AccountId: 011433970860
ContactId: a62c529f-4bf0-421f-ba2c-f49ac236ade1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398779 ms
Total Talk Time (AGENT): 193035 ms
Total Talk Time (CUSTOMER): 156985 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/a62c529f-4bf0-421f-ba2c-f49ac236ade1_20250107T20:05_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] And yes, I'm calling um regarding claim status.
[AGENT][NEUTRAL] OK, um, sure, I can assist you with claim status and you're calling from a provider's office or you're calling for your personal policy?
[CUSTOMER][NEUTRAL] A provider's office.
[AGENT][NEUTRAL] OK. Thank you. And may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Um, OK, so I just called the number on the back of the card that I do have on file and was transferred to this number and she stated that they take care of the wellness visits and that's the ID number that I have, but then I could give you the patient's social and you may be able to pull the patient with that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, yes, um, bear with me just a second, let me pull another system where I can use that, use that social, OK? Um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, um, OK, go ahead.
[CUSTOMER][NEUTRAL] OK, so I have [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. And may I have the name of the patient?
[CUSTOMER][NEUTRAL] This is uh [PII].
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Perfect. Thank you, Ms. [PII]. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Um, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm sorry I stepped out of that screen.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEGATIVE] And I can't find it.
[CUSTOMER][NEUTRAL] Here we are, it's uh the date of service is [PII] and the bill amount is $315.02.
[AGENT][NEUTRAL] OK. Let me see if I can find this claim, and that was [PII] for $315.02. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see if I can find it. And for future, you can check claim status online through our website at [PII], and that's just optional.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see, what is the procedure code?
[CUSTOMER][NEUTRAL] And looks like it's uh 99204.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] We have not received that claim.
[CUSTOMER][NEUTRAL] OK, and since there was an issue with us having the um information, like I don't know why we would send it to the patient's wellness policy who or whoever takes care of that. Um, can you verify a claims address?
[AGENT][NEUTRAL] OK, so usually this particular policy is one of our limited hospital indemnity plan and um if the provider part pays with multi plan um they get repriced through multi plan and that's why they're sent to IMA um so let me go ahead and verify that information.
[AGENT][NEUTRAL] Um, so all claims will go to IMA for repricing before they come to us, and that's [PII].
[CUSTOMER][NEUTRAL] OK, that's where we're showing it was sent.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Did they confirm if they received it or no?
[CUSTOMER][NEUTRAL] No, and, and like I said, um, the only thing because we're not set to send these electronically and we print them and mail them, um, we go by whatever numbers on the card to call and verify and so I was transferred here so I'm, I'm kind of running in circles seems like um.
[AGENT][NEUTRAL] Yeah. Mm.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is this you said this was a hospital plan is this for uh does that mean it's for outpatient claims as well, or is this usually like an inpatient facility hospital type claims?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, no, it does have additional benefits like office visit benefits. Um, let me check this one. Well, not all of them has that benefit, so let me just check the benefits on this one really quick, um, and see exactly what it covers, um.
[AGENT][NEUTRAL] OK, so, OK, so this one is for hospital admission, hospital confinement, surgery in
[AGENT][NEGATIVE] Hospital, surgery in office, and for imaging. So, no, this one doesn't cover office. This one doesn't have coverage for office.
[CUSTOMER][NEUTRAL] OK, so maybe the claim was mailed and then maybe not put into the system because it was rejected, do you think that's a possibility?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, we will not reject automatically. We will get the claim and we will reject it saying that it's not covered under the patient's plan. Um, but um, yeah, I'm not sure, but yeah, it doesn't cover office for this one, but yeah, most of our products do. This one just doesn't have that right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, well, I think at this point the easiest thing to do might be to um contact the patient to get updated insurance information or maybe just even bill it to him so he'll call in and provide the correct information if he does have coverage in some other way. OK, well, may I get your name and a call reference number just so I can document my findings.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Sure. My name is [PII]. That[PII].
[AGENT][NEUTRAL] And we don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK great alright thank you so much for your help today I appreciate your time.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome and thank you for calling ATO. Have a good day.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] You too bye bye.