AccountId: 011433970860
ContactId: 6fbfe22f-6864-4c4c-b20d-e1e2cf580154
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1499900 ms
Total Talk Time (AGENT): 659342 ms
Total Talk Time (CUSTOMER): 453569 ms
Interruptions: 9
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/6fbfe22f-6864-4c4c-b20d-e1e2cf580154_20250311T13:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, this is, uh, [PII], and I have, um, a question about a claim. It says that it was paid to the insured, which is me, um, but I don't, um, show any record of it, so, um, what would you like to start with?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. um, let me have a callback number just in case we get disconnected.
[CUSTOMER][POSITIVE] Oh, I appreciate that um it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And
[CUSTOMER][POSITIVE] That's so nice that you guys do that.
[AGENT][NEUTRAL] You're welcome. All right. And may I have the policy number if you have it, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes, it's uh 02277898.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And I just need to verify the date of birth, mailing address, and email address for security.
[CUSTOMER][NEUTRAL] OK. Sure, um, so, uh, date of birth is [PII], um, the address is [PII] and uh email address, I think you have my email address, so sometimes I put my wife's, but it's [PII].
[AGENT][POSITIVE] Thank you, yes, that is correct, Mr. [PII]. Alright, and let's see.
[CUSTOMER][NEUTRAL] Pardon me?
[AGENT][NEUTRAL] OK, I'm looking into your policy one moment.
[CUSTOMER][NEUTRAL] Oh OK. Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so, and you're looking for um a claim?
[CUSTOMER][NEUTRAL] Yeah, so, um, so, so just, you know, my wife had an ambulance ride from, uh, to the hospital, and, um, so the county EMS, uh, charged the ambulance ambulance, uh, ride was like $1,0059.60 was submitted to the primary uh insurance which is Blue Cross Blue Shield of of uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII], um, they paid, uh, their portion and then the claim was submitted to, to you guys for the remainder, um, and.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The explanation of benefits, um.
[CUSTOMER][NEUTRAL] Uh, shows that, you know, it says that that the that the claim appears to be a duplicate of the premiums. I mean expenses benefit payment has been made to the insured.
[CUSTOMER][NEUTRAL] So do you want the claim number?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I got it. Uh, it's for the, um, is it on the 3542723?
[CUSTOMER][NEUTRAL] 33442723 um what would that number be?
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I, I, I, I'm sure.
[AGENT][NEUTRAL] It's gonna say claim number. Are you online?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, I'm online. I'm seeing the claim number is 35.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] 29,740
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] OK, so that may be the.
[AGENT][NEUTRAL] The original.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Do you see like a process date? Oh, I think.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I, I'm not, I, I see a check date, uh, claim number.
[AGENT][NEUTRAL] OK. Mhm. Yeah, check date.
[CUSTOMER][NEUTRAL] Check date is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] But this is the one that says that it was a duplicate, but I never.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I can't seem to find the first one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] It's fine. I'm looking for.
[CUSTOMER][NEGATIVE] Yeah, but bottom line is I think you guys paid it. I just, but, but, you know, the bill, the bill collectors after me saying it hasn't been paid, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Got you. OK, uh, let's see, this is, OK, let me pull their original claim.
[AGENT][NEUTRAL] And let's see we have to.
[AGENT][NEUTRAL] I got 2 claims. Let me look at these 2 claims just to make sure. And you say we're looking at the ambulance charges, correct?
[CUSTOMER][NEUTRAL] Yeah, it's uh Buford County EMS and the uh the, the claim of the bill charge was $1,059.60.
[CUSTOMER][NEUTRAL] Um, I can tell you how much Blue Cross Blue Shield paid if you, if that's important.
[AGENT][NEUTRAL] No, that's fine. We don't need that part.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still waiting for the image of you be one moment.
[CUSTOMER][POSITIVE] Yeah, no, no problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Where are you based?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, OK. How's the weather there?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Um, today, um, it's, it's all right.
[AGENT][NEUTRAL] It's kind of cold a little bit, but the sun is out, so that's a good thing.
