NEUTRAL] In a.
[AGENT][NEUTRAL] Let me see if you have.
[CUSTOMER][NEUTRAL] Do you know who that was from?
[AGENT][NEUTRAL] Um, it's the provider is a Zimmerman, so I guess, well, I guess you have the, um, outpatient writers I guess it doesn't mean that.
[CUSTOMER][NEUTRAL] OK. That's my, that's my, um, that's my, um, regular, uh, GP.
[CUSTOMER][NEUTRAL] I had a uh
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I had my physical that day, the day after.
[CUSTOMER][NEUTRAL] Or no, no, was it my figure, no, for my blood work, for my physical.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The day after.
[AGENT][NEUTRAL] OK, so we'll need to.
[CUSTOMER][NEUTRAL] It was a
[AGENT][NEUTRAL] Let me make sure.
[AGENT][NEUTRAL] I'm seeing this correctly.
[CUSTOMER][NEUTRAL] Because I don't mean getting a bill though from them.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It's office visit services.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So we did process that.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then where is [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so we did process [PII] under you. OK, we did.
[CUSTOMER][NEUTRAL] OK, OK, um, so that, that should be it then, right? I'm thinking?
[AGENT][NEUTRAL] Yeah, from what I'm I'm seeing, the only thing that I'm not seeing that was processed under.
[AGENT][NEUTRAL] 11 7.
[AGENT][NEUTRAL] Undermili 117.
[AGENT][NEUTRAL] ER 62 let me make sure this is the same.
[AGENT][NEUTRAL] Yeah, I see we did process it under there, but we asked for the diagnosis.
[AGENT][NEUTRAL] OK. So I just need to go back and process it.
[CUSTOMER][NEUTRAL] OK, and did.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Put the diagnosis, we have the diagnosis.
[AGENT][NEUTRAL] OK, so yeah, we asked for the diagnosis. So I just need to.
[AGENT][NEUTRAL] But uh that is not the information you sent in that's the information.
[AGENT][NEUTRAL] Let me make sure who who filed it first.
[AGENT][NEUTRAL] Let me make sure.
[AGENT][NEUTRAL] I do this correctly.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So they sent it.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then,
[AGENT][NEUTRAL] And then you, OK, so they technically filed first.
[AGENT][NEUTRAL] OK, so they filed first, so OK, I'm good to go. I know what I need to do now.
[AGENT][NEUTRAL] So they sent it on [PII] and then you sent it [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's what happened. They did, they sent it, but they had, it was applied to the HI and we denied it saying this is not covered. And then you filed under the right policy, and then we were like, well, hey, we need the diagnosis, not knowing we already had it on the other policy.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh God
[CUSTOMER][NEGATIVE] Yeah, yeah, because I, we may have gotten something that it was denied. It's just, it's so confusing with this insurance. I don't know.
[AGENT][NEUTRAL] OK, so now I can go back and process and pay.
[CUSTOMER][NEUTRAL] Um, OK, so.
[AGENT][NEUTRAL] The provider
[CUSTOMER][NEUTRAL] Atlantic
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's it right that's who I got the bill from.
[AGENT][NEUTRAL] The AHS well they abbreviated it on their claim form but it it's gonna go to them.
[CUSTOMER][POSITIVE] OK, yeah, yeah, that's fine. All right, that'll that'll be wonderful. Thank you so much for your help.
[AGENT][POSITIVE] Alright, thank you for calling APL. You have a good day.
[CUSTOMER][POSITIVE] OK you too bye bye.