AccountId: 011433970860
ContactId: 63075613-4baf-49f1-a444-d48190bbc560
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 802700 ms
Total Talk Time (AGENT): 191337 ms
Total Talk Time (CUSTOMER): 466199 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/63075613-4baf-49f1-a444-d48190bbc560_20250403T16:38_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]. Do you spell your name [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, well, I'm calling about, um, I'm looking at our notes and it looks like somebody we spoke with somebody in your office and gave a fax number to fax and a claim with proof of filing. I just wanna verify that, but I also want to verify the effective dates of coverage for this patient because we don't have that either. So tell me what you need from me and I will help get it to you.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with that information. Um, first, let me get a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Sure, [PII], no extension.
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Sure, uh, the policy number is.
[CUSTOMER][NEUTRAL] 220389, I'm sorry, 02203895.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] And this is for
[CUSTOMER][NEUTRAL] [PII], uh [PII].
[AGENT][NEUTRAL] OK, and just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII], and I'm showing that this policy actually expired on [PII].
[CUSTOMER][NEUTRAL] Um mhm.
[CUSTOMER][NEUTRAL] [PII]. OK, alright, so this data service is for 216 of 24, so there was coverage for that period, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, the claim date of service was [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Now I saw
[CUSTOMER][NEUTRAL] Was it this one I saw?
[CUSTOMER][NEUTRAL] Did you receive this claim at all total charge of um.
[CUSTOMER][NEUTRAL] Total charge was $528.
[AGENT][NEGATIVE] Um, yes, ma'am. We actually received it 4 times. The first time it denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Hey, this is my card.
[CUSTOMER][NEUTRAL] Alright, hold on, hold on, hold on.
[CUSTOMER][NEUTRAL] Hold on, OK.
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, this is actually a first where somebody saying oh yes we did we got them so many times. OK, usually they don't get them at all, but anyway.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, said 4 claims received.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, let me, uh, let me go into my little thing here and see we're so we're on the same page because I've got, yeah.
[CUSTOMER][NEUTRAL] What's the first one you received? Do you have like an account number that begins with an E E B R E as in Edward, B as in boy, R as in Robert?
[AGENT][NEUTRAL] Um, no, ma'am. I have the claim numbers.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] The first claim number was 34296009 and it denied um because office visits are not covered under the policy.
[CUSTOMER][NEGATIVE] Not covered.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, really?
[AGENT][NEUTRAL] Right. Yes, ma'am. Um.
[CUSTOMER][NEUTRAL] What is this plan? Is it like hospital only?
[AGENT][NEUTRAL] Um, well, coverage in in office is there is coverage for an office, but we cover the charges that goes towards the co-insurance and the deductible, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] Oh, because, so you don't cover copay.
[CUSTOMER][NEUTRAL] But do co-insurance and deductible.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] That is a first. I never heard of that before. Uh, let me see something here. Hold on, I gotta see what Medicare, Medicare paid, Medicare paid 10807 and $30 co-pay. No wonder you're gonna deny it. OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So that was um.
[CUSTOMER][NEUTRAL] [PII], I just have to know what like what invoice that was with so you don't see anything with EBR 586-56027.
[CUSTOMER][NEUTRAL] Let's see what was the first one.
[CUSTOMER][NEUTRAL] 71.
[AGENT][NEUTRAL] No, ma'am. I'm not familiar with that. I apologize.
[CUSTOMER][NEUTRAL] No, but it will be on your, um, it'll be in the account somewhere like in the in the remit or something it'd be referenced.
[AGENT][NEUTRAL] OK. Let me look at, take a, I could take a look at, at, no, um, normally when we receive claims, they come directly from the provider. They don't come from the primary insurance company. We receive the EOB along with the claim form from the provider.
[CUSTOMER][NEUTRAL] Like a cross, did a cross over from Medicare?
[CUSTOMER][NEUTRAL] OK, what was the date you received the first one?
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] I'll try to see which one this is. I gotta make a, you know, I gotta make a note of it somehow, um.
[CUSTOMER][NEUTRAL] Because we have, oh my God, one.
[CUSTOMER][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] And then we have going to like a generic plan 4567.
[AGENT][POSITIVE] Oh wow. Let's see this first one.
[CUSTOMER][NEUTRAL] So, so I'm just trying to.
[AGENT][NEUTRAL] Yeah, the first one was received on [PII].
[CUSTOMER][NEUTRAL] [PII] of 24 received.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] First one.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And you're saying all the rest of them then denied as duplicates probably.
[AGENT][NEGATIVE] Yes, ma'am. They all denied this duplicate.
[CUSTOMER][NEUTRAL] OK, alright, so I just gotta get to the first one. Let's see here um.
[CUSTOMER][NEUTRAL] Let me see if I can see this view claim.
[CUSTOMER][NEUTRAL] This was submitted on.
[CUSTOMER][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] You said you received on [PII].
[AGENT][NEUTRAL] Right. And it was processed on [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] The process of [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh let me go back over there and see if I can find the next one. I don't know if that's gonna help me or not.
[CUSTOMER][NEUTRAL] Um, clear.
[CUSTOMER][NEUTRAL] Uh, service date.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you're saying.
[CUSTOMER][NEUTRAL] 71 didn't get to you.
