AccountId: 011433970860
ContactId: 4acb9fb6-e443-46c5-a338-87441a2e1816
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 772679 ms
Total Talk Time (AGENT): 418018 ms
Total Talk Time (CUSTOMER): 410130 ms
Interruptions: 16
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/4acb9fb6-e443-46c5-a338-87441a2e1816_20250317T18:49_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII] calling from a doctor's office, and I need to talk to you about a couple of old claims.
[AGENT][NEUTRAL] OK, going back, give me a good policy number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 01742617
[AGENT][NEUTRAL] Alright, [PII], thank you for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] Alrighty, [PII], thank you so much for all that information. Now, your patient's name and date of birth.
[CUSTOMER][NEUTRAL] At [PII] [PII].
[AGENT][NEUTRAL] Well, looks like [PII] is the insured on this medical supplemental plan, and you did say you want to check status of a couple of claims. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, um, we have already called this last year and I'm just needing to clean this up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Well, what can I do for you?
[CUSTOMER][NEUTRAL] OK, the first one, I have data service [PII]. I also have the claim number if you need that.
[AGENT][NEUTRAL] Well, let me just put that date in. Let's see.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm. Where's your bill from and how much is it for?
[CUSTOMER][NEUTRAL] Um, Mercy, Mercy Clinic East Communities, it's for ultrasound $174.
[AGENT][NEUTRAL] Alright, let's see, give me just a moment.
[AGENT][NEUTRAL] Alright, I see that claim for 174 looks like we paid 9920. And how can I help you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So back in February of last year um we called um your office we talked to [PII] um she said the same thing, she told us when it was received, processed, and, uh, paid 9920 with no patient responsibility. And then it says here the payment was made through check number 1806044 issued on [PII]. So this person who talked to [PII] said, Hey, could we have that EOB.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And we put it on hold um because we're not receiving these EOBs or checks um and I'm calling the actual clinic and they said they're not receiving receiving them um can you check to see if it was ever cleared?
[AGENT][NEUTRAL] Let's see, I sure can. Yeah, we are, yeah, uh, oh, you're welcome. Let me see, get that check number. Let's see.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And it is check number 1806044.
[AGENT][NEUTRAL] It's 1806044. Yes, ma'am. So let me put that check number in. I have to go to a different screen, so bear with me. Yeah.
[CUSTOMER][NEUTRAL] From [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thanks, sure.
[CUSTOMER][NEUTRAL] And how do you spell your name?
[AGENT][NEUTRAL] My name is spelled [PII]
[CUSTOMER][POSITIVE] Thank you much.
[AGENT][NEUTRAL] OK, yes, ma'am, and I do see this from Mercy Clinic East Community. We are having lots and lots and lots of problems with y'all getting your checks because we have to pay what is in box 33 on the claim, but that apparently is not where your check should be going.
[CUSTOMER][NEUTRAL] Yeah, that's us.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] And we can't change.
[CUSTOMER][NEUTRAL] Yeah, it looks like you're OK. Well, and you're sending in box 33 is the actual clinic. I've reached out to the office manager. I'm like, what do you do when you receive checks? And she goes, Well, we send them to the lockbox, but you know where they should go with a PO box in [PII]. So I was told that I need to maybe mail to you a W-9. Would that help? Yes, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It might help, but we still will not look at a W-9 on every claim we pay. We're gonna pay what's in box 333, so that needs to be changed on everything you're sending us.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hm OK and I see because this this insurance it's like a commercial, you know, I don't think we're really in network. I don't, we're not quite for sure what this is.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, we are a, yeah, we're a medical supplemental plan to their primary major plan. We're not, you know, yeah, there's not networks, yeah, we only coordinate with the primary.
[CUSTOMER][NEUTRAL] OK, and so that why?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so I don't think we can get this issue fixed unfortunately with [PII]. I'm not for sure they're billing so was this particular check we talked about?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, cause we're getting tons of chicks. Mhm.
