AccountId: 011433970860
ContactId: 905c3311-d61a-40c8-b34e-21962fd72f90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 942609 ms
Total Talk Time (AGENT): 331488 ms
Total Talk Time (CUSTOMER): 269086 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/905c3311-d61a-40c8-b34e-21962fd72f90_20250106T16:08_UTC.wav
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[AGENT][NEUTRAL] Yeah, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm the group ads I'm the plan administrator for group ID number 17273.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And what's a good phone number, [PII]?
[CUSTOMER][NEUTRAL] Excuse me?
[AGENT][NEUTRAL] What is a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, give me one moment.
[AGENT][NEUTRAL] And what is the name of the group?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Thank you. Can you verify your email address for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect and what is the mailing address for this location?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Great, thank you for that information.
[AGENT][NEUTRAL] And how can I help you?
[CUSTOMER][NEUTRAL] I have a patient ID uh MR number. It's [PII] [PII].
[AGENT][NEUTRAL] You said a medical record number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And how can I help you?
[CUSTOMER][NEUTRAL] 100
[CUSTOMER][NEUTRAL] OK, quick question, do you have anything that you received on the [PII] that she paid $303 for her Visa card at Baptist Hospital?
[AGENT][NEUTRAL] OK, what's it, you have the policy number for the patient? Because the medical record is not anything we could use to look up her information.
[CUSTOMER][NEUTRAL] Uh, I don't have a policy number on here. It doesn't show a policy number. It is an encounter number.
[AGENT][NEUTRAL] Can you spell her
[AGENT][NEUTRAL] Can you spell her first and last name? I get searched by the name.
[CUSTOMER][NEUTRAL] Sure. Sure. [PII]
[AGENT][NEUTRAL] I'm sorry, what's your first name?
[CUSTOMER][NEUTRAL] [PII], like [PII], but [PII]
[AGENT][NEUTRAL] You.
[AGENT][NEUTRAL] OK, got it. [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh, you said like [PII]. OK, got it.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And do you know what the date of service is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And who was the provider or facility?
[CUSTOMER][NEUTRAL] It was a payment of 300.
[CUSTOMER][NEUTRAL] Baptist Health.
[AGENT][NEUTRAL] Baptist Health. OK.
[CUSTOMER][NEUTRAL] Baptist Health. Mhm.
[AGENT][NEUTRAL] And I'm assuming this is your 24?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And is you just the employee or dependent on the policy? OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The employees.
[AGENT][NEUTRAL] And do you know what the total charge amount is for this data service?
[CUSTOMER][NEUTRAL] This was $303 that she paid for her visa.
[AGENT][NEUTRAL] That's what she paid, but is that the total charge or is that what she owed?
[CUSTOMER][NEGATIVE] Well, it just says no, I don't know what it was. It just says it just says she paid $203.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm just trying to locate the claim and just narrow the search that's all.
[CUSTOMER][NEUTRAL] She sent me she just gave me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You want an encounter number? I don't know that that's gonna help you, but.
[AGENT][NEUTRAL] Yeah, that doesn't help us. That's the doctor's office information. Give me a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still looking, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And did you say the provider is Gastro Health?
[CUSTOMER][NEUTRAL] Uh, back itself.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] So it's a hospital claim, OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you know what she had done on that day?
[CUSTOMER][NEUTRAL] Um, I.
[AGENT][NEUTRAL] And would that be Baptist surgery and endoscopy or Baptist Hospital?
[CUSTOMER][NEUTRAL] She had done a um
[CUSTOMER][NEUTRAL] That's Health Endoscopy Center.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She had gone in looking for bills.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So anesthesia done, office visit.
[CUSTOMER][NEUTRAL] Uh, she had gastrointestinal procedure.
[AGENT][NEUTRAL] OK, let's see, yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] And uh.
[AGENT][NEUTRAL] OK, so I do see a charge for date of service [PII] from Baptist surgery and endoscopy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, we, we paid a $500 benefit on this claim. Are you saying that she paid $303 out of pocket?
[CUSTOMER][NEUTRAL] Yeah, she did. That's what I wanted to. I knew about the $500 but she also, but she paid $303 which she did not submit the claim.
[AGENT][NEUTRAL] Correct. Did they require that she pay something up front before the surgery?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, so because we've issued a $500 check, um, let me look at the primary EOB. Her account may be overpaid. Give me a second.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, so now the maximum outpatient benefit under this policy is $500 per calendar day.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And, and so.
[AGENT][NEUTRAL] I'm showing based on the, um, primary explanation of benefits.
[AGENT][NEUTRAL] That $803 was applied towards her major medical deductible. And of that $803 amount, we paid $500. So that's gonna leave a balance of $303.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Which she would owe.
[CUSTOMER][NEUTRAL] But where is it the 303 that she owes because she's only received, she's received medical bills that she owes, she owes 7686.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So on this
[CUSTOMER][NEUTRAL] Says here.
[AGENT][NEUTRAL] So on the this particular claim I'm loo[PII] at the major medical explanation of benefits.
[AGENT][NEUTRAL] And they uh applied $803 towards her major medical deductible.
