AccountId: 011433970860
ContactId: a249b1cd-f743-4348-92b9-136389a42696
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408200 ms
Total Talk Time (AGENT): 136874 ms
Total Talk Time (CUSTOMER): 233945 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/a249b1cd-f743-4348-92b9-136389a42696_20250516T16:02_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][POSITIVE] Hey [PII], how are you doing?
[AGENT][POSITIVE] I'm good, yourself?
[CUSTOMER][NEUTRAL] Oh, I'm OK, [PII]. I have no complaint. [PII], I have a provider on the phone. She's calling about an HR policy, a claim. I gave her the status of the claim. I told her that this policy only offers $50 per visit for office visits, but she says that our ELB does not is not explain, doesn't explain.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Why it's not paying for procedures for a procedure code and it's not explanatory of such and such and she wants to know why and I told her that.
[AGENT][NEUTRAL] Jesus.
[AGENT][NEGATIVE] Cause it's not covered under the policy.
[CUSTOMER][NEUTRAL] Literally says that the benefits for that is not covered under the policy, but she wants to know why the ELB is not like other ELBs that states that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because we're not a company. God, I'm sorry.
[CUSTOMER][NEUTRAL] And I told her that we're not a primary insurance company, so we can't tell her that. But I did let her know that if you submitted a bill for $983 and we only pay $50 that means there's a possibility that that balance is still owed to you. However, I can't tell you to charge the insured, but she wants to go.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] More and beyond, just out of my, I don't know what to tell her.
[AGENT][NEUTRAL] I'm gonna tell her the same thing you did. Uh, give me one moment I'm just typing in this note is not covered.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I don't know why she is anime to.
[AGENT][NEUTRAL] Uh, it should be fine.
[CUSTOMER][NEGATIVE] Cause I'm gonna get in trouble if I charge the insured and I'm not supposed to. I said, well, this is not a discounted policy. It's just a.
[AGENT][NEUTRAL] Right. What's that policy number?
[CUSTOMER][NEUTRAL] Let me 238848-8 for [PII].
[AGENT][NEUTRAL] Say it one more time. 2388488.
[CUSTOMER][NEGATIVE] 438 mhm. Every everybody keeps saying my phone is going in and out. It just messed up that bad.
[AGENT][MIXED] It's not horrible. It's just, it's like the volume turns down and then turns up just a little bit.
[CUSTOMER][NEUTRAL] And it's all the way up.
[AGENT][NEUTRAL] That's all good. What's the name of the provider that's calling?
[CUSTOMER][NEUTRAL] It's [PII] and the claim ended in 6722.
[AGENT][NEUTRAL] And what's her name? You said [PII]?
[CUSTOMER][NEUTRAL] Mhm. [PII]
[AGENT][NEUTRAL] Just [PII] probably.
[AGENT][NEUTRAL] Uh, data service [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] This is just an indemnity plan.
[AGENT][NEUTRAL] Whatever, fella. Uh, you can transfer them to me and I'll explain to him.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Or try to.
[CUSTOMER][POSITIVE] All [PII], [PII]. Well, thank you. Have a good day.
[AGENT][POSITIVE] You're welcome. You too. Have a great weekend.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Hello [PII], I'm gonna transfer you over to TP. She's gonna better assist you. Thanks for calling APL you guys have a great day. Bye. Thanks you too.
[AGENT][NEUTRAL] OK, and Ms. [PII], you, uh, she said you had a question about a claim that was processed.
[CUSTOMER][NEUTRAL] Yeah, I just wanna make sure because the EOB that we have um for the two codes just has the one code actually submitted on our end it shows 0 and then allowed 0 all the way across and then the office visit that did pay the 50 says that it was submitted like we billed it at $50 so that's what they paid it so I didn't just want to make sure like she said you can't tell us what to bill the patient um so.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I thought we had a contract, but so my question is.
[CUSTOMER][NEUTRAL] Is there anything that we can get that actually shows what we build? I mean, I'm just saying because like by the EOB that I'm looking at.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] To us, it, it's not right. There's no details, there's no nothing. $50 that's it.
[AGENT][NEUTRAL] Yes, ma'am. That's just the max benefits payable. Uh, my name is [PII], last initial [PII]
[CUSTOMER][NEUTRAL] I'm sorry, what's your name?
[AGENT][NEUTRAL] And with this insurance policy, it's a limited indemnity plan. So for the office visit, that's just a benefit max payable per day, and it looks like the other code, uh-huh.
[CUSTOMER][NEUTRAL] No, I understand that.
[CUSTOMER][NEUTRAL] I understand that part. I'm just saying that I didn't know if there's like something else that can be sent out to have a better, you know, like at least show what we build, you know, at least if it was showed like the way that we build it and then just put, you know.
[CUSTOMER][NEUTRAL] Allowed 50 and then you paid 50.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like, like, um, normally would be done with an insurance.
[AGENT][NEUTRAL] Well, I understand, but our EOBs don't stay that way. It would just give the data service, the patient account number, the service description, procedure code, the remarks, and how much was paid, but it's not gonna have like additional information like that on our ELBs.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Cause I had disputed that. I had only disputed it because I show in here that.
[CUSTOMER][NEUTRAL] We have a thing we can pull up what our contract amounts are, so that's why I had disputed it so um.
[CUSTOMER][NEUTRAL] There's no contract then I take it for plans like this.
[CUSTOMER][NEUTRAL] Cause it's such
[AGENT][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] Like they can, the insurer.
[CUSTOMER][NEUTRAL] A limited plan is what you're saying.
[AGENT][NEUTRAL] Yes, ma'am. The insurer can go to a multi-plan provider, but we don't reprice claims, um, that would be through multiplan. I don't know what they would have as far as showing any repriced amount or the patient responsibility. Our ELBs only show how much we pay and the action code for it like or remark codes for it, but.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Well, if they have a very limited plan, then it probably wouldn't matter anyway.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's all I needed. Do you have reference numbers by chance?
[AGENT][NEUTRAL] Uh, no, ma'am, but if you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] OK, let me see something here. OK.
[CUSTOMER][POSITIVE] I appreciate that and you have a great day.
[AGENT][POSITIVE] Alright, you too, Ms. [PII]. Thanks for calling APL. Have a great weekend.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, you too bye bye.
[AGENT][NEUTRAL] Mm bye.