[CUSTOMER][NEUTRAL] Mhm, so it was it ever cashed?
[AGENT][NEUTRAL] Uh, looks like it, it came back with a non-res and it's been voided, so it's been sent over to get reissued.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So do you show an address of [PII]?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am, that's where this check went.
[CUSTOMER][NEUTRAL] Yeah and that's where.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, the office is still so.
[AGENT][NEGATIVE] And that's what's on your claim, that's where it went and y'all are not getting it, so I, I know it it's been a nightmare.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, yeah, on our end and you're in both, OK.
[AGENT][NEUTRAL] Yep, yep, both because we're steady boarding and resending because we have to resend what's in [PII]. We cannot change it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK, um, OK, so, uh, when, what's the process? When will you be resending that and what do I need to do?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That that check has been voided? No, there's nothing that you need to do on your end, but this check is going back to the same address, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and when is that check gonna be reissued?
[AGENT][NEUTRAL] Yeah, but it's.
[AGENT][NEUTRAL] Probably in the next 3 days.
[CUSTOMER][NEUTRAL] Oh, OK, all right, and I'm gonna reach out to the office manager and tell her again what's going on because I don't know if she's not getting them or the girls at the front desk if they don't know what to do, but they need to stop whatever they're doing.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, cause, yeah, it's.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh what, but yeah.
[AGENT][NEUTRAL] Yeah, cause yeah, [PII] is the only place we can send our checks to.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Yeah, OK, and that makes sense, of course. Can you look at about two other claims for the same patient?
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Sure, what them what that data service is.
[CUSTOMER][NEUTRAL] Um, the next one is 1025 23 for $84.
[AGENT][NEUTRAL] Well, let's see.
[AGENT][NEGATIVE] Mm, same problem.
[CUSTOMER][NEUTRAL] OK, um, OK, and so can that one be, uh, resent to us?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] My
[AGENT][NEUTRAL] Yes, ma'am, I'll have to stop pay and
[AGENT][POSITIVE] boarded on that, write that down. OK, I can get that done. Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because I see here yeah you paid 4798 check 1823495. OK, so again maybe 3 days.
[AGENT][NEUTRAL] It, yep.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, well, it might take a little longer because this check's not been voided yet, so I'll have to send it to accounting, have it boarded, and then have it reissued. So it's gonna take a little bit longer on that one, OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, that's totally fine, that's totally fine. OK, and then can you also look, yes, uh, [PII].
[AGENT][NEUTRAL] All right. Yes, ma'am.
[AGENT][NEUTRAL] And your other night.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEGATIVE] I know you hate this as much as we do.
[CUSTOMER][NEUTRAL] And I'm just trying to like I said, fix, fix loose ends.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And there's a lot of them right now.
[CUSTOMER][NEGATIVE] Oh, shit.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Uh, you say there's a lot of them for this particular address or all different [PII]?
[AGENT][NEUTRAL] Oh [PII].
[CUSTOMER][NEUTRAL] Huh
[AGENT][NEGATIVE] All [PII] we're having trouble with.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Interesting.
[AGENT][NEUTRAL] Yeah, now this check, let's see.
[CUSTOMER][NEUTRAL] I think it's already voided. Do you see it's 125. 70 you paid?
[AGENT][NEGATIVE] It, it has been, it has been voided and it's already been reissued to the same address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see what day this check was issued already.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yeah, this check was reissued on [PII], and it is going to [PII]. Yeah, that's where it's going.
[CUSTOMER][NEUTRAL] Yes, oh wait, wait, wait, wait, say that again, [PII] what?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Where's that at?
[AGENT][NEUTRAL] Uh, let me pull your claim up. Let's just see what's on your claim.
[CUSTOMER][NEUTRAL] Huh, because I'm looking at [PII] and it still has the office address.
[AGENT][NEUTRAL] Well, let's see.
