AccountId: 011433970860 ContactId: ae240906-3a06-4708-b0c9-4be465df94ed Channel: VOICE LanguageCode: en-US Total Conversation Duration: 2030589 ms Total Talk Time (AGENT): 450013 ms Total Talk Time (CUSTOMER): 660519 ms Interruptions: 0 Overall Sentiment: AGENT=0.4, CUSTOMER=0.3 Redaction Types: PII Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/ae240906-3a06-4708-b0c9-4be465df94ed_20250129T17:29_UTC.wav -------------------------------------------- [AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you? [CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling from provider's office to check on the denial status of the claim. [AGENT][NEUTRAL] OK [PII], can I get a good call back number? [CUSTOMER][NEUTRAL] Yes, my callback number, that would be [PII]. Uh just a second. Just a second. [CUSTOMER][NEUTRAL] Yes, my callback number, that would be [PII]. [AGENT][NEUTRAL] OK, thank you, [PII]. Can I get the policy number please? [CUSTOMER][NEUTRAL] Uh, yes, the policy number of the patient, uh that would be. [CUSTOMER][NEUTRAL] Uh, that is a benefit certificate number. That is the policy number, right? [AGENT][NEUTRAL] Yes, sir. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Uh, here, there are two, policy number is listed on this patient. Uh, so I will go through first one that is 08. [CUSTOMER][NEUTRAL] Sorry, just a moment. I have it here. [CUSTOMER][NEUTRAL] Yeah, OK. 01846260. M as in Mike, L as in Lima, 8. [AGENT][NEUTRAL] OK, thank you, [PII]. Can you confirm the insured's name and date of birth for me? [CUSTOMER][NEUTRAL] Yes, sir, that is uh [PII], and the date of birth of this member that is [PII]. [AGENT][NEUTRAL] OK, thank you, and you said you're calling to check the claim status? [CUSTOMER][NEUTRAL] Uh yes. [AGENT][NEUTRAL] OK, I can definitely take a look. What's that data service and build amount? [CUSTOMER][NEUTRAL] The, the date of service that is [PII] and the total bill amount for this patient, uh, [CUSTOMER][NEUTRAL] $11,348.15. [AGENT][POSITIVE] OK, thank you. [AGENT][NEUTRAL] OK, it doesn't look like we have a claim on file. [CUSTOMER][NEUTRAL] Uh, there is no claim on file? [AGENT][NEUTRAL] No, sir. [AGENT][NEUTRAL] Would you like to confirm the claim's mailing address? [CUSTOMER][NEUTRAL] Uh, uh, uh, the claim numbers, uh, having only 7 digits, right? [AGENT][NEUTRAL] Um, do you have a claim number? [CUSTOMER][NEUTRAL] Yes. [AGENT][NEUTRAL] OK, what claim number do you have? [CUSTOMER][NEUTRAL] 7 digit claim number. [CUSTOMER][NEUTRAL] That is 353-676-3. [AGENT][NEUTRAL] OK, let's see. [AGENT][NEUTRAL] OK, so that, that data service is 1029, not 1028. [CUSTOMER][NEUTRAL] No, that, that is, uh, yes, uh, that, that is only the date of service. Uh, sorry for my mistake. [PII]. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] So that claim. [AGENT][NEUTRAL] Was received on [PII] processed the same day. [CUSTOMER][NEUTRAL] But [CUSTOMER][NEUTRAL] Uh, received and processed the same, right? [PII]. [AGENT][POSITIVE] Yeah, decent. [AGENT][NEUTRAL] [PII]. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] It processed and paid $463.10. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] And I do have a check number for you? [AGENT][NEUTRAL] The check number is 2016685. [CUSTOMER][NEUTRAL] 2016685. This is EFT payment or check payment, check number, right? Is that uh [AGENT][NEUTRAL] It's uh [AGENT][NEUTRAL] It's a, it's a single check and the check cleared on [PII]. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK. It was clear and cash on the same date, right? [AGENT][NEUTRAL] On [PII]. [CUSTOMER][NEUTRAL] OK. Is on? [AGENT][NEUTRAL] [PII]. [CUSTOMER][NEUTRAL] Uh, is there any patient responsibility on this claim apart from that $463? [AGENT][NEUTRAL] I [AGENT][NEUTRAL] That's gonna be it from the provider or the facility to determine whether there's a balance of patient responsibility or provide a write off. [CUSTOMER][NEUTRAL] OK. Uh, what happened, you know, like, uh, initially, uh, you guys have processed this claim as a secondary, right? [AGENT][NEUTRAL] Yes, this is a secondary supplemental policy. [CUSTOMER][NEUTRAL] Uh, according to that primary, you'll be, uh, you