AccountId: 011433970860
ContactId: b7504f99-58ef-44f7-ae46-5625ed9b6dbb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 852940 ms
Total Talk Time (AGENT): 530598 ms
Total Talk Time (CUSTOMER): 229316 ms
Interruptions: 5
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/b7504f99-58ef-44f7-ae46-5625ed9b6dbb_20250124T13:48_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting APO. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Good morning, [PII]. Happy Friday.
[AGENT][NEUTRAL] How are you doing?
[CUSTOMER][NEUTRAL] Oh, nothing much, just sitting here twiddling my thumbs. What you doing?
[AGENT][NEGATIVE] Yeah, I know that's not true.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I'm ready for [PII].
[AGENT][NEUTRAL] Oh, I know. Tell me.
[CUSTOMER][NEUTRAL] Um, I've got an insured on the line. Can you check a claim? Something doesn't, something seems a little off.
[AGENT][NEUTRAL] Yeah, of course. What's the policy number?
[CUSTOMER][NEUTRAL] 161
[CUSTOMER][NEUTRAL] 852-2
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this is uh
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK. And what, uh,
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] Yeah, [PII], yeah, um, she is calling, so she called in last week or so and regarding claim number 3541279 she never received it.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, I'm, I'm sorry, [PII], what's the, what's the claim number again? I, I do apologize.
[CUSTOMER][NEUTRAL] So that has been sent.
[CUSTOMER][NEUTRAL] You can't follow me at the speed of light. I did, I did say that so quick. I'm sorry.
[AGENT][NEUTRAL] 3541279, right? That's the one.
[CUSTOMER][NEUTRAL] Yeah. Oh my gosh, I can't believe I said that so quick.
[AGENT][NEUTRAL] No, no, that's fine. That's the one from December, isn't it?
[CUSTOMER][NEUTRAL] Yeah, and so we voided the check. Now this new claim that was just processed 3554232.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Looks like the same claim, but it's not for the same amount.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So to check on that old claim, I had to go to Ouch to figure out how much it was exactly, and the check for the old claim was 172.93.
[AGENT][NEUTRAL] Ah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] Wonder, OK, OK.
[CUSTOMER][NEUTRAL] So she's wondering is this a new claim? Is it a different claim is and I did check the hub request and it was.
[CUSTOMER][NEUTRAL] Complete, but then when I'm looking at an M track I don't see a void check, you know how you can see that it's voided.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] On the
[CUSTOMER][NEUTRAL] 3541279
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Does it seem odd to you?
[AGENT][NEUTRAL] Like it's the same
[AGENT][NEUTRAL] OK. All right. OK, so, OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] 9301.
[AGENT][NEUTRAL] OK, so it looks to me like it should have been 9293.
[AGENT][NEUTRAL] So, OK, so, so, OK, so let me, let me, let me go to the actual real to the thing because it looks like there's 3 charges on here. Let me just, let's see if we can get this.
[AGENT][NEUTRAL] Sorry, my brain is not functioning before.
[CUSTOMER][NEUTRAL] I know, I need another cup of coffee.
[AGENT][NEUTRAL] I know and like.
[CUSTOMER][NEUTRAL] I think I need another pot. What am I saying?
[AGENT][NEUTRAL] I know like we just need to go to Starbucks and just have it, you know, intravenously. OK, 12124212. OK, so let me.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, let's just look at the claim itself. Let's just go to the claim itself, OK.
[CUSTOMER][NEUTRAL] So if we voided that check and we issued it for a different amount.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] OK, so it looks, uh, let's see what the original one was OK, because it looks to me like there are three charges. So there's 99205, a facility bill and 93,010.
[AGENT][NEUTRAL] OK, 99385. I knew that there was something, a cat got up on my desk and put his butt in my, in my yogurt. OK, so, uh, 99.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] 385. That's what I'm seeing. OK, so that was, I bet because that wasn't uh paid. I bet that's why she didn't add it again.
[AGENT][NEUTRAL] OK, so let's see what we've got here.
[AGENT][NEUTRAL] uh
[AGENT][NEUTRAL] OK, so the first charge would have been, OK, so that was the um uh
[CUSTOMER][NEUTRAL] You know what it looks like there's some charges on here that aren't on that new claim.
[AGENT][NEUTRAL] Yeah, so it's so because I think they weren't the ones that were being paid. It looks to me like, OK, so, so the first one that I talked about 99385, um, that was paid at 100% and it's and it and it looks like she even put it down as being uh a duplicate, so it'd been paid before.