[CUSTOMER][NEUTRAL] Let me see what is on the claim form? Does it say generic commercial or does it say American Public Life?
[CUSTOMER][NEUTRAL] Or it say something like IMA.
[AGENT][NEUTRAL] Let me take
[AGENT][NEUTRAL] Yeah, let me take a look at the claim form.
[CUSTOMER][NEUTRAL] Because I got that too and I'm thinking where they.
[CUSTOMER][NEUTRAL] Where did you get IMA from?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] IMA.
[CUSTOMER][NEUTRAL] That was [PII], so that's after.
[CUSTOMER][NEUTRAL] It has to be the first one I'm thinking.
[CUSTOMER][NEUTRAL] 2:16.
[AGENT][NEUTRAL] Yeah, now for the patient account number um on the HIFA, I'm showing a patient account number from the provider is [PII].
[CUSTOMER][NEUTRAL] 71, that's it. OK, that's what I was looking for.
[CUSTOMER][NEUTRAL] OK, so it's the 71.
[CUSTOMER][NEUTRAL] Which I kind of thought it was.
[CUSTOMER][NEUTRAL] 602-71, OK.
[CUSTOMER][NEUTRAL] Uh, how many claims did you receive?
[AGENT][NEUTRAL] We received 4, and this is the first one.
[CUSTOMER][NEUTRAL] They receive.
[CUSTOMER][NEUTRAL] 45s.
[CUSTOMER][NEUTRAL] The first
[CUSTOMER][NEGATIVE] One denied.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And remaining.
[CUSTOMER][NEUTRAL] 3 deniers.
[CUSTOMER][NEGATIVE] Denied as duplicate.
[CUSTOMER][NEGATIVE] OK, the first one denied, um.
[CUSTOMER][NEGATIVE] Due to plan does not cover copays.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] Holly covers.
[CUSTOMER][NEUTRAL] Coinsurance.
[CUSTOMER][NEUTRAL] And deductible.
[CUSTOMER][NEUTRAL] I never heard of that before.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well I've heard of supplement plans covering not covering deductible but covering everything else so but this is this is different, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can you send me a can you um email me the um or fax me the.
[CUSTOMER][NEGATIVE] The first remit that denied is not covered because it's office is not covered or co-pay is not covered.
[AGENT][NEUTRAL] Yes, ma'am. I can fax you the EOB. What's your fax number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Let me get that for you.
[CUSTOMER][NEUTRAL] My fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And by the way, let me get your correct claims address because we have so many plans in here now because I guess they thought well this is not getting there so we'll try this one.
[CUSTOMER][NEUTRAL] Are you affiliated with IMA in in any way?
[AGENT][NEUTRAL] Um, yes, ma'am. Um, they process, um, claims for our big, our big claims.
[AGENT][NEUTRAL] The primary insurance carrier they.
[CUSTOMER][NEUTRAL] What's a big claim?
[AGENT][NEUTRAL] Yeah, that's our primary insurance carrier.
[CUSTOMER][NEUTRAL] Oh, I am a OK processes for primary claims.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, that makes interesting sense. OK. So because this patient did not have, I don't think they were ever primary with you, right? This this patient?
[AGENT][NEUTRAL] No, ma'am. I only see a um secondary policy on file.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so that's all, OK.
[CUSTOMER][NEUTRAL] And patient only had them as secondary, OK.
[CUSTOMER][NEUTRAL] Alright, so let me get back to where the claims address is. The claims address we have here is [PII]. Is that right?
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK. All right, so we're going to.
[CUSTOMER][NEUTRAL] I just have to correct everything on this thing in case we have any other claims that go up before.
[CUSTOMER][NEUTRAL] Uh, 7, and so it'd be 6:30, 2020 24.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And what's your timely filing?
[AGENT][NEGATIVE] Um, there's no timely filing limit.
[CUSTOMER][POSITIVE] No timely filing limit. I like that.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, so that's uh.
[CUSTOMER][NEUTRAL] 6:30 24 let me move that up here.
[CUSTOMER][NEUTRAL] And God knows when they had that one. OK, so this one, OK, I can fix all that after. OK, so you're gonna email me that and um what's the call reference for the call or what's the um, give me the check number just in case whatever.
[AGENT][NEUTRAL] I'm gonna fax it. I'm gonna.
[CUSTOMER][NEUTRAL] The check number on that remit that you're faxing me.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Well, I could send you the claim number. There's no check number because it denied.
[AGENT][NEUTRAL] The claim number is
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] The claim number is 3429609.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No check number because it's denied.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, so we wouldn't even gotten, well, I don't know how we didn't get that remit. I mean that doesn't make any sense how we didn't get it.
[CUSTOMER][NEUTRAL] We had to have maybe I don't know, um.
[CUSTOMER][NEUTRAL] OK, call reference for the call?
[AGENT][NEUTRAL] Um, so the reference number, you can use my name in today's date. And again, my name is [PII] and last initial is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Got it. OK, excellent. Thank you.
[AGENT][NEUTRAL] OK. Could I verify your fax number one more time?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] OK. Thank you, [PII]. I just sent it. You should receive it in about 10 minutes. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Not today. Thank you so much.
[AGENT][POSITIVE] OK. Thank you again for calling APL. Have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] OK, bye.