AccountId: 011433970860
ContactId: 82b87bb5-7796-4c49-b3c7-7c33f8b22419
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 742650 ms
Total Talk Time (AGENT): 332704 ms
Total Talk Time (CUSTOMER): 213150 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/82b87bb5-7796-4c49-b3c7-7c33f8b22419_20250217T18:01_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][POSITIVE] Thank you for calling.
[CUSTOMER][NEGATIVE] Yes, how you doing? I'm going, I'm going through an issue with the billing company.
[CUSTOMER][NEUTRAL] And the claims being submitted. I just spoke to Aetna, which is my primary.
[CUSTOMER][NEUTRAL] This has been going, this was going on for a whole year, 2024.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Now my treatment is being denied because they're claiming the doctor's office is claiming.
[CUSTOMER][NEUTRAL] That their claims are being denied. However, what the issue was, um, the billing department was issuing claims and somehow, uh, the procedure code didn't match the medical code, something of that that nature that's why Aetna was not.
[CUSTOMER][NEUTRAL] Paying the claims. However, I guess the claims were resubmitted.
[CUSTOMER][NEUTRAL] And this is, this was going all the way back in January.
[CUSTOMER][NEUTRAL] And this is crazy. She got the whole year, whole year of claims if you can imagine. So someone dropped the ball.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] I just spoke to Edna. I guess the claims resubmitted. I don't know how many times I guess Edna finally accepted whatever they submitted they submitted it properly so I know that they, uh, my gap insurance APL.
[CUSTOMER][NEUTRAL] They pay the copay.
[CUSTOMER][NEUTRAL] They don't pay the copay until the primary insurance pays the.
[CUSTOMER][NEUTRAL] I guess the primary claim.
[AGENT][NEUTRAL] Mm, right.
[CUSTOMER][NEUTRAL] So I just spoke to, I, I just spoke to [PII]. They say all the claims were paid.
[CUSTOMER][NEUTRAL] [PII], I mean [PII], so I'm gonna ask you is, can you check on my history to see if all my claims were were paid.
[CUSTOMER][NEUTRAL] For [PII], I mean, yeah, uh [PII].
[AGENT][NEUTRAL] Got it.
[AGENT][POSITIVE] I got you. That's a lot, isn't it? Bless your heart. You have been through it with insurance, haven't you?
[CUSTOMER][NEGATIVE] Oh my God, this is crazy and it's, it's the, it's it's the incompetence of the billing department and you know how many calls I had to make.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Just to try to get them to submit something.
[AGENT][POSITIVE] I'm so sorry for your, I, I can't imagine the amount of frustration you must be going through with that and I'll be happy to check our site. What is that policy number for you? Do you have that available?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, let me see here uh.
[CUSTOMER][NEUTRAL] Policy number outpatient card number, is that the one you need?
[AGENT][NEUTRAL] That's it, yes sir.
[CUSTOMER][NEUTRAL] 1475555.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima 8.
[AGENT][NEUTRAL] All right, thank you. And do you mind verifying your date of birth please sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you and what's your current mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] It looks like we have received.
[AGENT][NEUTRAL] Several claims on [PII], so let me take a look.
[AGENT][NEUTRAL] And what is a good callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK great thank you.
[AGENT][NEUTRAL] Alright [PII], let's take a look now I do also see that you have an active portal account on our portal so you can actually view these claims on file if you.
[AGENT][POSITIVE] Are interested that way you know for sure.
[CUSTOMER][NEUTRAL] It will say it will say that the the claim was paid by APL.
[AGENT][NEUTRAL] It will. Those were processed on.
[CUSTOMER][NEUTRAL] It is that
[CUSTOMER][NEUTRAL] Is that the is that the EBO?
[AGENT][NEUTRAL] Well, let me check.
[AGENT][NEUTRAL] No, hang on just a second. I'm sorry that was [PII]. Let me check something.
[AGENT][NEUTRAL] Let's check this other policy.
[AGENT][NEUTRAL] That was your older policy that was active from [PII]. So let's get to your active policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now this one was active on [PII] and it's still active.
[AGENT][NEUTRAL] If you, if you go online to our portal, I see your username is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you do see that there were some claims processed on [PII].
[AGENT][NEUTRAL] On this policy.
[AGENT][NEUTRAL] And that's gonna be for 20.
[AGENT][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] I'm sorry, I got a I got a new, I got a new issue card here the outpatient card number is different. Can you want me to give you that one?
