AccountId: 011433970860
ContactId: 4d77c7e3-2916-470b-8e03-99a4bb1de6c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 453260 ms
Total Talk Time (AGENT): 154291 ms
Total Talk Time (CUSTOMER): 212412 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/4d77c7e3-2916-470b-8e03-99a4bb1de6c1_20250624T17:59_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. How are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] I'm good. Um, my name is [PII] and I'm with Prisma Healthcare. Um, I need to speak with someone about a claim on a patient.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what's the policy number for that patient?
[CUSTOMER][NEUTRAL] Policy number is.
[CUSTOMER][NEUTRAL] Hold on one second, hold on 1 2nd, I'm sorry.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] That's so weird.
[CUSTOMER][NEUTRAL] I'm thinking now that we.
[CUSTOMER][NEUTRAL] There's a mix up somewhere. OK, we got the EOB on a patient. Let me just give you the policy number that's on it, 02596440.
[AGENT][NEUTRAL] OK. Do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII] and her birthday is [PII].
[AGENT][NEUTRAL] And do you have the claim number?
[CUSTOMER][NEUTRAL] Claim number is 3603131.
[CUSTOMER][NEUTRAL] I think what has happened here.
[CUSTOMER][NEUTRAL] Because I actually the card we have on file actually has y'all has um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Sick, all kind of other people on it. So,
[CUSTOMER][NEUTRAL] I called um.
[CUSTOMER][NEUTRAL] I don't even know who I called the first time I got it right down, but anyway, and she said they didn't get the claim apparently there's the um the third party administrator or something like that um and so IMA is who it was and um.
[CUSTOMER][NEUTRAL] She said they didn't have the claim, but I have an EOB from y'all.
[CUSTOMER][NEUTRAL] Their ID number.
[CUSTOMER][NEUTRAL] On the card is different from the ID number on here. I'm thinking this got sent to y'all as a crossover from Medicare.
[CUSTOMER][NEUTRAL] No, because the patient doesn't have Medicare. OK, let's look at the claim.
[AGENT][NEUTRAL] OK, so, um,
[CUSTOMER][NEGATIVE] I'm so confused. I don't know two different ID numbers, so.
[AGENT][NEUTRAL] Uh, yeah, so
[CUSTOMER][NEUTRAL] Is she covered? Is she?
[AGENT][NEUTRAL] Um, this policy is a limited.
[CUSTOMER][NEUTRAL] OK, so she's at
[CUSTOMER][NEUTRAL] OK. And she is covered under it.
[AGENT][NEUTRAL] Yeah, it's a limited hospital indemnity policy, so it has very limited benefits.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] Limited
[AGENT][NEUTRAL] Um, in which services were not covered.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] No, but I was gonna ask about that because it says there's a router, hang on.
[CUSTOMER][NEGATIVE] I'm sorry, I'm having to go to 2 different pages here.
[CUSTOMER][NEUTRAL] OK, the outpatient rider only allows payment for outpatient surgery in an outpatient hospital or physician's office, office. Well, this was a place of service 22.
[CUSTOMER][NEUTRAL] Which is outpatient.
[CUSTOMER][NEGATIVE] And it still got denied.
[AGENT][NEUTRAL] Um, let's see, so.
[CUSTOMER][NEUTRAL] Can you see the claim?
[AGENT][NEUTRAL] Yeah, I can see the claim, um.
[AGENT][NEUTRAL] Yeah, I see the place of service 22.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I believe what what we require if you're building a place of service 22 we only pay on a UBO4, not a CMS 1500.
[AGENT][NEUTRAL] So it would have to indicate place of service 11 if you're billing on a CMS 1500.
[CUSTOMER][NEUTRAL] Oh, so y'all are needing, um, OK, so not a hick, but uh.
[CUSTOMER][NEUTRAL] Actually, what kind of phone would you call it?
[AGENT][NEUTRAL] Uh, UBO4.
[CUSTOMER][NEUTRAL] For the hospital phone?
[AGENT][NEUTRAL] The UV.
[CUSTOMER][NEUTRAL] And you be, yeah, you'd be 4, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] All right, so I'm confused. OK, um.
[AGENT][NEUTRAL] So this policy, so this is a a temp agency that for the patient, um, well, for the insured, and so they offer all these like supplemental policies, um.
[CUSTOMER][NEGATIVE] That's so weird.
[AGENT][NEUTRAL] One of which is the hospital indemnity plan, which is ours, APL, and then there's also a plan through 90 degree benefits, um, not sure if you have the card.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] That one and and we never know what if somebody's elected the 90 degree, but for some reason they, they, they always print the policy number on there. Um, so for us through American Public Life.
[AGENT][NEUTRAL] This is the hospital indemnity policy. So we're, we're not related to 90 Degree, so.
[AGENT][NEUTRAL] And then IMA is like the TPA that processes the claims for American public life.
[AGENT][NEUTRAL] And 90 degrees.
[CUSTOMER][NEUTRAL] Right, and she said she had not gotten it yet. So yeah, OK, so would y'all forward it to, uh, y'all are American Public Life now would y'all, uh, would y'all forward it to IMA after y'all process it or how does that work?
[AGENT][NEUTRAL] Um, so it looks like we received it. Um, let me see.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] I can't tell if did.
[CUSTOMER][NEUTRAL] Because IMA said they don't have it.
[AGENT][NEUTRAL] Yeah, so they, they send it on to us and then we have processed it so.
[CUSTOMER][NEUTRAL] That's what I'm
[AGENT][NEUTRAL] I so IMA only processes claims that are over $10,000. That's the only time they process claims, otherwise we're going to process the claim.
[CUSTOMER][NEUTRAL] Oh, OK, so your, your denial is correct then.
[AGENT][NEUTRAL] And then, yeah.
[AGENT][NEUTRAL] Yes, that's correct, yeah, so unless, unless you submitted a corrected claim, um, the place of service being 11, indicating physician's office versus outpatient hospital, which would have to be we would pay on a facility charge, um, then the, the denials correct, yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] That's so weird because
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I'm, I'm just learning this process, so I, I'm writing down questions to ask because I don't, um.
[CUSTOMER][NEUTRAL] Because I don't
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] Yeah, it wouldn't have went out on a UB uh a UB form. It would have went out.
[CUSTOMER][NEUTRAL] Yeah, I'm gonna have to ask about it.
[CUSTOMER][NEUTRAL] So, OK, well, um, let me, is there a reference number for today?
[AGENT][NEUTRAL] Yes, um, it's my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, well thank you so much for your help. I appreciate it.
[AGENT][POSITIVE] OK, well thank you for calling APL. I hope you have a good afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.