AccountId: 011433970860
ContactId: b21294d9-f286-4378-9f7f-f6d4a6fff2c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 709159 ms
Total Talk Time (AGENT): 297257 ms
Total Talk Time (CUSTOMER): 229725 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/b21294d9-f286-4378-9f7f-f6d4a6fff2c2_20250319T21:09_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, I, I was following up on um a couple of uh claims that we put in with you guys and you guys sent us a a letter saying you received it and you're just working on it and stuff like that so I just wanted to see if I can get an update on what's going on.
[AGENT][POSITIVE] OK, well, I'll be more than happy to check um for you and provide you with an update. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes [PII].
[AGENT][NEUTRAL] Thank you for that and may I have, um, can you spell your first name for me? I'm sorry.
[CUSTOMER][NEUTRAL] It's all right, uh, [PII] or [PII]?
[AGENT][NEUTRAL] And [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Um, yes, hold on one second, I where do I have that.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] See here.
[CUSTOMER][NEUTRAL] Alright, um, the policy number or when I'm sorry, you want my, my wife's ID number, is that what you mean, or?
[CUSTOMER][NEUTRAL] That what you mean by policy number?
[AGENT][NEUTRAL] Yes, the the APL policy number?
[CUSTOMER][NEUTRAL] Oh gosh, I don't know if I have an APL one we're through, um.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, what's our insurance company?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Yeah, we're through uh PHCS but um they use you guys for.
[AGENT][NEUTRAL] Oh, OK, you
[AGENT][NEUTRAL] You may be calling the wrong, OK, so are you trying to reach 90 degree benefits?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I don't know. I just got a letter from you guys saying that you're working on um our.
[CUSTOMER][NEUTRAL] Uh, claims
[CUSTOMER][POSITIVE] And so I just wanted now P PH uh PHC said and now it, it is now with uh APL so call them and they'll keep you on track. I said, OK.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Is there a reference number on the letter that you received?
[CUSTOMER][NEUTRAL] You know, strangely enough, there's not.
[CUSTOMER][NEUTRAL] Which I thought was kind of odd.
[AGENT][NEUTRAL] Because we're not affiliated with.
[AGENT][NEUTRAL] That's a different insurance company. Um, well, I mean, I, so is the claim, would the claim be under?
[AGENT][NEUTRAL] Is your wife the policyholder or would you be the policyholder?
[CUSTOMER][NEUTRAL] Uh, well, we both are, but it's, uh, my wife is the main one.
[AGENT][NEUTRAL] OK, um, I can look and see if there's a policy here with her first and last name.
[CUSTOMER][NEUTRAL] OK, we can try that or I can give you her uh.
[CUSTOMER][NEUTRAL] A guarantor account ID number.
[CUSTOMER][NEUTRAL] I don't know if that'll help at all, but.
[AGENT][NEUTRAL] It sounds like you're trying to reach another um insurance company because we don't use guarantor we don't use guarantor IDs.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was so they transferred you to us?
[CUSTOMER][NEUTRAL] No, no, no, I, I got your letter and I called the [PII] number at the bottom.
[AGENT][NEUTRAL] And it's [PII] or [PII]?
[CUSTOMER][NEUTRAL] It says here at the bottom [PII].
[AGENT][NEUTRAL] OK, so there's a claim here. Um, may I have your wife's first and last name?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] I'm sorry, yeah, we're from Business Workers of America Association that's what it is.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm still gonna check and see if she has a policy here with us, um, and then I'll be able to help you if we do. If not, I'll be more than happy to get you to.
[CUSTOMER][NEUTRAL] Well, it, it, it wouldn't, it, it wouldn't be a policy, it'd be a claim.
[AGENT][NEUTRAL] Right, but the claim, you, you file a claim.
[CUSTOMER][NEUTRAL] My, my, yeah, my company BWA uses you guys for claims and the, you know, you take a bill that we give you and you go there and fight for it to lower it that kind of thing.
[AGENT][NEUTRAL] Right, but it's due to an insurance policy that you're filing a claim for, so I'm looking to see if you have a policy with us.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh OK, got you, yeah.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] I think I just located it. Hold on one second.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK. And um can you verify your um date of birth and your mailing address?
[CUSTOMER][NEUTRAL] Uh yeah, mailing address is [PII].
[CUSTOMER][NEUTRAL] I'm sorry. Well, you may have in the in the system [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and uh, and then what else do you need? Date of birth? My wife's date of birth is [PII].
[AGENT][NEUTRAL] Date of birth and your email address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And email is [PII].
[AGENT][NEUTRAL] Thank you for that. And then what is your date of birth?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And so the claim, is it for your wife or would it be for you, just so I know who to go under?
[CUSTOMER][NEUTRAL] It's from, uh, it was uh a big bill from Providence for like uh 16,000 drop they dropped it down to 13 because they my insurance company paid some of it. Then there was the other like I said that remaining $13,000 that was.
[CUSTOMER][NEUTRAL] That we sent to you guys.