[AGENT][NEUTRAL] Is it the 250-566-6?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Yeah, that's the one I'm looking at. That's your active policy for [PII].
[AGENT][NEUTRAL] So that's the one I'm looking at.
[CUSTOMER][NEUTRAL] So the previous the previous number I can delete that?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There is a claim for [PII] for [PII] dermatology Group of Florida that was paid $60.
[AGENT][NEUTRAL] That's for data service 9:10.
[AGENT][NEUTRAL] Uh, for 7:30 24 for dermatology Group of Florida, we paid $60 and these were all paid on [PII].
[AGENT][NEUTRAL] Was this all for dermatology Group of Florida?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, Data service 10-12024 was paid $60.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] Tell me this is all sounding good to you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 1112, 24, we paid $60.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, 1210, 24 we paid $60.
[AGENT][NEUTRAL] 1126 we paid $60.
[AGENT][NEUTRAL] 1015 24 we paid $60.
[AGENT][NEUTRAL] 1029 we paid $60.
[AGENT][NEUTRAL] And 8 1324 we paid $60.
[AGENT][NEUTRAL] And that was all processed and paid on 214-25.
[CUSTOMER][NEUTRAL] OK, but does it show any more does it show any other claims that were not uh that were denied?
[AGENT][NEUTRAL] Not that we
[CUSTOMER][NEUTRAL] For 2024.
[AGENT][NEUTRAL] Yeah, not that we've just received. Let's check this one.
[AGENT][NEUTRAL] Oh, we also paid [PII] 24.
[AGENT][NEUTRAL] $60
[CUSTOMER][NEUTRAL] OK, so it seems like it seems like they're all being paid.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 6 1124 was paid.
[AGENT][NEUTRAL] April 1624 was paid.
[AGENT][NEUTRAL] Now let me look, there's 2 denials, let me just check those.
[AGENT][NEUTRAL] And this is 4:30 24.
[AGENT][NEUTRAL] See what they deny.
[AGENT][NEUTRAL] And let me just make sure because it might have come through on a different claim.
[AGENT][NEUTRAL] On this that we received this one was.
[AGENT][NEUTRAL] Processed earlier so we might have gotten that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, my
[CUSTOMER][NEUTRAL] It might have been a duplicate
[AGENT][POSITIVE] Right, exactly.
[AGENT][NEUTRAL] OK, so this was denied. We don't have any other claim for [PII].
[AGENT][NEUTRAL] Um, we need a valid ICD 9 code.
[AGENT][NEUTRAL] A valid diagnosis code.
[AGENT][NEUTRAL] On that claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] They did not
[CUSTOMER][NEUTRAL] When was that, when was that submitted?
[AGENT][NEUTRAL] That was submitted on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] 25.
[CUSTOMER][NEUTRAL] 0 25.
[CUSTOMER][NEUTRAL] No, it can't be
[CUSTOMER][POSITIVE] [PII] favorite.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] I did say April. I'm sorry, February [PII].
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] I was looking at the data service. The date of service was [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And what else? Any other any other than I?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, let me check this one for you for [PII].
[AGENT][NEUTRAL] Same thing.
[AGENT][NEGATIVE] They did not give us a valid diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And once we get that back we can continue processing these two dates [PII] and [PII].
[CUSTOMER][NEUTRAL] [PII], when was that submitted?
[AGENT][NEUTRAL] That was was actually submitted on the same day on [PII].
[CUSTOMER][NEUTRAL] OK, that's so that's all you see is that two claims that's not paid or that that rejected for [PII].
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Oh we got back to January?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] Oh, I, I've got one more. I'm sorry, this one snuck up on me.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And that was submitted also on [PII].
[AGENT][NEUTRAL] I think that that one was submitted prior to that that one was submitted. Let me just check this one real quick and make sure we didn't get that.
[AGENT][NEUTRAL] And another submission, we did not. That claim was submitted and this is [PII] that was actually submitted back on [PII].
[CUSTOMER][NEUTRAL] The [PII] and it was again it was it was uh rejected because ITD 9 code.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][POSITIVE] OK, OK, thank you very much, miss.
[AGENT][NEUTRAL] And you can and like I said, if you go on the portal any of the codes that have a D as in delta, that means denied.
[AGENT][NEUTRAL] Um, you can click on those claims and view the denial reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] And Mr. [PII], I'm so glad that they're getting this taken care of for you and we were able to process and pay those claims. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] OK, OK, you too, miss.
[AGENT][POSITIVE] Thank you bye bye.