guys, uh, pay only like $463.10. So remaining, because, uh, that the primary has uh uh applied patient responsibility of $978.50 but we have received only $463.10. So, may I know the reason for this uh remaining 500. [CUSTOMER][NEUTRAL] $15.40 because in that EOB there is no uh you guys are not mentioned remaining amount is applied towards uh uh patient responsibility or right off in the EOB. So just we are uh uh uh seeing that whatever the amount is paid by the insurance, but there is uh no information we are, yes, please, please go ahead. [AGENT][NEUTRAL] This is [AGENT][NEUTRAL] This is the max this is the max benefits that can be paid for this data service for the policy, so any balance that is remaining, it's gonna be up to the provider or the facility whether or not the patient can be billed as patient responsibility or whether or not it's gonna be provider write off. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Then the remaining balance it should be uh applied towards the provider's discount, right? [AGENT][NEUTRAL] That's gonna be up to the provider or the facility. APL cannot advise that information. [CUSTOMER][NEUTRAL] OK. Uh, then we are, we are not able to build this balance, remaining balance to the patient, right? [AGENT][NEUTRAL] That's gonna be up to the provider or the facility. APL cannot advise this information. [CUSTOMER][NEUTRAL] OK. Just a moment. [CUSTOMER][NEUTRAL] You guys allowed and paid maximum benefit uh for this uh patient, right? [AGENT][NEUTRAL] For that data service, yes sir. [CUSTOMER][POSITIVE] Allowed and paid maximum benefits. [AGENT][NEUTRAL] Oh [CUSTOMER][NEUTRAL] Uh [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] Uh [CUSTOMER][NEUTRAL] Uh, just give me one moment. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Just give me one moment. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Uh [PII], uh, thank you for bearing with me. Uh, may I have the complete, uh, detailed UOB because whatever the UOB we have, no, that was incomplete UB we have. [CUSTOMER][NEUTRAL] Uh, in that EOB there is only paid amount is mentioned on that, uh, EOB. So, the remaining amount, you are saying like uh remaining amount is applied towards the facility or provider, uh, discount. So, uh, it should be mentioned in that UB. So I need a clear uh UOB for this, uh, for the course of action. Do you have that UB with you? [AGENT][NEUTRAL] OK, so the EOB that you were saying, it's gonna be the complete EOB. I can send you that same EOB. We're not gonna have an EOB that tells you that the remaining balance should be provider write off or patient responsibility because like I said, APO cannot advise that information so the only EOB that you're gonna get is showing the payment. [CUSTOMER][NEUTRAL] Uh huh. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] There's not gonna be a, there's not gonna be an EOB showing a discounted. [CUSTOMER][NEUTRAL] Uh, yes, yes. [AGENT][NEUTRAL] Um, discounted rate or contractual rate. [CUSTOMER][NEUTRAL] So, what is the solution for that to take a course of action on this patient account? Because without having that, uh, because what happens, you know, this is a confidential information or without uh before taking any adjustment or before taking any uh uh uh uh billing to the patient or uh for anything, before taking any uh uh actions on this account, we need a clear UOB. [AGENT][NEUTRAL] That's like [AGENT][NEUTRAL] You'll have to speak with your billing supervisor regarding the remaining balance whether or not you're gonna bill the patient or do provide a write off regarding the facility or the provider if that's something that you guys wanna do. [CUSTOMER][NEUTRAL] So that way. [AGENT][NEUTRAL] Because APL cannot advise that information. [CUSTOMER][NEUTRAL] Uh, [PII], one more thing. [CUSTOMER][NEUTRAL] Yes, and one more thing here, I'm seeing one more link uh that uh portal link in the back, uh, in the back of the ID card of this patient that's [PII]. uh [PII]. So if I log in into this means I will get the clear UB or not like just I will get the only payment details or I will get the remaining all the details of the uh claim or not? [AGENT][NEUTRAL] You'll