AccountId: 011433970860
ContactId: 696f681c-3b66-4eb9-a8f8-5cc51ee918f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 698770 ms
Total Talk Time (AGENT): 241313 ms
Total Talk Time (CUSTOMER): 284560 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/696f681c-3b66-4eb9-a8f8-5cc51ee918f1_20250321T19:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] I'm calling from the business office of Newberry Hospital. We received an EOB from you all and you all denied services as non-covered, and we just want to verify if this is patient's responsibility.
[AGENT][POSITIVE] OK, um, I'll be more than happy to help you with the claim, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, area code [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Mhm 02594876.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh 0R.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] His birthday, uh, uh, wait a minute, [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm looking at this and I'm gonna, I know I'm like why I can't say it right, OK, tap.
[AGENT][NEUTRAL] OK, it's Friday.
[CUSTOMER][NEUTRAL] OK, yeah, 7, his birthday is [PII]. I'm like, wait a minute.
[AGENT][NEUTRAL] I know, I know that.
[CUSTOMER][NEGATIVE] [PII], what in the world? I went blank. You know how you go with blank.
[AGENT][NEUTRAL] Thank you for verifying. It's OK. And all the information provided is a verification of benefits, not a guarantee of payment, you're fine. Um, and so,
[CUSTOMER][NEUTRAL] I'm sorry, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The denial, what is the data service or the claim number for the claim you want me to look at?
[CUSTOMER][NEUTRAL] The data service is
[CUSTOMER][NEUTRAL] A 216 of 2025.
[AGENT][NEUTRAL] OK. And then you said, so in terms of patient responsibility, so APL doesn't determine patient responsibility because we're not the major medical insurance company.
[CUSTOMER][NEUTRAL] OK, well we.
[AGENT][NEUTRAL] So it will be whatever um your procedures are for outstanding.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This right it OK because this it's like paid.
[CUSTOMER][NEGATIVE] I paid $10. I don't understand.
[AGENT][NEUTRAL] 10.
[CUSTOMER][NEUTRAL] We sent you a claim. It don't decline. This EOB doesn't have a charge on it or not. Can you do you see a do you see a uh claim for this day's service 216 of 25?
[AGENT][NEUTRAL] Mhm. And you said 10 $10? Yes, I have the claim here. Do you need a copy of the um EOB the explanation?
[CUSTOMER][NEUTRAL] In your system?
[CUSTOMER][NEGATIVE] Uh, is this not what you sent me is not ELB? Yeah, I need something with like charges on it. No, no, no, I have it. I have the EOB and I was just wondering why they denied the charge, and they only paid $10 and I don't know what this means surgery urge because this is not a surgery. mine was the EOB I mean mine was um emergency room, but surgery, I don't know if this is our $10. It could be somebody else's $10.
[AGENT][NEUTRAL] Oh, I thought you said you didn't have it. Wait a minute, what did you say?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, let me look at this. Hold on one second.
[CUSTOMER][NEGATIVE] This is, this ELB is terrible.
[AGENT][NEUTRAL] So the ER, I'm gonna look at the ER one first. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the ER code was denied because the accident doesn't provide a benefit for any accidental injury.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then let me look at the 2nd 1.
[CUSTOMER][NEUTRAL] Now how much is that total charge you're talking about?
[AGENT][NEUTRAL] The total charge for that, for the claim or for this the that ER code, right?
[CUSTOMER][NEUTRAL] For the, for the claim period.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] Oh, the total bill doesn't come. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] $1,506.20 and there was a payment of $10.
[CUSTOMER][NEUTRAL] No, 1000.
[AGENT][NEUTRAL] $506.20.
[CUSTOMER][NEUTRAL] OK, that's not our client.
[CUSTOMER][NEUTRAL] OK, now what is the surgery? How much is the total charge for the surgery?
[AGENT][NEUTRAL] Well, hold on one second. What's your tax ID?
[CUSTOMER][NEUTRAL] My tax ID is [PII].