[CUSTOMER][NEUTRAL] Uh, OK, we're in [PII]. It's a sunny day. It's supposed to warm up, but it was pretty chilly when I took the dog out this morning.
[AGENT][NEUTRAL] Mm, yeah, I think.
[CUSTOMER][NEUTRAL] Like maybe maybe 60.
[AGENT][NEUTRAL] Oh yeah, I think we're in the same boat. I think we're in the same weather, yes. That's exactly how it's like cold outside, but the sun is out, so yeah, it looks nice, but yeah, you don't want to be out too long. Um.
[AGENT][NEUTRAL] OK, that other one was not it. So I'm looking at the next one.
[AGENT][NEUTRAL] Next claim, um.
[AGENT][NEUTRAL] Looks like she was hospitalized during that time.
[CUSTOMER][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] Yeah. OK.
[CUSTOMER][NEGATIVE] Poor thing.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] But she's OK, that's the good news.
[AGENT][POSITIVE] That's good, yes. Mhm.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Not it either.
[AGENT][NEUTRAL] Hmm.
[AGENT][NEUTRAL] OK, I will have to search um a little bit.
[AGENT][NEUTRAL] More because I don't, I don't see the one for the ambulance. Do you mind holding just a minute? I'm just gonna go ahead and check and see if I can find it, um.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] No, OK. Because what I see here that we did pay the um the, the last claim, the one you just provided to me which is the last claim we processed was a duplicate. It's for the intensive care, which we did pay for the intensive care.
[AGENT][NEUTRAL] Um, but we pay directly to the provider of service, but I don't see anything for the ambulance, for the EMS. Um, let me just check one more time. Let me check on the other claims. There's two more that I need to check that, um, most recently processed. OK, I'm gonna put you on a brief hold.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] Thank you. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me.
[AGENT][NEUTRAL] OK. So after reviewing all the claims I have for that date of service, um, I did not find the one for the ambulance. There is no claims for EMS, um, you heard of EMS, and, um, the only two claims um we received was the one for the intensive care and the one for, um.
[CUSTOMER][POSITIVE] Oh yeah, no problem.
[AGENT][NEUTRAL] Anesthesiologist and those two were um were paid, but they were paid directly to the provider of service.
[CUSTOMER][NEUTRAL] Sure, yeah, yeah, that's, I, I, yeah, that's not the so so.
[AGENT][NEUTRAL] And mhm mhm.
[CUSTOMER][NEUTRAL] So I, I.
[CUSTOMER][NEUTRAL] It's interesting, so can you, are, are you able to um.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, to look at claim number 352 9.
[CUSTOMER][NEUTRAL] 740.
[AGENT][NEUTRAL] Yeah, that's the one I have pulled up, which is the one that is um a duplicate and it's duplicate.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But so you don't see one before that so.
[CUSTOMER][NEUTRAL] Yeah, so how do I reprocess this, I guess.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh no, that one was paid.
[CUSTOMER][NEUTRAL] Since it obviously didn't get paid, it was paid?
[AGENT][NEUTRAL] No, this one, yeah, this is not the EMS. This is um this is for the intensive care.
[AGENT][NEUTRAL] Um, so it's a totally different claim than the ambulance charges.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Hm, can I share my screen with you or do you have that ability?
[AGENT][NEUTRAL] We don't have that ability, but, but I'm looking at the claim that you have pulled up.
[CUSTOMER][NEUTRAL] For now.
[CUSTOMER][NEUTRAL] And it's it does it say Buford County EMS?
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Let me, let me see what is in the document because what I see here is that it says intensive care.
[CUSTOMER][POSITIVE] Interesting.
[CUSTOMER][NEUTRAL] So I wonder if somehow they messed up the claim number.
[CUSTOMER][NEUTRAL] Um, can I email you this?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It doesn't come to me, unfortunately. So bear with me just a second. Yeah, it, it goes to different departments, so yeah, um, one moment.
[CUSTOMER][NEUTRAL] So we're looking at
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so let's reprocess. Let me see what's the reprocess.
[CUSTOMER][NEUTRAL] Um, 10.
[AGENT][NEUTRAL] There.
[AGENT][NEUTRAL] OK, let me look at.