only see the payment. There's not gonna be a contracted rate and there's not gonna be a balance showing that it's patient responsibility or provide a write off. [CUSTOMER][NEUTRAL] OK. Just give me one moment. Just I will, I will go to the, go to my supervisor and just I will uh ask him regarding this. Just, can you please bear with me for two minutes? [AGENT][NEUTRAL] Yes. [CUSTOMER][POSITIVE] OK, thank you. [CUSTOMER][NEUTRAL] Hi, [PII], thank you so much. Uh, so, according to a discussion with my supervisor, they are requesting a UP if that information is available or may not be available, uh, so we need uh uh EOB from that, uh, insurance only, they are asking, so I need an EOB copy of UOB for this patient. [AGENT][NEUTRAL] OK. What is your fax number, [PII]? [CUSTOMER][NEUTRAL] Uh yes, my fax number, that would be uh [CUSTOMER][NEUTRAL] Yes, I'm going to delete the fax number. [CUSTOMER][NEUTRAL] Yes, uh, my fax number that is [PII]. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] And uh, uh, are you guys able to send this EOB through email? [AGENT][NEUTRAL] No, sir. It has to be through facts. So. [AGENT][NEUTRAL] If your fax machine is clear, you should receive it in about 30 minutes. [CUSTOMER][NEUTRAL] 30 minutes, right? [AGENT][POSITIVE] Yes, I'm gonna go ahead and get this taken care of for you. [AGENT][NEUTRAL] It will have the payment on there. [CUSTOMER][NEUTRAL] Uh [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] Um, so I'm getting this together now to go ahead and get it faxed to you. [CUSTOMER][NEUTRAL] Uh, you need, uh, yeah, yeah, OK, you are going to fax it, right? [AGENT][POSITIVE] Yes sir, I'm gonna fax it. um I'm getting it downloaded now to get it together to fax to you. [CUSTOMER][NEUTRAL] Uh. [CUSTOMER][NEUTRAL] OK, OK. You can do the fact for this patient. Uh, I have [CUSTOMER][NEUTRAL] I have 4 more patients. Total, I have 51 is got cleared. Another 4 patients I have. [AGENT][NEUTRAL] Um, [AGENT][NEUTRAL] Let's see. [AGENT][NEUTRAL] OK, [PII], this fax has been sent, so you should receive it, like I said in about 30 minutes. [CUSTOMER][NEUTRAL] Oh OK. [AGENT][NEUTRAL] What is that next policy number? [CUSTOMER][NEUTRAL] Uh, the call reference symbol will be the same for our, uh, entire call, right? [AGENT][NEUTRAL] Yes, it'd be my name [PII] with the first initial to my last name, [PII], and today's date. [CUSTOMER][NEUTRAL] OK, [PII]. [CUSTOMER][NEUTRAL] Uh [CUSTOMER][NEUTRAL] Just uh uh I have still on that account, right? Just I need some more in, no, no, OK, OK. I have, I have that uh received it and process it the same. [AGENT][NEUTRAL] Yes. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK. I'm moving towards the next one. [CUSTOMER][NEUTRAL] Uh yes. Uh, the next patient ID number, that would be. [CUSTOMER][NEUTRAL] [PII]. Same patient I think this one is. [CUSTOMER][NEUTRAL] Yes, same patient, different date of service. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] What's the data service and build amount? [CUSTOMER][NEUTRAL] Uh, that is [PII] and the total bill amount for this one. [CUSTOMER][NEUTRAL] That is $15,382 even. [AGENT][NEUTRAL] Do you have a CPT code or no? I don't think so. Let's see. [CUSTOMER][NEUTRAL] Yeah [AGENT][NEUTRAL] Give me just a second. [CUSTOMER][NEUTRAL] [PII] 6, 2024. [CUSTOMER][NEUTRAL] Uh, the claim number, wait, I will, I will go with the claim number. Uh, it will be the very useful, eas easiest way for you also. OK, I have the claim number. Can I go with the claim number? [AGENT][NEUTRAL] Bear with me for just a minute. [AGENT][NEUTRAL] Yeah. [CUSTOMER][NEUTRAL] 352-630-4. [AGENT][NEUTRAL] OK, I thought that was it. [AGENT][NEUTRAL] OK, so this claim was received on [AGENT][NEUTRAL] 114 2024 processed 11 5 2024. [CUSTOMER][NEUTRAL] Mhm. [AGENT][POSITIVE] It processed and paid. [AGENT][NEUTRAL] $249.75. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] This was a Mac that was allowed for that data service. [AGENT][NEUTRAL] I have a check number. [CUSTOMER][NEUTRAL] Yeah [CUSTOMER][NEUTRAL] Uh-huh. [AGENT][NEUTRAL] Check number 2012005. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] The check was issued on [PII]. Check cleared on [PII]. