AccountId: 011433970860
ContactId: 8529c1fb-4a88-460d-961c-2b01048ff6c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 843130 ms
Total Talk Time (AGENT): 253853 ms
Total Talk Time (CUSTOMER): 412986 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/8529c1fb-4a88-460d-961c-2b01048ff6c7_20250303T14:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I wanted, I, I'm getting passed back and forth from, um, to IMA to, to you. So, so I, I was first talked to APL, then she sent me to IMA, and now IMA is sending me back to you and, um, so I'm getting different messages.
[AGENT][POSITIVE] OK, let's see what if we can help you.
[AGENT][NEUTRAL] OK, what's your name?
[CUSTOMER][NEUTRAL] Yeah, so I don't know.
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]
[AGENT][NEUTRAL] And [PII], let me get your policy number that way I can pull up your file and then we can move forward, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] 0258.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4564
[AGENT][NEUTRAL] All right, what's a good phone number, [PII] in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I have written down [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what's the name on the account?
[CUSTOMER][NEUTRAL] The dress [PII].
[AGENT][NEUTRAL] OK. And did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and so you're calling, are you affiliated with this policy or who are you calling in regards?
[CUSTOMER][NEUTRAL] OK, I'm a provider.
[AGENT][NEUTRAL] OK, you're a medical provider. OK. And so are you checking a claim status or?
[AGENT][NEUTRAL] Eligibility
[CUSTOMER][NEUTRAL] Right, cause, so.
[CUSTOMER][NEUTRAL] Right, so I was checking uh the claim status. So I just called, you know, about uh 20 minutes ago, and the APL talked to said that they don't handle medical claims that I have to talk to IMA and then I talked to IMA and they said they don't handle medical claims only wellness claims.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Can you verify the patient's date of birth for me?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that, [PII]. I mean.
[AGENT][NEUTRAL] Yeah, [PII], one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the date of service of the claim?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] What year?
[CUSTOMER][NEUTRAL] This year, yeah.
[AGENT][NEUTRAL] Uh, OK, and what's the total charge, uh, [PII] for that claim?
[CUSTOMER][NEUTRAL] Um, yeah, so I submitted the for the insurance company, let's see, um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So this the it was billed at 175 and then the um the uh 159.98 was applied to the deductible.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is this for an office visit?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, OK, and so when you called earlier, what were you advised?
[CUSTOMER][NEGATIVE] I was told that you guys don't handle.
[CUSTOMER][NEUTRAL] Um, claims that, uh, IMA does that IMA handles it and then they send it over to you guys.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah, we we we we do process the claims. I'm not showing that date of service received at this time. When was it submitted?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let's see, uh, but yeah, I submitted it to, but I submitted it to IMA, but I guess that's not really I am, that's the clearing house.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It goes through the clearing house through that entity that is correct, but we process the claim. So when did you send it to IMA?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, let me see uh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, I submitted it to um.
[CUSTOMER][NEUTRAL] And um [PII].
[CUSTOMER][NEUTRAL] I mailed it right.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah, so on our end it's just a matter that the process isn't complete and we've not received it to process it. American Public Life will process the claim.
[CUSTOMER][NEUTRAL] OK, so, uh, so, um, so I should call, so for an update I should call you guys.
[AGENT][NEUTRAL] Correct, not IMA because if it's a medical claim, we, we process it here at American Public Life, so we're just waiting for them to submit the claim over to us to process it.
[CUSTOMER][NEUTRAL] No, not IMA.
[CUSTOMER][NEUTRAL] Uh, so
[CUSTOMER][NEUTRAL] All right, and then I, so I was so um.
[CUSTOMER][NEUTRAL] The the the uh.
[CUSTOMER][NEUTRAL] For the second so under the payer ID.
[CUSTOMER][NEUTRAL] So what payer ID do I use 2 there's two payer IDs.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, on the card.
[AGENT][NEUTRAL] What payer ID numbers do you have? There should be only one.
[AGENT][NEUTRAL] 645-556.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's 64556.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so I, this is what I, I, I sent you, um, um, I sent you the the original claim right from [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then I or they because they processed it right and then I put in uh then I sent you the 15 the CMS 1500.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I put other insured.
[CUSTOMER][NEUTRAL] I put other insured, right? And then I put American Public Life.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then I put in payer ID 64556.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And then,
[CUSTOMER][NEUTRAL] But did I put in the right, let's see, yep, I, and then I put under um policy group ID I put 02584564, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] That was correct, right? Oh, OK, alright.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, so, and I sent that all to [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh, OK, so that's how I'm supposed to do it?
[AGENT][NEUTRAL] Yeah, you did it the correct way and so now it's just a matter of us waiting, you know, for them to do their due diligence and it comes to us to actually process the claim.
[CUSTOMER][NEUTRAL] So I submitted the CMS 5 1500 and I also submitted the um.
[CUSTOMER][NEUTRAL] Uh, the EOB, right, I submitted the, you know, OB from Harvard Pilgrim saying they applied it to the deductible.
[AGENT][NEUTRAL] Yes, it
[AGENT][NEUTRAL] OK, so it's Harvard, is that their primary?