[AGENT][NEUTRAL] Now, the next one is for Quest Diagnostics, and that would have been paid.
[AGENT][NEUTRAL] In full, so that is not on here. Let's just see if I can go on here. But I think labs, do you see where it says labs? So she didn't add the labs because they were all paid in full. So let's go down to the next one.
[AGENT][NEUTRAL] I think what she did was she only, OK, so here's the next one. OK. All right. Yeah. OK.
[AGENT][NEUTRAL] Its go on here. OK. [PII], 99213.
[AGENT][NEUTRAL] Let's look at that one. OK, so 9.
[AGENT][NEUTRAL] 9, darn it. 99213.
[CUSTOMER][NEUTRAL] [PII] is good. The office is isn't covered.
[AGENT][NEUTRAL] The office visit is not covered. OK, so we're, so we're good on that.
[AGENT][NEUTRAL] Uh, the next one, OK, we have Quest Diagnostics again, again, not being paid.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then there should be a charge from for [PII].
[AGENT][NEUTRAL] Yeah, yeah, that's what I'm looking for. I'm looking for Orlando Health, uh, [PII] and this Shinn guy. So let's just see, because what it looks like to me is that rather than going through the whole claim, which I, you know, I, I get, um, she, uh, here we go. OK, here's, I bet this is where we are. OK, so [PII], right? So this is, this is one that can be paid, that's 1293.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. This is for 93,010. OK, so that's 930, yeah.
[CUSTOMER][NEUTRAL] Which is
[CUSTOMER][NEUTRAL] Well she paid that one on this claim.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, ma'am. Yes, she did. Um, so, uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], whatever his name is.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Well, she paid that.
[CUSTOMER][NEUTRAL] But out on the new claim.
[AGENT][NEGATIVE] I don't think she's supposed to pay it at all.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Shoot.
[AGENT][POSITIVE] Good heavens, all right.
[AGENT][NEUTRAL] It's confusing because it looked OK, so we have the one that she, that she, uh, that was voided and that's 33 things.
[AGENT][NEUTRAL] Because I don't think this this policy covers office visits, so she may not, I bet that's where we have our.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] If it, if it's not for cancer treatment, she does have a cancer treatment. I see that one claim was paid for [PII] for 80.
[AGENT][NEUTRAL] I think that
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so in that case, then, OK, in that case, it could have been paid to.
[CUSTOMER][NEUTRAL] I don't know this one just.
[CUSTOMER][POSITIVE] Bless your heart.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so, OK, so we do, OK, we do have a cancer treat. OK, so, so the $80 would have been paid plus the $1293 OK? And now we're going to Orlando Health, uh, REG.
[AGENT][NEUTRAL] And that would have been
[CUSTOMER][NEUTRAL] Well she paid $80 for that one on [PII].
[AGENT][NEUTRAL] So it looks to me like the only two.
[CUSTOMER][NEGATIVE] I can't figure out how she paid it.
[AGENT][NEUTRAL] I think what I think what is, I think what the confusion is, so the original check, if I'm looking correctly, was the original check 93.
[CUSTOMER][NEUTRAL] Hm. The original check was 17293.
[AGENT][NEUTRAL] Oh good grief. OK.
[CUSTOMER][NEUTRAL] Yeah, it's a long way from 92.
[AGENT][NEUTRAL] OK, so what
[CUSTOMER][NEUTRAL] 93.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To me, for me, it is.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, wait a minute.
[AGENT][NEUTRAL] so
[CUSTOMER][NEUTRAL] So it's that $80 charge is the difference.
[CUSTOMER][NEGATIVE] Oh man, she hung up.
[AGENT][NEUTRAL] OK, yeah, so it is the $80 charge that's the difference. So, um, OK, so.
[AGENT][NEUTRAL] So let's see.
[AGENT][NEUTRAL] 18532.
[AGENT][NEUTRAL] OK, so 172, OK.
[AGENT][NEUTRAL] 172.
[AGENT][NEUTRAL] 93 minus OK.
[AGENT][NEUTRAL] Well, um, I'm not seeing what it is right now, uh, right off the bat because it's $80. So on this very first one, there was, there was a, OK, let's look and see what she actually paid. So she paid [PII], OK, she paid, OK, so we're looking on here, she paid [PII] $80. OK, we're the thing for on the original claim, right, now on the facility bill.
[CUSTOMER][NEUTRAL] On the original claim, not on the, yeah.
