AccountId: 011433970860
ContactId: 7ed8fb32-73bc-4f8a-a078-dfcb9f2c79a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 296339 ms
Total Talk Time (AGENT): 96841 ms
Total Talk Time (CUSTOMER): 149082 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/7ed8fb32-73bc-4f8a-a078-dfcb9f2c79a4_20250401T17:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on the care team. How you doing?
[AGENT][NEUTRAL] Fine, how are you?
[CUSTOMER][NEUTRAL] I'm doing good. I have a provider on the other line. They, um, well, let me give you the policy number, it's 252.
[CUSTOMER][NEUTRAL] 0934.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Mhm. And it's um claim number 3515863.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For the data service of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So we're asking for the surgery bill because they just provided anesthesia um charges. The providers wanted to speak to you because he's saying, well, we're not, we're two separate entities. Like we just provide the anesthesia for the hospital cause I was telling him that, you know, like for the itemized bill. But he's saying I can't get that cause we're not.
[CUSTOMER][NEUTRAL] We just provide the anesthesia and he wants to know, uh,
[CUSTOMER][NEUTRAL] What else he can provide or what he can do cause they, I said, well, they won't provide you with the billing and he was like, well, no, cause we would be the third party then.
[CUSTOMER][NEUTRAL] Um, but it looks like the hospital's gonna get denied anyway or has already been denied because they weren't confined long enough. But I didn't tell him that.
[AGENT][NEUTRAL] Mm, let me look at this here.
[AGENT][NEUTRAL] Yeah, with this coverage, yeah, surgery benefits are not paid until we have the surgeon's bill. As far as that, this claim wouldn't even be reprocessed until we receive, receive it when, once the surgeon actually filed their claim.
[AGENT][NEUTRAL] So I can let them know that, cause yeah, moving forward, there's nothing else that we would do with their claim until we receive the surgeon's bill.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, so if this was
[CUSTOMER][NEUTRAL] You know how sometimes, well, never mind, because there, I understand what you're saying. I just
[AGENT][NEUTRAL] Yeah, cause they wouldn't, they wouldn't have the surgeons.
[CUSTOMER][NEUTRAL] Just for me, if this, if this was
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] If this had the, like the surgery bill on it and the anesthesia was included, like if this was the anesthesia at the facility, then we would have been able to process everything, right?
[AGENT][NEUTRAL] Yes, but since this is just the anesthesiologist's bill, we're just pretty much letting him know that benefits wouldn't be payable.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Until we have the surgeon charges. Yeah. Cause the anesthesia is based on a percentage and we can't determine the percentage until we have that surgeon's bill.
[CUSTOMER][NEUTRAL] Because we need to know what the charges are for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cos.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. I just want to make sure I understood for me so I know what I'm saying. Thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] All right, hold on one moment, OK?
[AGENT][NEUTRAL] What's his name?
[CUSTOMER][NEUTRAL] This is [PII]
[AGENT][NEUTRAL] You said [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, OK. OK.
[CUSTOMER][NEUTRAL] And did you need the callback number or anything or you OK?
[AGENT][NEUTRAL] You can give me the callback number.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, hold on one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How
[CUSTOMER][POSITIVE] Yes. Thank you so much for holding. I have [PII] on the line and she'll be assisting you further, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hi, [PII], this is [PII]. You have questions in regards to the claim for data service of [PII] or [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am, we're just trying to figure it out. Um, she thought that it looked like the claim denied because the surgery hadn't been billed yet, but we realized obviously it had. We're just a separate entity that's a blind provider to that surgery center. So we're trying to see if we can get this claim reprocessed since it should be paid since obviously the patient couldn't pick their anesthesia. We just provided it for the surgery to occur.
[AGENT][NEUTRAL] OK. So I'm looking here. This is a limited hospital indemnity plan, so it only pays a percentage based off the surgeon's charges. I don't show that we have received the surgeon's bill yet at this time. Once we do receive that, then we can move forward processing the anesthesia billing.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I got you. Alright, well thank you for your help and I will note the account.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, is there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Thanks bye.
[CUSTOMER][POSITIVE] That's it thank you.
[AGENT][POSITIVE] OK, thanks for calling APO you have a good day.
[CUSTOMER][NEUTRAL] OK bye.