[AGENT][NEUTRAL] Wait, so it's the right tax ID?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said that charge is $1500 is that correct?
[AGENT][NEUTRAL] Well, not for the whole claim. So the, the way the hospital indemnity claims come over, it doesn't, I have to add up the total bill. So for ER it was $1,037.20.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh huh, that's right.
[AGENT][NEUTRAL] And then the third charge was $469.
[AGENT][NEUTRAL] And I'm looking to see what that is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And what's that tax ID because that's not our money.
[AGENT][NEUTRAL] Well, it's the same tax ID on both codes.
[CUSTOMER][NEUTRAL] Mhm it is but what's the um you don't have an MPI?
[AGENT][NEUTRAL] MPI? No, just the, um, the patient account number, the tax ID.
[CUSTOMER][NEUTRAL] OK, that'll that's good. Give me the patient account number for the $467.
[AGENT][NEUTRAL] It's the same. It's M like Mary.
[AGENT][NEUTRAL] 00
[AGENT][NEUTRAL] 16.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 0
[CUSTOMER][NEUTRAL] OK, that's a, that's a Medicare, I mean that's a medical records number.
[CUSTOMER][NEUTRAL] I'm trying to find the checkbook. I'm trying to find out, wait a minute, let me look and see if she has any more claims. See what happens is, especially with um a medical um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Especially with
[CUSTOMER][NEUTRAL] ER
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The doctor actually has a bill that they send you all to.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I was, I was just trying to see where, where we need to send this $10 to because for 469, even though it has our tax ID, it should have something else different like.
[CUSTOMER][NEUTRAL] You, you all lump them together when they're, they're really separate. One is for the physician and one is for the hospital.
[CUSTOMER][NEUTRAL] And the hospital probably looking for the doctor office probably looking for their money.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Wait a minute, hold on one second. Let me pull up the documents, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So the, so you're saying the 469 charge shouldn't have came in with this claim. It should have been, it, it shouldn't be with the ER, it should be like the like the physician's charge.
[CUSTOMER][NEUTRAL] Yeah, yeah, it's a physician's charge. It's not our charge because my claim that I have in my system is only for the $1,037.20 that you, you know, you told me was mine, which that's correct, and then the other one should be the physicians, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one second, because there's another client. I see what you're saying. I pulled up the um documents. I'm gonna have to send this back to claims. Hold on one second.
[CUSTOMER][NEUTRAL] Should be a physician for the physician.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So I'm gonna go ahead and send both of these because there's another claim um that came in from you all for the same date of service and it looks, I'm going to send this back for them to reprocess it and then um
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That $10 payment.
[AGENT][NEGATIVE] They'll either request a refund or I don't know how they're gonna handle it on that end, but it looks like, like you said, it looks like it's flip-flop, like I don't, um.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] I don't know, like it's two charges that are supposed to be for the ER, but it's on the claim with the
[AGENT][NEUTRAL] Eat with the um like the it's flipped. Mhm.
[CUSTOMER][NEUTRAL] Right, with the hospital claim.
[AGENT][NEUTRAL] So I'm just gonna have them look back at this.
[CUSTOMER][NEUTRAL] Yeah, yeah, I have, yeah.
[CUSTOMER][NEUTRAL] Yeah, and they need to process them separately because we don't, we don't deal with the same banks or nothing like that. So if we need to give this $10 to them we can always, you know, they're in our, you know, that we still up on the same roof, but we just don't do the same billing we'll just have to give them this $10 right, two different entities, yeah.
[AGENT][NEUTRAL] Like two different entities.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty great well thank you so much uh for looking into that.
[AGENT][NEUTRAL] What
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] What was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII], and is there a reference number for the call?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date, and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Oh, OK, great, thank you so much [PII] you have a great day.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help with you, sir?
[CUSTOMER][NEUTRAL] No ma'am, that's it.
[AGENT][POSITIVE] Alright, thanks for calling APO. Have a great weekend.
[CUSTOMER][NEUTRAL] You too bye now.
[AGENT][POSITIVE] Thank you. Bye-bye.