[AGENT][NEUTRAL] Oh, this is for a different date of service. This was [PII]. OK, bear with me just a second.
[CUSTOMER][POSITIVE] Uh yeah, sure, no problem.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let's, yeah.
[AGENT][NEUTRAL] Let me look at that day.
[AGENT][NEUTRAL] I had the most recent one, which is September, the day that she was, um, looks like she had surgery. One moment.
[AGENT][NEUTRAL] 220, 0, this is [PII]. All right. OK, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Diagnostic.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] 27
[AGENT][NEUTRAL] 37537
[AGENT][NEUTRAL] Alright, OK, so, um, this one was paid, um, and this is for [PII]. That's why I have 2024. I do apologize. I was looking for 2024. OK, so.
[CUSTOMER][POSITIVE] Oh yeah, no worries.
[AGENT][NEUTRAL] OK, the claim that it was paid on was uh claim number 3379537.
[CUSTOMER][NEUTRAL] OK, let me see here so.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let me write that number down. Hold on just a second. I apologize.
[CUSTOMER][NEUTRAL] OK, it was what what numbers claim number?
[AGENT][NEUTRAL] OK, that's 3379537.
[AGENT][NEUTRAL] That's the one I have. Um, oh, I don't see that EMS here. Let me see if I have another one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 337.
[AGENT][NEUTRAL] This is.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] 125238429.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] here it is.
[CUSTOMER][NEUTRAL] OK, it's downloading it's downloading for me right now, so I'll be looking at the same page as you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, so.
[CUSTOMER][NEUTRAL] I'm looking at that and and they paid 1000.
[CUSTOMER][NEUTRAL] $341.36 in total, right?
[AGENT][NEUTRAL] Mhm, yes, and then um we have the [PII] for medical transportation merest.
[CUSTOMER][NEUTRAL] MedTrust. OK, so she got, she got to have two ambulance rides. So the, the first, the first ambulance ride was from where she had um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] You know, passed out on, on, on the ground at a seafood festival, and that went to the [PII] Head, um.
[CUSTOMER][NEUTRAL] Emergency room, um, and then the doctor there, uh, [PII], who's listed on the bill there, um, said, you know, this, this is, we can't do uh anything here. We need to send her to [PII].
[CUSTOMER][NEUTRAL] Um, so the [PII], so [PII] had the [PII], uh, ambulance ride was at MedTrust.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, so there were actually two separate ambulance rides and maybe that's where the confusion came in.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Got you. And they're both on the same date? or was it a day apart or was the same date, the same date?
[CUSTOMER][NEUTRAL] Yes, yeah, yeah, yeah, no, they were both, yeah, so that happened in the, in the afternoon when she got the first ambulance ride which was the, the one, the, the, the county one that has not been paid, at least it doesn't appear it's been paid, um, so that was the one from the incident site to the emergency room and then the second ambulance ride was probably at about [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, after she'd been through a bunch of tests and everything, and that was the Med trustst ambulance, right, which I get to follow the ambulance the whole way from.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] To go to the next emergency room.
[AGENT][NEUTRAL] Oh wow. 00 yeah, I was bad. OK, so that probably is worth it, yeah, I see. OK, so yeah, I will have to get uh an examiner to review this claim and probably reprocess, um, because, yeah, you're, you're definitely right. It looks like they may be thinking that it's the same one, you know, sometimes the, um, some entities they, they just work with a different billing department.
[CUSTOMER][NEUTRAL] And see the doc. Yeah, it was a long day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that may be where the confusion is coming from.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I could see where somebody was, yeah, I can absolutely see where, where that would be confused.
[AGENT][NEUTRAL] Yeah, OK, so I'm gonna go ahead and send this over for review.
[AGENT][NEUTRAL] Um, and let them know that it's 2 ambulance on ride for that day. Um.
[CUSTOMER][NEUTRAL] Yeah, so do you have the 2nd 1? Do you see the 2nd 1?
[AGENT][NEUTRAL] Yeah I see the one that um.
[AGENT][NEUTRAL] The one for the um before and then I see the one that we pay so yeah they're different they're they're different so I mean yeah.