[AGENT][NEUTRAL] Of the 803, American Public Life paid $500 which is her maximum benefit per calendar day, and so that would leave a balance of $303.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Which the patient would owe.
[AGENT][NEUTRAL] Because
[CUSTOMER][NEGATIVE] Right, but then why is she receiving, why is she receiving bills that she owes 3267676 86? What are these bills then?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and so the bill that I'm looking at is for the facility. You did mention the uh anesthesia bill. So remember, the benefit is $500 per calendar day. So it's basically the provider that submitted their claim first, which it looks like in this instance would have been the hospital. They, they they ate up that $500 benefit. But let me look at the anesthesia charge because I think uh we denied it citing that the maximum benefit is exhausted. Let me go back.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] She's receiving a bill for how much for the anesthesiologist?
[CUSTOMER][NEUTRAL] Well, I'm gonna look for the anesthesiologist, hold on.
[AGENT][NEUTRAL] Yeah, because we did process that charge and um the remark code on that claim is just citing that the maximum outpatient benefit per day was exhausted because it was paid on the hospital charge.
[CUSTOMER][NEUTRAL] OK, hold on, and, uh, let me ask her. Then I and uh hold on, let me ask her. Hold on, I'm so sorry. I'm speaking a different language and then, and then physiologist and huh.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, no worries. OK.
[CUSTOMER][NEUTRAL] OK, the anesthesia, it says here, anesthesia, it says here that the bill was $3,045. Do you have that?
[AGENT][NEUTRAL] Yes, let me pull that back up. Give me one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, that is from Galloway Anesthesia Associates.
[AGENT][NEUTRAL] I do show the bill here they billed for $3,045.
[CUSTOMER][NEUTRAL] Right, the insurance covered 296814.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And it shows a co-insurance amount of $76.86. Is that correct?
[CUSTOMER][NEUTRAL] And it says
[CUSTOMER][NEUTRAL] That she owes, yeah, that she owes, but you're saying that she owes $303.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] No, no, no. That was for the hospital fee. The 303 was for the endoscopy center.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK, so you, you, you tell the anesthesiologist, so that's why I'm not understanding you said for the anesthesiologist. So which is the, is the one.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, so when she has.
[AGENT][NEUTRAL] Let me explain.
[AGENT][NEUTRAL] When she has a sur surgery, she's gonna be receiving several bills. One is from the facility, which is the endoscopy center.
[AGENT][NEGATIVE] On that claim, we paid $500 which exhausted her outpatient benefit.
[AGENT][NEUTRAL] So we paid 500. The 303 is her responsibility for the hospital claim.
[AGENT][NEUTRAL] For the endoscopy center claim.
[CUSTOMER][NEUTRAL] Which bill is that
[CUSTOMER][NEGATIVE] Because all I have here for for gastrointestinal procedure, she owes $246.76. There's another bill here for $326.76 for a gastrointestinal procedure again, she owes $326.76. There's another bill here, the one for the anesthesia. That's all I have. She didn't get anything else.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so there's not a bill for the endoscopy center?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, I thought you gave me a balance of that she paid 303 out of pocket. What was that? Who did she pay that to?
[CUSTOMER][NEUTRAL] She gave me, she gave me the she gave me the, the invoice, the receipt where she where she paid 303 to Baptist house that's what it says.
[AGENT][NEUTRAL] And who
[AGENT][NEUTRAL] OK, that's gonna be for the endoscopy center.
[AGENT][NEUTRAL] The one that we went over, the first one that we went over.
[CUSTOMER][NEUTRAL] OK, so the doctor said, oh, OK.
[CUSTOMER][NEUTRAL] OK, so she's gonna so she hasn't received that bill.
[CUSTOMER][NEGATIVE] Which it should have been zeroed out because if you already paid 303, it just said pay 303. We don't, we don't have that.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK. Well then she'll need to reach out to the Baptist Surgery and endoscopy center.
[CUSTOMER][NEUTRAL] You know what I'm saying?
[AGENT][NEUTRAL] If you're saying that she paid 303 and we paid $500 that equals 803, which is the amount that was applied towards her deductible. So you're correct. It, it shows, OK, if she paid it to the Baptist Surgery and endoscopy Center. So she'll need to clarify if that receipt says that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] Yeah, well,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, the receipt just says it just says Baptist Health, that's it. It doesn't say where, but I'm gonna ask her now when she went, yeah, I'll ask her.
[AGENT][NEUTRAL] OK, so then she'll need to
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, OK, thank you so much.
[AGENT][POSITIVE] All [PII]. Any other questions I can help with today, [PII]?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] OK. And I wanna add, so any other services related to that surgery, the anesthesia office, and any other charges, nothing else was paid or if we receive further claims because we pay the maximum to that the surgery. OK. OK. I was just trying to be clear. All [PII]. Thank you for calling. Have a good day.
[CUSTOMER][POSITIVE] Correct. Yeah, that's right. Yeah, that I know. Yeah, that I know. Thank you so much. OK, bye-bye. All right, thank you. OK. Bye-bye. Bye-bye, bye-bye.