AccountId: 011433970860
ContactId: 532daa1a-7396-4d20-9252-6ab558d22e83
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 661200 ms
Total Talk Time (AGENT): 198248 ms
Total Talk Time (CUSTOMER): 305583 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/532daa1a-7396-4d20-9252-6ab558d22e83_20250318T21:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm with the broker's office and I'm calling um to find out if a provider has filed a claim.
[CUSTOMER][NEUTRAL] For an employee of a group, um, I was gonna, um, file the claim for him, but I got the EOBs from the insurance company and based on the EOBs and then based on the amount that he's being sent a bill for we're wondering if possibly they filed the APL and got reimbursement for part of what was um due and we don't need to file a claim.
[AGENT][NEUTRAL] OK, yeah, let's take a look, [PII]. What's the uh patients or the insured's policy number?
[CUSTOMER][NEUTRAL] It is 01735266.
[AGENT][NEUTRAL] OK. And then can I get their name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII] and let me check for his date of birth. let's see.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright thank you and then do we have a data service?
[CUSTOMER][NEUTRAL] Uh, yeah, there was one that was, uh, [PII].
[CUSTOMER][NEUTRAL] And the other one was [PII].
[CUSTOMER][NEUTRAL] [PII] I believe.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] [PII] they're just now in fact they they got a letter from a lawyer telling them they were being sued and she's like this is the first bills we've gotten I don't even know what to think about this.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh my. OK. Um, what was the, um, on [PII], what was the billed amount that you show?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, well, that was the doctor and the facility, um, the facility charged $2600.
[CUSTOMER][NEUTRAL] The doctor charged $2000.
[AGENT][NEUTRAL] Do you have an amount after the primary paid?
[CUSTOMER][NEUTRAL] Uh, yeah, uh, the doctor was $848.51 and the facility was 1396 24 cents.
[AGENT][NEUTRAL] And the facility that was same date was that still [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for the first one for the 84851.
[AGENT][NEUTRAL] I show we did get a claim for that one. it looks like we did send payment to the provider for 848-51.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it was a single check. I don't know what details you need from that.
[CUSTOMER][NEUTRAL] No, that's fine just I know that they paid that the provider got that OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see what this.
[AGENT][NEUTRAL] OK, and then the other claim for the 2600, there was a facility charge it looks like that one is showing a denial, um, it looks like the outpatient max was already met, so there was nothing additional that we could pay out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So probably the other um the other data service 12424.
[CUSTOMER][NEUTRAL] It was virtually I think the same charges because he had like a cataract surgery in one eye and then he had it in the other eye so it was like pretty much the same charges I believe.
[CUSTOMER][NEUTRAL] 124 was.
[CUSTOMER][NEUTRAL] Uh uh
[CUSTOMER][NEUTRAL] The surgery center was again $2600.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the doctor.
[CUSTOMER][NEUTRAL] 2000 again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for the 124 24, there was a a claim sent for a facility charge. It looks like we got a bill amount of 1,30462.
[CUSTOMER][NEUTRAL] Yeah, that was the amount that went to the deductible.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so a benefit payment was sent on this for looks like 42098.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When were these payments made? I guess that'd be a good thing to know.
[AGENT][NEUTRAL] Uh, let me double check.
[AGENT][NEUTRAL] And then the other one for the 24th paid the 845 51.
[CUSTOMER][NEUTRAL] 848 51 paid.
[AGENT][NEUTRAL] Um, 8:45 51.
[CUSTOMER][NEUTRAL] OK, let me check that.
[CUSTOMER][NEUTRAL] 124 well on here it says 848 51 hm anyway.
[AGENT][NEUTRAL] So that payment, that payment was sent out on 313-24.
[CUSTOMER][NEUTRAL] On the EOB
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the other one for the 24th looks like it was sent out on [PII].
[CUSTOMER][NEUTRAL] OK, so y'all paid.
[CUSTOMER][NEUTRAL] 420 98 8 4551.
[CUSTOMER][NEUTRAL] 848 51.
[CUSTOMER][NEUTRAL] So had he had other claims for 2024 that had been filed because that's $2,115.
[AGENT][POSITIVE] Yeah, we can.
[CUSTOMER][NEUTRAL] And that one claim was denied.
[AGENT][NEUTRAL] So the 12 for the 24th, I don't know that, do we have the, yeah, that was 8:45 51, that's what you had said, correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well it was 84851 so it's on the EIB, but for some reason y'all paid 84551, but there was um a couple of other things that went to his deductible that they may have filed to you as well there was a charge of $420.
[AGENT][NEUTRAL] Oh, OK, uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, it says anesthesia, the deductible amount was $210.
[AGENT][NEUTRAL] For the same data service, 124.
[CUSTOMER][NEUTRAL] Um, that was on, well, that was on 110, but that was probably one for 124 as well.
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, uh, charge of 350.
[CUSTOMER][NEUTRAL] And 175 went to the deductible for 124.
[CUSTOMER][NEUTRAL] So that was one that was an anesthesia charge on both of those dates of service.
[AGENT][NEUTRAL] So there's another claim here for Georgia, [PII] I Center for [PII].
[AGENT][NEUTRAL] The procedure code is 0142. The charge amount is showing 210.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] showing
[AGENT][NEGATIVE] Doesn't match.
[CUSTOMER][NEUTRAL] Uh, yeah, that's the deductible.
[AGENT][NEUTRAL] OK, so that was paid.
[CUSTOMER][NEUTRAL] OK, so the 2:10 was paid?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if we go back
[CUSTOMER][NEUTRAL] Pay 2:10.
[AGENT][NEUTRAL] Then the only other thing that I see.
[CUSTOMER][NEUTRAL] Should be like one for um 175 maybe for 124.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yep, so there is, there's one for 124 24 that paid out 175 also.
[CUSTOMER][NEUTRAL] OK, so let's see 2:10.
[CUSTOMER][NEUTRAL] And 175 yep, that comes up to the 2500.
[CUSTOMER][NEUTRAL] OK, so everything got paid except.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] And oddly enough the the surgery on 110 didn't get paid but the surgery on 124 did.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I was just about when they got submitted, it looks like probably.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] Or when they were received, yeah, so.
[CUSTOMER][NEUTRAL] OK, well good to know um because well like I said they're they're, you know, trying to the lawyer's sending her a letter now for.
[CUSTOMER][NEUTRAL] Like 500 or $600 and.
[CUSTOMER][NEUTRAL] You know, when I got the EOB I said well according to the EOB you owe um.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Like $4700 I said obviously they must have filed it to the gap and got paid.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And they'd already paid them about $2000 themselves, so anyway, but that clarifies the situation. It doesn't clarify why they're just, you know, all of a sudden sending them a letter from a lawyer.
[AGENT][POSITIVE] Wow, yeah, yeah.
[CUSTOMER][NEUTRAL] Um, but it does clarify the amounts a little bit, so.
[AGENT][NEUTRAL] Right, right. No, exactly. Yes. Did you have anything else you wanted me to check on for you, [PII]?
[CUSTOMER][NEUTRAL] Um, no, I think I don't know, I feel like I had somebody else I wanted to check on, but I don't know.
[CUSTOMER][NEUTRAL] No, no, yeah.
[CUSTOMER][POSITIVE] [PII]'s working on something for me but she's following up on that one so alright thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.