AccountId: 011433970860
ContactId: 51a392fb-2d01-4e7d-a690-be0beb0c8e07
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 310880 ms
Total Talk Time (AGENT): 89326 ms
Total Talk Time (CUSTOMER): 201246 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/51a392fb-2d01-4e7d-a690-be0beb0c8e07_20250218T16:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] over on the care team. How are you?
[AGENT][NEUTRAL] Fine, how are you?
[CUSTOMER][NEUTRAL] Alright thank you I've got a provider needing to talk to y'all um she well actually she said she's with Multiplan um she's calling regarding a claim for uh HI and frankly I'm a bit confused as to what I, I believe she wants a more detailed EOB um she has an EOB showing the benefit amount that we paid, but I think she's wanting a more detailed one with the total charges versus what we paid.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] It is 02574226.
[CUSTOMER][NEUTRAL] And it is for uh part one. I do have that claim number.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] It's 3558043.
[AGENT][NEUTRAL] So since this is an indemnity policy, this is how benefits are processed in a system, there's not any other there, this is as detailed as the, the EOBs get that we that they processed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what I figured um she was asking specifically if we used multi plan pricing, but I mean it just goes off of our policy doesn't it?
[AGENT][NEUTRAL] Right, even with the multi-plan is based off the policy provisions. It only covers the indemnity amount outlined under the policy.
[CUSTOMER][NEUTRAL] That's what I thought. I've just never had a somebody asked me that before, so I was like I have no idea. Would you mind explaining that to her?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure, you can send it to me. What's her name?
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you. Are you ready for her now?
[AGENT][POSITIVE] You're welcome. Yeah, I'm ready.
[CUSTOMER][NEUTRAL] OK, bye bye.
[AGENT][NEUTRAL] Claims department, this is [PII].
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII] calling from Multiplan. How are you?
[AGENT][NEUTRAL] Fine, how are you?
[CUSTOMER][NEUTRAL] I'm good thank you. I'm not sure whether [PII] filled you in or not, but I'm calling in regards to a claim issue that was forwarded over to us for review on a claim that Multiplan had returned multi-plan network pricing for the patient, but the remittance of the facility received isn't listing the total bill charges whether the multi-plan discount was used, it's simply only accounting for the $700 payment.
[AGENT][NEUTRAL] OK, and this is in regards to the data service uh.
[CUSTOMER][NEUTRAL] So I was looking to see if a multi plan was used.
[AGENT][NEUTRAL] This is in regards to the date of service of [PII].
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Right, for a claim that was billed for total bill charges of 4,316,410.
[CUSTOMER][NEUTRAL] And multiplan had returned multi-plan network pricing for an allowed amount of 37,55278.
[CUSTOMER][NEUTRAL] For a discount of 5,061132.
[CUSTOMER][NEUTRAL] But the remittance is only accounting for the $700 payment.
[AGENT][NEUTRAL] Correct, that would be correct. Um, this is a hospital indemnity plan, so the benefits that were payable were processed based off the policy provisions, and those were the indemnity amounts payable under the policy. So as far as the EOB that would be
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, but is there a.
[CUSTOMER][NEUTRAL] I'm just wondering if there's another EOB that shows.
[CUSTOMER][NEUTRAL] APL processed $43,000 utilize the multi-plan network discount of the 5,611 I think it was for an allowed amount of the $30,000 and that the patient is responsible for the remaining allowed over the $700 payment.
[CUSTOMER][NEGATIVE] Because this document doesn't even document that multi plan was used.
[AGENT][NEUTRAL] No, it would not it would not outline that information. It will only, on the EOB that we provide, it will only provide what was payable under the policy for their indemnity benefits.
[CUSTOMER][NEGATIVE] It doesn't document the total bill charges.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So you don't have any other um formatted explanation of benefits that that normally would show the um total bill charges, the discount, the allowed this is all that is supplied to a provider because this isn't letting them know that multi plan was used.
[AGENT][NEUTRAL] Yes, this is the only information that's provided to the provider.
[CUSTOMER][NEUTRAL] For even the discount to be.
[CUSTOMER][NEUTRAL] OK, because this isn't even showing that their that their discount was used, so in fact.
[CUSTOMER][NEUTRAL] A patient could get billed the discounted amount.
[CUSTOMER][NEUTRAL] Like the extra 5,0611.
[CUSTOMER][NEUTRAL] So that's why I was wondering if there was another formatted remittance that would show that multiplan was used so that the patient doesn't get billed the additional $5600.
[AGENT][NEUTRAL] No, there's not any other um information provided to the provider. This is what we provide to the provider.
[CUSTOMER][NEUTRAL] OK, I will have to work with our sales and marketing team. Thanks so much. I'm sorry, you said your name again was?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you [PII] you have a great day.
[AGENT][POSITIVE] You're welcome. You too. Thanks for calling.