AccountId: 011433970860
ContactId: 70d72e32-d087-4849-98d2-8f7213a7bbfe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 600320 ms
Total Talk Time (AGENT): 173751 ms
Total Talk Time (CUSTOMER): 205515 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/70d72e32-d087-4849-98d2-8f7213a7bbfe_20250102T18:02_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling about, um, I don't know what information you would need from me actually this, uh, what do you need from me?
[AGENT][NEUTRAL] May I ask who I'm speaking with?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and Miss [PII] in case this call is disconnected, may I have your call back number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have your policy number?
[CUSTOMER][NEUTRAL] Um, yes, it is 023291-21.
[AGENT][NEUTRAL] Thank you, and that was 02329121?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And can you please verify your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And can you also verify your date of birth?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][POSITIVE] Thank you and how can I help you today, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, I was calling in regards to a bill that I received from AnMed, uh, for the birth of my daughter. Um, the date was between [PII].
[AGENT][NEUTRAL] OK, so you have questions in regards to a bill for dates of service of [PII] for your daughter?
[CUSTOMER][NEUTRAL] Yes, I um.
[AGENT][NEUTRAL] And her name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][NEUTRAL] OK, was there a particular bill you wanna see if they submitted a claim into us or were you trying to file a claim?
[CUSTOMER][NEUTRAL] Um, they said that that it was denied by APL, so APL is our, uh, supplementary supplementary insurance, and then EBMS is our primary, so EBMS filed it and then carried on the $442 to APL and APL denied it is what the uh is what Med told me.
[AGENT][NEUTRAL] OK, do you know the name of the provider in the total bill amount?
[CUSTOMER][NEUTRAL] Yeah, hold on.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] I'm trying to figure out. It just says and med health.
[AGENT][NEUTRAL] That's the name of the provider in Med.
[CUSTOMER][NEUTRAL] And that Health.
[AGENT][NEUTRAL] And do you know the bill amount, the total bill amount?
[CUSTOMER][NEUTRAL] The the bill I uh well, she told me on the phone.
[CUSTOMER][NEUTRAL] That the total bill was 1,026.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] EBMS covered 583.
[AGENT][NEUTRAL] OK, so do you know if this was like the facility bill by chance or was this a physician bill, the professional fees?
[CUSTOMER][NEUTRAL] It says newborn care services and hospital inpatient services.
[AGENT][NEUTRAL] OK, let me just look and see if we got any claims in for that time frame.
[AGENT][NEUTRAL] Now, I see we got a couple of claims in for the professional charges, but you're not sure if they're for the professional charges or not, and they're different bill amounts.
[AGENT][NEUTRAL] I don't see that particular bill amount that you're referring to though.
[CUSTOMER][NEUTRAL] The only
[CUSTOMER][NEGATIVE] The only thing that I it's very vague what they mailed me.
[CUSTOMER][NEGATIVE] And I asked about it. When I asked and that all they just said was that it was denied by APL. That's all they said. They don't give me any details. So literally like all my bill says is date of service [PII] through the [PII] clin clinician is with Piaani MD.
[CUSTOMER][NEUTRAL] And then it just gives it's very, very vague puts newborn care services 747 and then hospital inpatient services 279.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] OK. Let me take a look. You said the physician's name was [PII], you said?
[CUSTOMER][NEUTRAL] I've gotten it
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and then I can spell the last name for you.
[AGENT][NEUTRAL] OK, sure, can you spell that for me?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, let me take a look.
[AGENT][NEUTRAL] OK. I see we did get a claim in for that particular physician and the claim was denied because the max inpatient has already been met for the calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] That's why it was denied.
[CUSTOMER][NEUTRAL] OK, and, OK, can I, um, mm.
[CUSTOMER][NEUTRAL] Is there a statement that I can get from APL just so that I can show my husband because I think that we hit the max for the year altogether because I also got a bill from Prisma too.
[AGENT][NEUTRAL] Yeah, the copy of the EOB was sent out on every claim that was filed into us a copy was submitted out as well, letting you know what, what the date of service is, who the provider was, and the build amount on each of those claims. They were sent out. You can obtain a copy of it on our online service center.
[CUSTOMER][NEUTRAL] Yeah, I'll just do that.
[AGENT][NEUTRAL] Yeah, all the copies that were received for that time frame, yeah, you can just you can obtain them on the online service center.
[CUSTOMER][NEUTRAL] So basically all for all of 2024, we hit the max.
[AGENT][NEUTRAL] Yes, for inpatient. The policy only covers a max for inpatient of 2500. It looks like, yes, that has already been exhausted for 2024.
[CUSTOMER][NEGATIVE] OK, and then while I have you on the phone, I guess I'll kill two birds with one stone since I was trying to figure out what to do with Prisma. Um, I'm assuming that it's the same for Prisma because we received a bill for them as well.
[AGENT][NEUTRAL] Is it for the same date of service?
[CUSTOMER][NEUTRAL] It's a different one.
[AGENT][NEUTRAL] What is the data service?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] There's a couple.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] Uh, 65 2024.
[AGENT][NEUTRAL] OK, you said 6524?
[CUSTOMER][NEUTRAL] Yeah, there's like several on here.
[AGENT][NEUTRAL] And you said the provider was Prisma?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And these are also for [PII] as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, I see we got a couple of claims in from Prisma.
[AGENT][NEUTRAL] Health
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] I show we've paid some of them as but the outpatient only covers a max of 500 per calendar day and it has already been exhausted for 6524.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it looks like we have paid them 500 for that data service and that will be the max payable for that data service.
[CUSTOMER][NEUTRAL] OK, got you, and then I see.
[CUSTOMER][NEUTRAL] OK, I see, I see.
[CUSTOMER][NEUTRAL] I see that on my bills here these are a little bit more detailed so basically that's that's what happened that's why we're getting these bills.
[AGENT][NEUTRAL] Yes, cause the outpatient only covers a max of $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a
[CUSTOMER][POSITIVE] OK, great. OK, I appreciate it very much.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] That is it.
[AGENT][POSITIVE] OK, well thanks for calling APO you have a good day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] You're welcome bye.