[CUSTOMER][POSITIVE] OK, yeah, OK, alright, perfect, yep, yep, totally different ones.
[AGENT][NEUTRAL] Yeah, the charges are different and yeah, so let me see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And do you need what um was paid by Blue Cross Blue Shield on that other in on the
[CUSTOMER][NEUTRAL] On the ambulance ride, would that be helpful?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see. She will have to research and see if we're missing anything, but let me, let me take a quick peek at the documents and see if we have the copy of the explanation of benefits, um.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment, I pulled so many of them. OK, let me, let me get the right one pulled up.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so AOY.
[CUSTOMER][NEGATIVE] I know it's a little overwhelming.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] OK, we, we need to figure this out. Let's see.
[AGENT][NEUTRAL] OK, so yeah, they did not send the EOB. OK, yeah, if you can send us a copy of the explanation of benefits because it looks like um you first send us just a claim without an EOB without a copy of the explanation of benefits from the primary insurance. If you can send a copy of the explanation of benefits, we'll go ahead and process uh for that part for [PII], OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, where do I send it to?
[AGENT][NEUTRAL] All right, you can either fax it, mail it, or if you have registered online, you can just upload it as a new file, new document.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the fastest way is if you go to our website and just upload it to your to your account under her name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm that would be the fastest way and once we receive that one, it will reprocessed. I'll go ahead, so I'm not gonna go ahead and send it for reprocess because we're gonna need that. So once you send that document, it will reprocess automatically. I'm just gonna go ahead and notate the account indicating what's happening or why you're gonna be sending that document to us, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And the other thing is, um, so, so the, you know, they put it to, you know, collection and so when I filed my state um tax return they they just deducted it from my refund.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, I, I guess instead of paying the insured.
[CUSTOMER][NEUTRAL] I mean, instead of paying the, the provider, um, can you note that they should pay, pay me the insured, since I've I've already paid it.
[AGENT][NEUTRAL] OK, in order to send the payment over to you, you will have to submit the whole claim.
[AGENT][NEUTRAL] Um, and the reason for this is because um the document they send us.
[AGENT][POSITIVE] It came directly from Beaufort and it has an assignment of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When it has assignment of benefits, we cannot send the payment to the insured. It has to be sent by um to the provider of service. Yes.
[CUSTOMER][NEGATIVE] To the provider, so then I just need to contact the provider and say hey you've been overpaid.
[AGENT][NEUTRAL] And get a refund if they have, you know, yeah, if they have an overpayment, yeah, and that's what I'm looking at. I'm looking at the document, it does have assignment of benefits, so yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] Yeah, yeah, yeah, yeah, no, no, no worries.
[CUSTOMER][NEUTRAL] I get it
[AGENT][NEUTRAL] OK. All right, sorry, yeah, yeah.
[CUSTOMER][NEUTRAL] I just feel like I'm chasing my tail a little bit.
[AGENT][NEUTRAL] Yeah, and it is, it is good that I was looking at the uh the document and I can see that because yeah, um, then you will be surprised why I didn't get the payment. Yeah, um, just, uh, go ahead and send us the explanation of benefits and we'll go ahead and process now if you want the payment to go to you, uh, you can send the whole claim again um the whole claim will be the claim form which is in the website at [PII].
[AGENT][NEUTRAL] Uh, and then you can send the itemized bill like you can get in contact with Buford and see if they can send you an itemized bill and the explanation of benefits. So if you send all three, that will be considered a claim and you're gonna be sending a claim directly to us, so we'll process for you and it will pay directly to you. But right now what we have is from the provider of service. It's just missing on the explanation of benefits.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Otherwise it'll just go back to them.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right sounds good thank you so much.
[AGENT][POSITIVE] OK. You're welcome. Is there anything else I may help you with today? Any other questions? any other concerns?
[CUSTOMER][POSITIVE] Uh, no, that, that'll do it. I appreciate your time. Thank you.
[AGENT][POSITIVE] You're welcome. Have a good day and thank you for calling ATL.
[CUSTOMER][NEUTRAL] You too uh huh bye bye.
[AGENT][NEUTRAL] Mhm.