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Uh, and what is the pay to address? [AGENT][NEUTRAL] Um, Holy Cross Hospital, [PII]. [CUSTOMER][NEUTRAL] [PII]. Just a moment. [CUSTOMER][NEUTRAL] Holy Cross Hospital, [PII]. And the ZIP code is [PII]. Is that right? [AGENT][NEUTRAL] Yes. [CUSTOMER][POSITIVE] OK, thank you. [CUSTOMER][NEUTRAL] And the remaining balance were applied towards the provider, uh, right now, right? Because here also the same thing. [AGENT][NEUTRAL] That's [AGENT][NEUTRAL] That is the same thing it's gonna be up to the provider or the facility to determine whether it's provider write off or patient responsibility. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] It was paid through single check, right? Single check. [AGENT][NEUTRAL] Yes, single check. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Not an EFT, right? [AGENT][NEUTRAL] Not an EFT, it's a single check. [CUSTOMER][POSITIVE] OK. OK. Thank you so much, uh. [CUSTOMER][NEUTRAL] And I have done with this patient, and please send me the copy of you before this one also. So we need a you before this one. [CUSTOMER][NEUTRAL] To the same fax number. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] Give me just a second. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] OK, so that first fax that I sent you? [AGENT][NEUTRAL] It has been that. [CUSTOMER][NEUTRAL] Uh, sorry? Uh. [AGENT][NEUTRAL] That first fax that I sent you? [CUSTOMER][NEUTRAL] Uh-huh. [AGENT][NEUTRAL] It it has went through, uh, it's went through. [CUSTOMER][NEUTRAL] Uh, it's already got, uh, completed, you're saying? [AGENT][NEUTRAL] Yes, yes. [CUSTOMER][NEUTRAL] OK, OK. I will check that one. Just a moment. I will go ahead and I will check that. [AGENT][NEUTRAL] OK, so that fax has been sent. What is the next? [AGENT][NEUTRAL] Membra. [CUSTOMER][NEUTRAL] Uh, uh, we'll check this letter. [CUSTOMER][NEUTRAL] This fax [CUSTOMER][NEUTRAL] Mm, the next member ID number you need, right? [AGENT][NEUTRAL] Yes. [CUSTOMER][NEUTRAL] The next member ID number of the patient. [CUSTOMER][NEUTRAL] 231-728-8. [AGENT][NEUTRAL] Remember's name and date of birth? [CUSTOMER][NEUTRAL] Member name [PII], and the date of birth of this member, [PII]. [AGENT][NEUTRAL] Data service and build amount. [CUSTOMER][NEUTRAL] Date of service [PII] and the total bill amount for this patient. [CUSTOMER][NEUTRAL] 29 $42.91. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] OK, so I have a claim number for you. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] OK, that claim number. [CUSTOMER][NEUTRAL] Just a moment, uh, just a moment, just a moment, because, uh, uh, I don't have the claim status for this. I need to take a complete information on this patient. [CUSTOMER][NEUTRAL] Uh yes. Uh, what is the claim number? [AGENT][NEUTRAL] 349. [AGENT][NEUTRAL] 5359. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] It was received [PII], processed [PII]. [AGENT][NEUTRAL] It was processed and paid in the amount of $500. [CUSTOMER][NEUTRAL] Mhm. [AGENT][POSITIVE] The max benefits that. [CUSTOMER][NEUTRAL] Uh, sorry? [AGENT][NEUTRAL] It was processed and paid in the amount of. [CUSTOMER][NEUTRAL] Allowed? [CUSTOMER][NEUTRAL] Uh-huh. [AGENT][NEUTRAL] $500 that was the max that could be paid for that data service. [AGENT][NEUTRAL] I have the check number. [CUSTOMER][NEUTRAL] $500 right? [AGENT][NEUTRAL] Yes, I have the check number. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Uh-huh. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] So this this check was issued on [PII]. [AGENT][POSITIVE] But it's still outstanding. [CUSTOMER][NEUTRAL] 821-2024. It was issued on, right? [AGENT][NEUTRAL] Yes. [AGENT][NEUTRAL] Let me see if there's any note. [CUSTOMER][NEUTRAL] What is the check number you store? [AGENT][NEUTRAL] 1869311. [CUSTOMER][NEUTRAL] 1869311. OK. [AGENT][NEUTRAL] Um, [AGENT][NEUTRAL] Let's see here. [CUSTOMER][NEUTRAL] May, may I know the reason, uh, reason for the delay for this check? [CUSTOMER][NEUTRAL] Yeah, yeah, it was been like uh [AGENT][NEUTRAL] 316. [CUSTOMER][NEUTRAL] 5 months, I think, 5 more than 5 or 6 