AccountId: 011433970860
ContactId: 5d4320f6-b72a-4821-8c2e-0a9a0743390d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 692719 ms
Total Talk Time (AGENT): 246253 ms
Total Talk Time (CUSTOMER): 227725 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/5d4320f6-b72a-4821-8c2e-0a9a0743390d_20250425T16:16_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII], and I was reaching out because I got a bill from, uh, the C-section that I had with my daughter, and they paid for the 3rd day we were in the hospital, but not the other two. So something tells me, someone, not you guys, but somewhere on their end, didn't submit the right things to you guys. So I wanted to see why, um,
[CUSTOMER][NEGATIVE] One day was paid for, 3 days, you know, the 3rd day and not the 1st 2 days, which is really weird. So.
[AGENT][NEUTRAL] OK. Do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Absolutely it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, sure do. Let me pull that up here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 018
[CUSTOMER][NEUTRAL] 94727
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] And what's your date of birth, Miss [PII]?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][POSITIVE] Thank you, Miss [PII], and you were just needing
[AGENT][NEUTRAL] To know why we didn't pay on all of the claim.
[CUSTOMER][NEGATIVE] Yeah, it's just weird that only, so we were there the [PII], obviously that was the birthday of my daughter, [PII] and the [PII] and the [PII] is the only day that was covered, which makes no sense whatsoever.
[AGENT][NEUTRAL] OK, I can help you with that. What data, what data service was it for?
[CUSTOMER][NEUTRAL] If I had to guess, I figured.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, so we were in the hospital after [PII] was born on, uh, [PII], [PII], and [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And was this claim for you?
[CUSTOMER][NEUTRAL] No, it was for her, so it was regional pediatrics associates or something.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Now, the last I had spoken with somebody about this regional neonatal Associates, they did say that it all, obviously you can't guarantee it, but they did say that it should all be covered. So that's why I'm just like this makes quite a total amount of sense here.
[AGENT][NEUTRAL] OK, we've paid on doctor's charges. We don't, I don't see where we have the hospital bill. Now, we paid 1011, let me see.
[AGENT][NEUTRAL] Hold on, let me see who this is.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] On the first claim, we paid $267.18 for [PII].
[AGENT][NEUTRAL] Doctor's charges.
[CUSTOMER][NEUTRAL] Uh, is that the regional neonatal associates or is that like an in-hospital physician?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Hold on just a minute. Let me go back to that now. 354-8758.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, this one.
[AGENT][NEUTRAL] Is
[AGENT][NEUTRAL] It must be inpatient um doctor because it says inpatient and then it was the service was at Blunt Memorial Hospital.
[AGENT][NEUTRAL] So that was for
[CUSTOMER][NEUTRAL] Yeah, it was inpatient we were.
[AGENT][NEUTRAL] [PII] [PII], right, so we paid that one on for [PII] for [PII].
[CUSTOMER][NEUTRAL] In the hospital.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But is that the neonatal?
[AGENT][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] Because, you know, when you're in there, there's, when you're in there, there's a million and they said that you guys only paid on 1013 for that doctor.
[AGENT][NEUTRAL] Now, all I know is this was an inpatient doctor, [PII].
[CUSTOMER][NEUTRAL] So I'm wondering if, if.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Data service 1011.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Other than that, I'm not sure that's the claim we got in.
[AGENT][NEUTRAL] And we paid.
[AGENT][NEUTRAL] 268, 267 18 on that one.
[AGENT][NEUTRAL] And then we got one other claim.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] So it sounds to me like you guys don't have the claims for the correct days if I had to guess.
[AGENT][NEUTRAL] Let me see what this other one is.
[AGENT][NEUTRAL] That was 1011, so 1012.
[CUSTOMER][NEUTRAL] And that was for [PII].
[AGENT][NEUTRAL] This is for oh.
[AGENT][NEUTRAL] Pull the claim up.
[AGENT][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Data service 1012.
[AGENT][NEUTRAL] We paid $67.14.
[AGENT][NEUTRAL] And that was an inpatient doctor as well.
[CUSTOMER][NEUTRAL] For [PII]
[AGENT][NEUTRAL] I'm not sure what you're talking. I don't see anything with [PII]. I don't know what you're talking about on that.
[CUSTOMER][NEUTRAL] OK, so, so the claims are for should be under [PII], the newborn infant, neonatal Associates, uh, UT physicians Group.
[AGENT][NEUTRAL] Oh yeah, that's for [PII], yes, the claim is on [PII], yes, ma'am.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Both of those claims were on [PII].
[CUSTOMER][NEUTRAL] What I, so,
[CUSTOMER][NEGATIVE] So does it say that you guys didn't a reason why you didn't pay for it all if that's the correct thing or why they were all paid for on Thursday but not or the 3rd day but not the 1st 2 days?
[AGENT][NEGATIVE] I don't understand what you're talking about. I can tell you the claims that we have.
[AGENT][NEUTRAL] Now we pay 1011, 1012 and 1013. These are provider charges. We do not have the hospital bill itself. The facility bill we do not have.
[CUSTOMER][NEUTRAL] OK, so I may need to speak with someone else.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Do you have someone else who may understand more of what I'm saying?
[AGENT][NEUTRAL] I I understand what you're saying, but we do not have the claims that you're talking about. The claims that I'm giving you is the only claims that we have for [PII]. We only have 123 claims for her.
[CUSTOMER][NEUTRAL] By chance
[AGENT][NEUTRAL] This policy only coordinates, this is a secondary policy.
[AGENT][NEUTRAL] It only coordinates with the primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We only pick up deductibles, co-pays, or co-insurances.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Right. Yup, yup, that makes sense.
[AGENT][NEUTRAL] So that's what we've done on each claim.
[AGENT][NEUTRAL] That we have now, we don't have any other claims.
[CUSTOMER][NEUTRAL] Well, what I'm trying to see
[AGENT][NEUTRAL] So if you're thinking we didn't pay on something, then we probably don't have the claim.
[AGENT][NEGATIVE] Because all 3 claims that we received we paid on.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so the two claims that I have in front of me that didn't get paid on, they're 2 from the [PII] and 1 from the [PII], so I'm going to.
[CUSTOMER][NEUTRAL] Reach out to someone else, but I appreciate your help very much.
[AGENT][NEUTRAL] What procedure codes are on the bills that you're looking at because.
[AGENT][NEUTRAL] I can tell you if that is the ones we already have.
[CUSTOMER][NEUTRAL] Uh, all I see right now is the data service was 10/11, and there's two charges for regional neonatal associates. And those are a UT physicians group that are called into the hospital for inpatient, uh, neonatal checkups because [PII] doesn't have their own neonatal group.
[AGENT][NEUTRAL] Yeah, and when we get the claims in we go by the doctor's name, so I'm not sure on the neonatal group that came in. All I can give you is what's on the claim, the doctor's name, the data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The charges, how much we paid.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right. I think I'm gonna have to call um.
[CUSTOMER][NEUTRAL] A different call the insurance company and get more information.
[AGENT][NEGATIVE] But as far as the facility bill, we haven't received it on [PII].
[CUSTOMER][NEGATIVE] Uh, you shouldn't receive a facility bill.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] That is it. Thank you.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day, Ms. [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mm