[CUSTOMER][NEUTRAL] Yeah, because that is not our, that's not our lockbox.
[AGENT][NEUTRAL] Mm, let me pull up that mail number.
[AGENT][NEUTRAL] Do y'all have one lock box that all checks need to go to?
[CUSTOMER][NEUTRAL] Yes, uh, all insurance is sent.
[AGENT][NEUTRAL] Can that be put on all your claims?
[CUSTOMER][NEUTRAL] Can it? I know, wouldn't that be nice? I think I asked them.
[AGENT][POSITIVE] Yeah, that's what we're gonna need.
[CUSTOMER][NEUTRAL] Yeah, I think I asked registration about this. Let me see what they're saying.
[CUSTOMER][NEUTRAL] [PII], um, but I wonder though that one the address you just gave me, where does that come from?
[AGENT][NEUTRAL] Yeah, I'm pulling that claim up. My computer's just slow so bear with me. uh, let's see.
[CUSTOMER][NEUTRAL] So I sent a message to our registration team about what's going on, and she said when payers are loaded as generic or if claims are mailed, it will only put the clinic's address. The insurance will only pay to the address on the claim.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then she goes yes if they stop the payments then they should be able to send them again you may have to send them a W-9 if they don't have one but then like you said, you know that's fine, but.
[AGENT][NEUTRAL] Yeah, W9 is not gonna matter. Yeah, we're not gonna look at a W-9 when we pay a claim, but yeah, and I do have this claim pulled up for 1122. That address is not on here.
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][NEUTRAL] That [PII], yeah, I don't know what that is.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, that street address [PII].
[CUSTOMER][NEUTRAL] Yep, yep, that's the clinic, um, yeah, but that PO box because our lock box where everybody sends checks to it's in [PII].
[AGENT][NEUTRAL] Um hm.
[CUSTOMER][NEUTRAL] When they're not even here in [PII], so that I know that.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh my. Is that address on any [PII]ms ever?
[CUSTOMER][NEUTRAL] That [PII] or [PII]. No, I've never seen it, never heard of it before.
[AGENT][NEUTRAL] What is the PO box that these checks should be going to?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] [PII]. That's [PII], zip [PII]. Was that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEGATIVE] Alright, I'm gonna go ahead and get a stop paper on this, but I will, uh, because, yeah, it hasn't even.
[AGENT][NEUTRAL] Yeah, that's not even my, so yeah, I'm not even sure they got that address from, but I will get that voided and I will maybe speak with my supervisor, which I think several people have already about this problem that we're having, um, and seeing how we can, you know, clarify it, but, you know, definitely getting the address updated where it needs to go in [PII] is what's going to be the big clincher, so.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] It take care of everything, right, exactly, OK, and I'm gonna send a message to maybe the supervisor of registration so we can all get on the same page. Alright, yes, um, is there a reference number for my call today?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, uh, yeah, same page, yes. OK, well, I'll do.
[AGENT][NEUTRAL] No, but you can use my name in today's date, [PII], and I am in the claims department. My name is [PII].
[CUSTOMER][NEUTRAL] Nope.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, and do you want me to send the W-9 or just kind of hold off?
[AGENT][NEUTRAL] Just hold off because I mean, honestly, um, like I said, we probably already have one as many people, yeah, if we get daily phone calls about this problem, um, until that address gets changed into [PII] 33, I, I'm not seeing it, yeah, ending, so I hate to say it, but that's just the truth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's not gonna change.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] There's nothing you can do.
[CUSTOMER][POSITIVE] OK, OK, OK, well, you've been, I know, I understand, I understand. Well, thank you so much, you've been a lot of help.
[AGENT][POSITIVE] Well, yes, ma'am, [PII] and thank you for calling APL and you have a great rest of your Saint Patty's Day, OK?
[CUSTOMER][POSITIVE] Oh yeah you too bye bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.