months. [AGENT][NEUTRAL] Yeah, I'm trying to see what's going on with it. Give me just a second. [AGENT][NEUTRAL] I'm trying to see if there's any notes in the system. [CUSTOMER][NEUTRAL] Can you please uh go ahead and uh escalate this claim for your supervisor for this reason? [CUSTOMER][POSITIVE] So we can go ahead and we can wait some more days for the payment clear and all. [AGENT][NEUTRAL] Yeah, I'm gonna [AGENT][NEUTRAL] I'm gonna put a stop payment on this check and we're gonna get a check reissued. [CUSTOMER][NEUTRAL] Uh, you are going to reissue the check, right? [AGENT][NEUTRAL] Yeah, we're gonna put a stop payment on this check, put a void on it, and then we're gonna get the check reissued, so I'll get this check um. [AGENT][NEUTRAL] Let me put some notes in the system. Give me just a second. [AGENT][NEUTRAL] And then [AGENT][NEUTRAL] I need the [CUSTOMER][NEUTRAL] OK, you can reissue the check and the what is the payment uh uh pay, pay to address you are having on this check? [AGENT][NEUTRAL] You mean [AGENT][POSITIVE] What now? I'm so sorry. [CUSTOMER][NEUTRAL] Uh, like, uh, uh, what is the pay to address you are having on this check? Uh, you are going to reissue the check, no? So whether that, uh, address, what is the pay to address you, you guys are having that is whether it is correct or not, just I'm verifying that one. [AGENT][NEUTRAL] OK, give me just a second. Let me get these notes in or give me just a second. [CUSTOMER][NEUTRAL] OK, OK. [CUSTOMER][POSITIVE] Take your time. [CUSTOMER][NEUTRAL] Yeah [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] OK, so the pay to address is [PII]. [CUSTOMER][NEUTRAL] Uh, OK. Uh, 35, sorry, uh [PII]. Sorry, what is that one more time, zip code? [PII]. [AGENT][NEUTRAL] [PII]. [CUSTOMER][NEUTRAL] [PII], right? You guys are having? [AGENT][NEUTRAL] Yes, yes. [CUSTOMER][NEUTRAL] Uh, but it should be 31,860, I think. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] It should be [PII]. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] OK, do you need, OK, I'll get that fixed. Do you need a copy of this EOB? [CUSTOMER][NEUTRAL] Yes, yes. [AGENT][NEUTRAL] OK, bear with me for just a minute, let me get that faxed. [CUSTOMER][NEUTRAL] Let's go to it. [CUSTOMER][NEUTRAL] 3 [AGENT][NEUTRAL] No, you're fine. [AGENT][NEUTRAL] OK, this EOB has been faxed. Um, I will put in that request as soon as we hang up to get that check voided and then get a new check out. [CUSTOMER][NEUTRAL] OK. Uh, you, uh, you sent a voided check, uh, already, right? [AGENT][NEUTRAL] I will do that as soon as we hang up the phone because I have to put in a request. [AGENT][NEUTRAL] So what is [CUSTOMER][NEUTRAL] OK, OK. After hang upping the phone, you are going to reissue the check, right? [AGENT][NEUTRAL] Yes. What is the next member I? [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Uh, [CUSTOMER][NEUTRAL] Next member ID number uh [CUSTOMER][NEUTRAL] OK. Uh, I, that, that two patients, uh, uh, I will do it later and I will go ahead and I will call back after some time, uh, because I go, uh, I have some little, I, uh, I met with some little work and I was doing that. So, uh, I will, for that to claim status, I will go ahead and I will call back again. So this is the, yeah, this one is you are going to resue the check for this also, right? [AGENT][POSITIVE] Yes, I will get that taken care of. [CUSTOMER][NEUTRAL] OK. You guys are allowed in the uh the uh uh ready to pay for uh 500 for this patient, right? [AGENT][NEUTRAL] Yes, that's what's set to pay is 500, yes. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK. Uh, what is the turnaround time, uh, to follow up on this claim to know the [AGENT][NEUTRAL] I would allow 30 business days. [CUSTOMER][NEUTRAL] Uh, [CUSTOMER][NEUTRAL] OK. OK. I will go ahead and I will after the uh 30 days of 30, after 30 days, I will uh follow up on this claim for the payment status. [CUSTOMER][POSITIVE] Thank you, [PII]. Thank you so much for your assistance. [AGENT][POSITIVE] OK, great. [CUSTOMER][NEUTRAL] Uh, [CUSTOMER][POSITIVE] Thank you so much for your assistance. Have a nice day. Take care. Bye-bye, [PII]. [AGENT][POSITIVE] All right, thank you. Bye bye.