AccountId: 011433970860
ContactId: 50fe0370-a1d1-4ceb-8203-61f2314b760a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 701020 ms
Total Talk Time (AGENT): 213627 ms
Total Talk Time (CUSTOMER): 290484 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/50fe0370-a1d1-4ceb-8203-61f2314b760a_20250404T14:41_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Baptist Memorial Hospital. I've got a couple of patients that have pending claims with you guys, and I was wondering if I could get a status on them if possible.
[AGENT][POSITIVE] Sure, I can assist you with that.
[AGENT][NEUTRAL] Can I have a callback number for you, [PII], and the policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure, call back is [PII].
[CUSTOMER][NEUTRAL] And uh one of the policy numbers is 02479150.
[AGENT][NEUTRAL] What is this member's name and date of birth?
[CUSTOMER][NEUTRAL] Um, you guys.
[CUSTOMER][NEUTRAL] Oh sure, [PII] date of birth is [PII].
[CUSTOMER][NEUTRAL] Y'all actually made a payment on this, um, and I was wondering, is this a um self-funded plan or a gap plan, um, or is this considered a primary insurance? It's got you Hospital indemnity. Are all of your plans hospital indemnity?
[AGENT][NEUTRAL] The hospital indemnity. This is indemnity policy.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] This depends on what type of policy the member has.
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][POSITIVE] I got you y'all offer several, OK.
[AGENT][NEUTRAL] Mhm, we have a boat load of different policies. What is the date of service or the claim number? Mhm.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Y'all do.
[CUSTOMER][NEUTRAL] Sure, I can provide the claim number excuse me.
[CUSTOMER][NEUTRAL] Um, 347-03347-0131.
[AGENT][NEUTRAL] Thank you, so it looks like we paid $150 which was the maximum benefit amount allowed for that visit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] It's the max allowed for that visit. Thank you.
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's your next policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, it is 12895997.
[AGENT][NEUTRAL] And what is this member's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][NEUTRAL] See this policy here is a gap insurance.
[CUSTOMER][NEUTRAL] This one is a gap, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, have y'all received that claim, and do you have the primary EOB along with it?
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] Sure, uh, that helps [PII].
[AGENT][NEUTRAL] Is this for facility charge?
[CUSTOMER][NEUTRAL] Um, no, it is for a surgery she had, so yes, I guess it's our hospital charges.
[AGENT][NEUTRAL] What is the billing amount?
[CUSTOMER][NEUTRAL] Yes ma'am, total bill on our claim is $8,836.22.
[AGENT][POSITIVE] Thank you. 571.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like we received this claim [PII]. It was processed [PII], and there was no payment made on this claim due to.
[AGENT][NEUTRAL] Benefits are only payable if the major medical insurance provider provides the benefits, say if something went towards deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me just pull this claim up to see what's going on with this.
[CUSTOMER][NEUTRAL] OK, so let me.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Would you like that claim number? or do you already have it?
[CUSTOMER][NEUTRAL] Yeah, I need the claim number that way I can pull the EOB up on y'all's website.
[AGENT][NEUTRAL] It's 355-3571.
[CUSTOMER][NEUTRAL] 357135-53571.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So it looks like the ELB that you guys sent in, it does not.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Provide any information.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] It just says PR patient responsibility, but then it says reason code 204, the service equipment, drug is not covered under the patient's current benefit plan. So that means that they denied the claim. So we would deny it as well. But if something had went towards the deductible co-pay or co-insurance, then we would have made a payment towards it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][POSITIVE] Yeah it did that as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll, I'll review that EOB and possibly send a different one if there's a if there's any kind of coinsurance or anything like that.
[CUSTOMER][NEUTRAL] Um, all right, my next one.
[AGENT][NEUTRAL] Give me one moment, I have to make notations on the policy that I'm currently in.
[CUSTOMER][POSITIVE] Yes, you go ahead, yes, yep, go ahead.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] OK, this patient is [PII] um member ID is 982519.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] Thank you, and [PII], what is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And what is your bill amount?
[CUSTOMER][NEUTRAL] Built amount is $9,398.25.
[AGENT][NEUTRAL] So [PII] had a gap insurance policy as well.
[AGENT][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Gap plan got it.
[AGENT][NEUTRAL] The policy, this claim was denied due to the policy being terminated. The policy was active from [PII].
[AGENT][NEUTRAL] Until [PII] of, I'm sorry, [PII].
[AGENT][NEUTRAL] So the date of service of [PII], the policy was terminated.
[CUSTOMER][NEGATIVE] Is not.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][POSITIVE] I've only got 2 more. I appreciate you helping me with these. Um, let me know when you're ready for the next policy number.
[AGENT][NEUTRAL] Would you like the claim number?
[CUSTOMER][POSITIVE] Yes, that'd be helpful, thank you.
[AGENT][NEUTRAL] It is 351-9601. It's 351-9601.
[CUSTOMER][POSITIVE] That's it thank you.
[AGENT][NEUTRAL] What is your next policy number [PII]?
[CUSTOMER][NEUTRAL] 982-081
[AGENT][NEUTRAL] What is the member's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][NEUTRAL] Thank you, what is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your bill amount?
[CUSTOMER][NEUTRAL] Total charges are $45,035.95.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] 6232 thank you. 232.
[CUSTOMER][NEUTRAL] A
[AGENT][NEGATIVE] We received this claim [PII]. It was processed [PII], and there was no payment made on this claim.
[AGENT][NEUTRAL] Let me see what was the reason.
[AGENT][NEUTRAL] There are no benefits payable for chemotherapy and radiation. So was this for chemo or radiation?
[CUSTOMER][NEUTRAL] As
[CUSTOMER][NEUTRAL] It looks like outpatient, so let me check.
[CUSTOMER][NEUTRAL] Radilogy, chemotherapy administered pharmacy drugs, IV therapy, yes, yeah.
[CUSTOMER][NEGATIVE] No plan benefits for chemo or radiation.
[AGENT][NEGATIVE] Mhm, policy doesn't cover that service unfortunately.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, and may I get the claim number for that one so I can get that EOB off the portal.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim number is 3556232. That's 3556232.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] 3556232 OK.
[CUSTOMER][NEUTRAL] And looks like my last one.
[CUSTOMER][NEUTRAL] Let me know when you're ready for the.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Member ID OK.
[CUSTOMER][NEUTRAL] Um, this ID number is different NEO 682,238,980.
[AGENT][NEUTRAL] Thank you, so that's not a policy number here at American Public Life. Do you have that member's social, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let me look and see if I've got maybe a card and information was entered wrong by admissions. Let's see here.
[CUSTOMER][NEUTRAL] Insurance card.
[CUSTOMER][NEUTRAL] Um, that is not y'all.
[AGENT][NEUTRAL] Alright. Hi there, is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] At all, like not even, not even close, that is it thank you so much. um, do you mind if I get a reference number for our call?
[AGENT][NEUTRAL] Unfortunately, we don't provide those [PII], however, you can use my name in today's date as a reference. It's [PII] and today's date is a reference.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much I appreciate your time today.
[AGENT][POSITIVE] You're welcome thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thanks. Goodbye.