AccountId: 011433970860
ContactId: 670eaafc-03f2-459f-937f-0373f686881b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 545190 ms
Total Talk Time (AGENT): 220872 ms
Total Talk Time (CUSTOMER): 257272 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/670eaafc-03f2-459f-937f-0373f686881b_20250115T21:29_UTC.wav
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[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] Hi, this is [PII] with the care team and who is this again? I'm sorry.
[AGENT][NEUTRAL] Um, this is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I'm sorry, I thought you said [PII] at first. I just wanna make sure I got you right.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um, um, Ms. [PII], I have an insured on the line. Um, his policy number is 02288208.
[CUSTOMER][NEGATIVE] Um, his name's [PII]. I verified him and everything, and he's calling. He's, he's really upset. He doesn't understand why we're not covering, um, his bill, and he's got a charge from these guys, but like I'm trying to look through his like claims and they're all just like a mess of resubmitted claims on top of each other. And so I'm just like trying to help him out to see if I can identify like what codes maybe weren't covered under the charge he's getting so I could explain it to him.
[CUSTOMER][NEGATIVE] But I, I just, maybe I'm not well versed enough. I, I think he just needs more assistance than I can offer him.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right. Is this callback number the one in the system?
[CUSTOMER][NEUTRAL] Um, yes, it is, um, the bottom claim, uh, the paid to him one for $800 it had a charge on it from [PII], and he said that they're billing him like $1000 but we only gave him $800 but I can see like all the stuff he submitted like is from different providers and.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It, I don't know, like it's a whole mess, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then that top claim, the most recent one, that one came from that, um, facility, and we denied it as a duplicate and you can see the charge was like 3500 something so I was trying to look at those two claims to see if I could figure out what matched up and I couldn't if that in any way helps point you in the right direction of what he's gonna be asking for, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And those were
[CUSTOMER][MIXED] I don't know, it's, I mean, it's really messy, so I'm really sorry, but I really appreciate you.
[AGENT][NEUTRAL] Yeah, well, it's almost time to go. No, I'm just playing. You can send them over.
[CUSTOMER][NEUTRAL] OK, I'll introduce you when we join Miss [PII]. Is that OK?
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Thank you, sorry, I got a lab car one sec.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Hi [PII], are you still there with us? Yes, hey, thank you so much for your patience um I do have [PII] on the line she is one of our claims examiners and she's gonna be able to hopefully provide you more insight and information than I was able to, um, but here's news for you my friend.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. My pleasure.
[AGENT][NEUTRAL] Hello, [PII], um, I'm [PII] in the claims department and one moment, I'm pulling up your information.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Yes, sir. Was there a particular claim that you wanted to ask about that you needed to verify payment on?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK. What's the date of service?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah, um, uh, a treatment.
[CUSTOMER][NEUTRAL] And um like outpatient and um um and they and they charged me 1000.
[CUSTOMER][NEUTRAL] 1000
[CUSTOMER][NEUTRAL] And you only guys and you only got paying um 76663 cents with 96 cents.
[CUSTOMER][NEUTRAL] So that means I have to pay a balance of $800 with like $800?
[AGENT][NEUTRAL] OK, and that's for date of service, [PII] or [PII]?
[CUSTOMER][NEUTRAL] Repeat that again.
[AGENT][NEUTRAL] That's for date of service, [PII].
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK. Yes, sir, I'm showing that we paid $700.63 dollars 96 cents because according to the EOB that
[CUSTOMER][NEUTRAL] That's correct. I had, I had the check I have the check here with me.
[AGENT][NEUTRAL] Yes, sir, and
[CUSTOMER][NEGATIVE] I haven't cash it up
[AGENT][NEUTRAL] OK. That claim paid that amount because that's what's showing that you owe. That's, we cover the portion that goes towards your co-pay, your co-insurance, and your deductible. And according to the documentation that we received, that's how much we owe. Now, if you have further document
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] showing that we owe more than that, you can um submit that information to us. But according to the documentation that we have on file because we can only go by the documents that we've received, that's how much we owe $763.93 96 cents, I'm sorry.
[CUSTOMER][NEUTRAL] So, so they send you a bill for 700 and.
[CUSTOMER][NEUTRAL] And 63 cents.
[AGENT][NEUTRAL] No, um
[CUSTOMER][NEUTRAL] Sorry, 700 and 760. Go ahead, go ahead.
[AGENT][NEUTRAL] No, you sent us the EOB showing where you owe $763.96.
[AGENT][NEUTRAL] For those services and we paid you already according to the documentation that you sent and the claims that we're showing on file or from the provider for this same claim. So we've already paid you so we wouldn't pay them because we've already paid you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][MIXED] Yes, that's correct, but um they didn't send you a bill for more than that.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Endoscopy Center, no. The only bill we received for date of service [PII] from the endoscopy center was this um from you, was from you.
[AGENT][NEUTRAL] We received the bill from you and then we.
[CUSTOMER][NEUTRAL] So they they.
[CUSTOMER][NEGATIVE] Because I, I have a letter from them, they're saying the APO did not cover anything, which, which I have to pay.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] $1,565.
[AGENT][NEGATIVE] No, sir, that's not correct. Um, well, we didn't pay them anything because we paid you.
[CUSTOMER][MIXED] Yes, that's correct, but they did not they did not submit any payment.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] No, the only bill that the, the bill that they submitted to us is the same bill that you submitted.
[AGENT][NEUTRAL] The bill for the facility charge, and yeah, we paid you instead of paying them.
[CUSTOMER][NEUTRAL] OK, so that means I have to.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, yeah, I know, I, I, I that's correct because I have the check here in front of me.
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] So, yeah, and that's the only bill that they sent us. They haven't sent us any more bills.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] If, if, if I pay if I pay them the 765 763 with 96 cents, they have to submit again the balance.
[AGENT][NEUTRAL] Well, yeah, we're showing, according to the documentation that we've received, all we owe is $763.96. You said that they sent you a bill for over $1000. You will need to contact them to see uh what are those other charges for because all we cover is the co-pay, the co-insurance, and the deductible. And according to the documentation, $763.96 is all we owe.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] So you will need to contact them and see what, where are those additional charges coming from.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Alright, I'm gonna call them then.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Thank you for the for the for, no, thank you for the clear information now if let's say a hypothetic.
[CUSTOMER][NEUTRAL] Uh, I called them
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And, and they say I have to, I have to pay 100 over $1000 and, and if I pay them the $700 they have to submit again the balance to you guys.
[AGENT][NEUTRAL] If there is a balance, yes, sir. If there, if there's a balance that went towards the copay, the co-insurance or deductible. Any other uh charges we don't cover. We only cover what goes towards the copay, the co-insurance, and the deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Thank you for the clear.
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII] for calling APL. You have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Mhm. You're welcome. Mm bye.