[CUSTOMER][NEUTRAL] So that's what you.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah.
[AGENT][NEUTRAL] OK. OK, that's fine.
[CUSTOMER][NEUTRAL] So you need that too, right, so you need the EOB that says that Harvard Pilgrim has processed it, right? And then you need the CMS 1500.
[AGENT][NEUTRAL] Yeah, under this policy, if they have other coverage, yes, you could send the primary explanation of benefits. What's the procedure code on the hos on the office visit claim?
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] 090791.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so we're just sitting tight until you know we uh receive the claim for processing but you did it correctly.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So you wouldn't call, you would not call if it's a medical claim, you would not call IMA for status you would contact American Public Life.
[CUSTOMER][NEUTRAL] Yeah, so I send it, so.
[AGENT][POSITIVE] So you may wanna just give it some more time and call.
[CUSTOMER][NEUTRAL] OK, when I
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, how long does it usually take for you guys to get it?
[AGENT][NEUTRAL] And then we can't gauge that, you know how long it takes to receive it from another entity. Yeah, we can't gauge that.
[CUSTOMER][POSITIVE] I pretty
[AGENT][NEUTRAL] Because it just depends on their processing time. We do not, I mean I can't, it's almost like when will I receive it from the post office? I mean you know we can't gauge that.
[CUSTOMER][NEUTRAL] I mean 30 days, 90 days.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] When we would receive a document from another entity.
[CUSTOMER][NEUTRAL] No, no, no, I'm saying
[CUSTOMER][NEUTRAL] No I'm saying so you'll get it, but you'll hear from the clearing house, right? Yeah, you hear from the clearing house sends you the claim, right?
[AGENT][NEUTRAL] Once we receive the claim from IMA, our standard processing time is 7 to 10 days from the date that we received the documents.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, but you, but you don't, you don't know how long it takes, uh, for IMA to get for the for the clearing house to get it over to you that uh you, you're not sure on that, right? Yeah.
[AGENT][NEUTRAL] Well we wouldn't know that information [PII]. I can't tell you how long it takes them to get it to us.
[CUSTOMER][NEUTRAL] So when I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK, OK, alright, so that's, uh, but that's what they do. They, they get it. I mail it to them and then they send it off to you and then it takes 7 to 10 days for you guys to process.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Once we receive it, correct.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, right, once you receive it, right, OK, so yeah, so, so, uh, the other thing is when I called that, that, um, number, it, it, it, what, what a prompt do I do? They said 123 and 4, and there wasn't one that just said medical claims.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so in this instance you wouldn't have contacted them their their option is one, but you would not have contacted them because we process the claim. You don't call them to verify.
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Well, first of all, what number did you dial? What number did you dial?
[CUSTOMER][NEUTRAL] So when I call
[CUSTOMER][NEUTRAL] Let's see, well, I've got um let's see, so the number here on the card.
[CUSTOMER][NEUTRAL] I um
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][POSITIVE] Ok, no problem, um.
[CUSTOMER][NEUTRAL] Yeah, so I think the number that I have is this um.
[CUSTOMER][NEUTRAL] Wait, the [PII].
[CUSTOMER][NEUTRAL] [PII], right? That's what I, that's where I get you.
[AGENT][NEUTRAL] You and you would you.
[AGENT][NEUTRAL] Right, and you would select option 2 when you dial that number.
[CUSTOMER][NEUTRAL] Oh, it's option two, right, because it was, it was a little, little confused, yeah, alright, so when I hit that [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I know Option
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Option one will take you to IMA so don't select option one, select option 2 if you're checking claim status, and that takes you to American Public Life.
[CUSTOMER][NEUTRAL] 00, OK.
[CUSTOMER][NEUTRAL] Uh, so do I, I, I forgot if I hit provider. I do hit provider when I call that [PII] or do I just hit 2?
[AGENT][NEUTRAL] Select option 2, option 2.
[CUSTOMER][NEUTRAL] Oh, OK, alright, alright, so just tell, so that's interesting, so I don't really need to talk to uh IMA.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For a claim status for a medical claim, no, no.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] No, no, yeah, OK, so that's, uh, yeah, so that's a little confusing, yeah, because it says IMA and it doesn't say they said wellness and that's, uh, alright, so I'll, I'll see, um, but it sounds like I, I submitted it correctly. It just has to, um, I have to wait wait a little while and see what happens uh.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Right, exactly.
[CUSTOMER][NEUTRAL] Yeah, oh, OK, and then, and then put um.
[CUSTOMER][NEUTRAL] Uh, and then the number that the woman did from APL says because there's two numbers on the card and the number I need to use is that not the D4 number, right, but the 0258, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] That's right, right, right, so I really don't even need that number, that D4 number.
[AGENT][NEUTRAL] Yeah, so the D4 number, um, is, um, IMA which or 90 degrees that you called and they perhaps may have a wellness policy, but this is not a wellness claim that you submitted. It's a medical claim, so that's why you would use the 0258 number for medical.
[CUSTOMER][NEUTRAL] No, yeah. On the
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Right, right, right, OK, I appreciate it.
[AGENT][NEUTRAL] Oh, you're welcome, [PII]. Did you have any other questions?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No that's good thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye.