AccountId: 011433970860
ContactId: 9808a213-7d64-4d8b-9f02-fc9011b07b02
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 569479 ms
Total Talk Time (AGENT): 249944 ms
Total Talk Time (CUSTOMER): 221091 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/9808a213-7d64-4d8b-9f02-fc9011b07b02_20250117T18:08_UTC.wav
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[AGENT][NEUTRAL] APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I just had some questions about some payments from y'all.
[AGENT][POSITIVE] I'd be happy to assist with um questions about payments today Ms. [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Do you need my policy?
[CUSTOMER][NEUTRAL] OK, it's 02.
[CUSTOMER][NEUTRAL] 292696
[AGENT][NEUTRAL] If you could please provide your date of birth and email address.
[CUSTOMER][NEUTRAL] [PII] [PII] or either I might have put [PII]. I'm not sure which one I use.
[AGENT][NEUTRAL] We have the Outlook
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, and how can I assist today?
[AGENT][NEUTRAL] With the bills or what's the date of service for the bills?
[CUSTOMER][NEUTRAL] Well, I've been on the phone with my.
[CUSTOMER][NEGATIVE] OK, I've been on the phone with my regular, um, EBMS insurance, my original insurance, and so, and then I was on the phone with Amed and I have 3 outstanding payments that they said they billed y'all and hadn't heard anything. So if I could get you to look on [PII].
[AGENT][NEUTRAL] And what was the name of the provider?
[CUSTOMER][NEUTRAL] Um, honestly, I do not know that. She just told me that there was an original charge of $1,282.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] On [PII] and there's still a balance owed of 5580 and they they sent it to y'all on [PII] and hadn't heard anything.
[AGENT][NEUTRAL] OK, I'm showing we received a claim.
[AGENT][NEUTRAL] Um, let's see, so they, they sent the claim twice. The first time they sent the claim, they did not send the primary EOB, so we denied it and asked for the EOB. They sent the claim back at the end of [PII], and they, your patient responsibility was $27.61 and we paid that $27.61 and they cashed the check on [PII].
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] So unless they're talking about a different claim, those are the only two claims that we have received for [PII]. So if it's something different.
[CUSTOMER][NEUTRAL] Well,
[AGENT][NEUTRAL] Then they'll need to submit it, but the one the claim that they did submit we made payment on and they cashed the check.
[CUSTOMER][NEUTRAL] But it did it look like it was originally 1282 or you wouldn't know that, would you?
[AGENT][NEUTRAL] The, the charge, the original charge was $57 and your patient responsibility was $2761.
[CUSTOMER][NEUTRAL] $57.
[CUSTOMER][NEUTRAL] OK, I don't know if that's the right one or not. I don't, I don't know because she said that the balance on there was 5580.
[AGENT][NEGATIVE] Well then she'll need to, we didn't, we didn't, we never got a claim for that amount. We got a claim the charge amount was $57. We denied it asked for the EOB they sent it and we paid patient responsibility that was on the EOB which was $2761. Anything outside of that, they'll need to submit it.
[CUSTOMER][NEUTRAL] OK, OK, so you never got.
[CUSTOMER][NEUTRAL] OK, so y'all didn't get anything asking for 5580.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, alright, will you take this one for me? OK, I've got two claims on [PII]. I had some knee surgery, so I got bills coming from everywhere.
[AGENT][NEUTRAL] OK, so I see 2.
[AGENT][NEUTRAL] Claims.
[AGENT][NEUTRAL] One moment, um.
[CUSTOMER][NEUTRAL] One of them should be an emergency room and one is the ER physician.
[AGENT][NEUTRAL] These are kind of 2.
[AGENT][NEUTRAL] Low for that. OK, so we only received.
[AGENT][NEUTRAL] OK, so we only received a claim for that data service from Diagnostic radiology of Anderson.
[AGENT][NEUTRAL] They submitted the claim once the first time they submitted it, we um asked them for a detailed explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then they sent it, and then when they sent it the patient responsibility was $16.61 and we paid that.