[AGENT][NEUTRAL] For uh [PII].
[AGENT][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] That looks good because she paid the $80 on it.
[AGENT][NEUTRAL] OK, so let me get down to that. I see. OK, so she paid the $80 on that. Now the next one is at $1293 which we know that she paid. I just got through looking at that. So we've got $80 twice, $1293.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, what it looks like is, as you say, I think what ends up happening that the $90 for, um,
[AGENT][NEUTRAL] Oh, [PII], how did you lose that?
[AGENT][NEUTRAL] I think on the new one that she did.
[CUSTOMER][NEUTRAL] So she's saying.
[AGENT][NEUTRAL] She didn't
[CUSTOMER][NEUTRAL] What? What? OK, so on the new claim, she denied that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] [PII], that's what she did. She denied [PII].
[CUSTOMER][NEUTRAL] You can pay to the provider.
[AGENT][NEUTRAL] Was it paid to the provider? Did she already did?
[CUSTOMER][NEGATIVE] That's her denial.
[AGENT][NEUTRAL] Well, OK. So, you know, I wonder if it was a mistake because I, I did that one time before and it's confusing because um I made a mistake on a claim and then what ended up happening is that uh when the check wasn't uh 99205.
[CUSTOMER][NEUTRAL] Maybe claim number 353-3465.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] 533465. OK, so that was, maybe she made a mistake.
[AGENT][NEGATIVE] Jeez.
[AGENT][NEGATIVE] I think she made a mistake. That's what happened. OK, yeah, that's what it is. OK, so we're looking at 3533465. All right, OK, so that's for Orlando Health Medical Group, right, for 99205. That's the mistake. So when this was first done, 99205 should not have had that $80 paid.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] So I think that's why you.
[CUSTOMER][NEUTRAL] If that is in fact for [PII], have you got the claim pulled up?
[AGENT][NEUTRAL] I've got the, I've got 9, I've got 353-3465 pulled up. Is that what you're looking at?
[CUSTOMER][NEUTRAL] Yeah, I don't have it in on base. Is that for [PII].
[AGENT][NEUTRAL] No, this is for the, uh, wait a minute. Orlando Health, uh, yeah, hang on a second. Let's see. We get to that.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Because on the [PII] they have it listed as Orlando Health, but on this one.
[AGENT][NEUTRAL] Yeah, yeah, it's
[CUSTOMER][NEUTRAL] It is for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK, OK, OK.
[AGENT][NEUTRAL] Yes ma'am, it is [PII] 9-13-2024, um, CPT 99205 with a payout of $80. That's the difference, OK.
[AGENT][NEGATIVE] So what ended up happening is on the one that she processed back, they didn't get the check for, it looks to me like she paid them this, this, the insured this $80 which she shouldn't have because it's already been paid to the provider. So Orlando Health Medical Group.
[AGENT][NEUTRAL] Claim 3533.
[CUSTOMER][NEUTRAL] For data service, yeah, for data service 9:13, not 920.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, I've got the one. OK, so on, on the new claim, on the new claim 9-13-2024, it looks like she had originally paid that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] $80 but she shouldn't have because that had already been paid out to Orlando, whatever it is. It already been paid out to this, so when she redid it.
[AGENT][NEUTRAL] When she redid it, she realized her mistake or had been pointed out, and that's the difference between those two. So if whenever at least whatever her name is, calls back, that's gonna be that.
[CUSTOMER][NEUTRAL] She realized her mistake.
[CUSTOMER][NEUTRAL] I'm gonna have to call her. I'm, I'm not gonna wait for her to call back.
[AGENT][NEUTRAL] OK, well, that, that is, just tell her that that is what the original check that was sent out. That, that's what I'm finding on this [PII] is that the original check that 99205 had already been paid to to the provider and then uh whenever, whoever this is, I don't know who this is, uh, paid it again, um, that's what happened. So that's the difference in the, in the checks.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And it's uh, yeah, now, is, is there anything else? Are we, are we good? Are we, uh,
[CUSTOMER][NEUTRAL] I will, I will find out when I call her back.
[AGENT][NEUTRAL] OK, OK, yeah, yeah, OK, if there's anything else I can help with and that's, but that's what I'm finding on this.
[CUSTOMER][POSITIVE] OK, thanks [PII]. I appreciate it. Let me give her a call back real quick. Take care. Have have a good weekend.
[AGENT][NEUTRAL] OK. You bet.
[AGENT][NEUTRAL] OK, let's hear from you later to.