[CUSTOMER][NEUTRAL] To get worked on
[AGENT][NEUTRAL] Is it, so it's a claim for your wife?
[CUSTOMER][NEUTRAL] Uh huh, correct, and there's actually two of them. One's for 1700 and the other one was the 13,000 instant change.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 2, OK.
[AGENT][NEUTRAL] Hold on one moment let me see what this is.
[AGENT][NEUTRAL] OK, so it's, so this is um
[AGENT][NEUTRAL] So we're needing other documents. So it's not legible. It says claim information received, unable to process as copies could not be read. Um, let me see if it came in darker. Let me try to give you some type of explanation. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And are you guys in conversation with Providence so they know that you guys are working on that stuff?
[AGENT][NEUTRAL] Um, so we send out explanation of benefits, but since you filed this claim, the explanation of benefits went to you.
[CUSTOMER][NEUTRAL] OK, but you guys are talking to Providence though, right? to negotiate this and to work it out? Have you already begun a conversation with them?
[AGENT][NEUTRAL] No, no, no, that's not how that works. So when you file a claim, we process our claim based on your, your benefits on your policy and then we send it back. What this is saying is we can't process it because we can't read it.
[CUSTOMER][NEUTRAL] 00 got you.
[CUSTOMER][NEUTRAL] I'm sorry, now I understand you, OK.
[AGENT][NEUTRAL] So let me see, I'm trying to pull up the documents to see what, sometimes they come in like really dark so I can let you know what
[AGENT][NEUTRAL] What it looks like so we can try to fix it.
[AGENT][NEUTRAL] It's coming up now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think it's probably a list of all the things that they did uh for my wife at the hospital.
[AGENT][NEUTRAL] OK, here we go. So if the, um, we'll need the
[AGENT][NEGATIVE] It looks like this has explanation of charges, but it is hard to read, it's like pixelated.
[CUSTOMER][NEUTRAL] Oh brother.
[CUSTOMER][NEUTRAL] That figures.
[AGENT][NEUTRAL] So it looks like this was the the um the billing.
[CUSTOMER][NEUTRAL] OK, alright, well I definitely have that.
[AGENT][NEUTRAL] But I will point this out to you.
[AGENT][NEUTRAL] They may, so with what this looks like and from what what I can see because I see the procedure codes and everything.
[AGENT][NEUTRAL] You may want to reach out to Providence and is Providence a hospital or a like a doctor's office?
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] It's both.
[CUSTOMER][NEUTRAL] But this was uh through uh the hospital.
[AGENT][NEUTRAL] So I would
[CUSTOMER][NEUTRAL] And I have the print out of there all the things they sent me a copy of it.
[AGENT][NEUTRAL] I will reach out to Providence and I will ask them for a universal bill. The universal bill is the bill that this explanation of charges is generated from, but you see how it only shows the procedure code, that's basically telling us what treatment she received and what y'all paid for. We need the diagnosis code, which is what the diagnosis was, the medical necessity for this treatment and what you paid for.
[AGENT][NEUTRAL] So that's the difference between the patient bill and the bill that we're asking for.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK, so it's called the universal what?
[AGENT][NEUTRAL] Yes, a universal bill or a UBO4.
[CUSTOMER][NEUTRAL] Universal bill or UB04.
[AGENT][NEGATIVE] And and just stress to them that it needs to have the diagnosis codes, the procedure codes, and then all the charges for this data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, diagnosis code.
[CUSTOMER][NEUTRAL] Uh, procedure code which you have that already and what else?
[AGENT][NEUTRAL] Diagnosis and all the charges.
[CUSTOMER][NEUTRAL] OK, yeah, this is already broken down on there. OK, so you need a you need a UBO for a universal bill.
[AGENT][NEUTRAL] Right, uh, the hospital's version of the billing versus the patient, so it has everything on there.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, this says it's from Providence, but you're, but you're still missing information.
[AGENT][NEUTRAL] Right, it is from Providence, but this is your patient bill, so it only shows what she received and what she paid for, not why. We need to know why to prove necessity.
[CUSTOMER][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] That makes more sense. I wish they would have told me that weeks ago, but alrighty then.
[AGENT][NEUTRAL] Alrighty, so as soon as we receive it, we will go ahead and um continue processing, but yeah, they usually can email that to you, um.
[CUSTOMER][NEUTRAL] What am I gonna do?
[CUSTOMER][POSITIVE] OK good that'll help.
[AGENT][POSITIVE] And then you'll be able to send it electronically. So hopefully that'll be faster.
[CUSTOMER][POSITIVE] Yeah, in theory it should be correct, yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Yeah, alright, awesome, then I will do that in just a second here. I appreciate the help. Thank you so much.
[AGENT][POSITIVE] You're very welcome, Mr. [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Um, no, I think we're at this point we're good.
[AGENT][POSITIVE] Alrighty. Well, thank you for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Alright thank you ma'am you too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][POSITIVE] Alrighty bye bye.