[AGENT][NEUTRAL] So that is the only claim that we have gotten for that data service.
[CUSTOMER][NEUTRAL] All right, so you don't have the emergency room. They're asking for a balance of 285. My original insurance paid it all except for 285. 11 and then um.
[CUSTOMER][NEUTRAL] On that same day [PII], uh, the ER part, um, was $975 and it paid it all except for $100.
[CUSTOMER][NEUTRAL] And so they said they submitted that to.
[AGENT][NEUTRAL] No, we don't have those. We don't have those.
[CUSTOMER][NEUTRAL] You don't have either one of those.
[CUSTOMER][NEUTRAL] OK, alright, um.
[CUSTOMER][NEUTRAL] What about 5:15? They said they sent it to y'all on [PII]. 5:15 was the surgery facility and it was 40,000.
[CUSTOMER][NEUTRAL] And the only thing remaining was a copay at $195 20% which was $926.57 dollars for a total of $1121.57.
[AGENT][NEUTRAL] OK, we didn't get any facility claims, but the 5:15 data service is maxed out, so even if they did send it, it would have been denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I need to pay this 1121.
[AGENT][NEGATIVE] Right, because if they, if we get any more claims for [PII], they're going to deny for not covered because we we actually denied uh.
[AGENT][NEUTRAL] Yeah, there's a charge. What is this? uh let me see who sent this claim.
[AGENT][NEUTRAL] Anesthesiology services of Anderson.
[AGENT][NEUTRAL] They got the last of the benefit amount and so we paid them $40.33 and the and that maxed out your data service um but the who sent the claim in first um.
[AGENT][NEUTRAL] So AnMed sent a claim first and so.
[AGENT][NEUTRAL] Both of the charges that they submitted we paid which was um patient responsibility $180.97 and then the other one was $278.70.
[AGENT][NEGATIVE] And so when we received the claim from the anesthesiology, all you had left was $40.33 for that day. We paid them that and denied the rest, but no facility ever filed a claim with us.
[CUSTOMER][NEUTRAL] Because y'all just pay $500 a day, is that correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so I will let them know that, but now they'll need to resubmit the 422s because you don't have that.
[AGENT][POSITIVE] That's correct because you still have money for um that day, yeah.
[AGENT][NEUTRAL] And the other one, the 5:15, you still have money on that day too.
[AGENT][NEUTRAL] Not 5:15. What the first one? What, what was the first one you asked me about?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, but I had 2 for 4:22.
[AGENT][NEUTRAL] Oh, OK, yeah, so yeah, you still have money for the that data service so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, well, so do I have like $385?
[AGENT][NEUTRAL] Um, what, let me, I have to, what was the date you want me to check? and I'll have to add it up.
[CUSTOMER][NEUTRAL] Um, it was [PII], it was [PII]. Um, they said I still owe, uh-huh.
[AGENT][NEUTRAL] So [PII].
[AGENT][NEUTRAL] Yeah, we only paid $16.61 for that data service.
[AGENT][NEUTRAL] So yes, 483 39 is what you have left in benefits.
[CUSTOMER][NEUTRAL] Yeah, OK, well they need to they need to do that then.
[CUSTOMER][NEUTRAL] Because I only owe for the hospital.
[CUSTOMER][NEUTRAL] Uh, for let's see, 9 for the emergency room position was $974 and it's down to $100 now is all I owe and then for the emergency room it was $1772 and I owe 28511.
[CUSTOMER][NEUTRAL] Alright, so I'll call them back right now and tell them they they need to resubmit those that there is money in there for that to be paid, but that y'all have never received that from that on those two on those those two on those on that date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Was there anything else I could assist with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh, that's the only ones I brought today to try to handle. I they talk to you next week.
[AGENT][POSITIVE] OK, well thank you for calling APL you have a good day.
[CUSTOMER][POSITIVE] OK. Thank you, ma'am. You too. Have a great weekend.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] You too. Bye bye.
[CUSTOMER][POSITIVE] Thanks bye bye.