AccountId: 011433970860
ContactId: c598c0e3-e078-415c-bcb7-05f9e103c624
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413679 ms
Total Talk Time (AGENT): 199688 ms
Total Talk Time (CUSTOMER): 182289 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/c598c0e3-e078-415c-bcb7-05f9e103c624_20250410T17:34_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes [PII] this is uh is multi plan with APL.
[AGENT][NEUTRAL] Uh, Multiplan is the network company for some of our members.
[CUSTOMER][NEUTRAL] Got you. OK, let's check and see if it's more with this.
[AGENT][NEUTRAL] But we are not multi-plan.
[CUSTOMER][NEUTRAL] Yeah, I know, uh, this is what I found on the back of the card. Let's check to see if much plan is one of your pricers or payers. How about that? And your name again? I'm sorry.
[AGENT][NEUTRAL] Yes ma'am. Oh.
[AGENT][NEUTRAL] It's [PII], and who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII] and I'm a provider rep trying to check and see why this claim was not paid.
[AGENT][NEUTRAL] OK, [PII]. So your name, you did say your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am, and [PII].
[AGENT][POSITIVE] OK, thank you. And your
[CUSTOMER][NEUTRAL] Provide a rap.
[AGENT][NEUTRAL] OK, and you're calling to find out to get claim status from APL is that correct?
[CUSTOMER][POSITIVE] Yes, ma'am. Yes, yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] [PII] secure line directly to me.
[AGENT][NEUTRAL] Thank you. And then what is the member's policy number?
[CUSTOMER][NEUTRAL] I have and I hope it's correct, honey, 0202544749.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you, so give me a moment [PII] to get the member's information pulled up please.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And pending any information that I do provide today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth [PII], I'm sorry, [PII].
[AGENT][NEUTRAL] Thank you. And then what is the date of service and total bill amount that you're calling about?
[CUSTOMER][NEUTRAL] Uh, [PII]:30, 2024, 1 day, we built an outpatient claim for $1,797.
[AGENT][POSITIVE] OK, thank you. Give me just.
[CUSTOMER][NEUTRAL] And would you like the MPI or the hospital name or whatever?
[AGENT][NEUTRAL] Mm, not yet. Give me just a moment to look for the data service first.
[CUSTOMER][NEUTRAL] Yeah, because you got multi plan whatever they did, they didn't pay on it.
[AGENT][NEUTRAL] OK, so I do see that we did receive a claim here at APL for that data service and that total bill amount. The claim number [PII] is 356.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hang on a minute, let me, uh, get that. I apologize.
[AGENT][NEUTRAL] 01
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Claim number is 356.
[AGENT][NEUTRAL] Uh-huh. 0140.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] North Carolina Baptist Hospital.
[AGENT][NEUTRAL] OK. So yes, ma'am, this policy, or excuse me, this claim was denied.
[AGENT][NEUTRAL] And the reason for the denial on it states our records indicate that premium for this service state was not received. Therefore, benefits are not payable. This policy termed with APL as of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] term date [PII]. Got you.
[AGENT][POSITIVE] Yes, ma'am. That is correct.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] She's gonna get billed for that because I have nothing else. Let me check my registration but.
[CUSTOMER][NEUTRAL] Yeah, I have Blue Cross and Blue Shield PPO and Multiplan.
[CUSTOMER][NEUTRAL] And that's all I have in your APL right? and.
[AGENT][NEUTRAL] Yes, ma'am, and we do not have another policy active for her beyond the [PII] date of termination.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Wait a minute.
[CUSTOMER][NEUTRAL] It shows.
[CUSTOMER][NEUTRAL] OK, so she turned 121, yeah, because I fed it down on here. All right, I'll uh go ahead and turn it and then ARP it to the patient. And uh may I have a uh
[AGENT][NEUTRAL] Reference number?
[CUSTOMER][NEUTRAL] Yeah, hang on a minute. Let me that this really that balance and a reference number for the call, please and thank you.
[AGENT][NEUTRAL] Yes ma'am, uh, you're welcome, and you're gonna use my name in today's date, [PII], as your call reference number and then one last thing with a with, with APL we do have a portal that you should be able to check claim status and also for once we've processed the claim our portal website is secured.
[CUSTOMER][POSITIVE] No problem, I can do that.
[CUSTOMER][NEUTRAL] Oh really? What is it?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Secure. PL.
[AGENT][NEUTRAL] A.
[AGENT][NEUTRAL] [PII] no, let me start over, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII] like [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] [PII]. [PII]. Yes ma'am, it's a self registering portal.
[CUSTOMER][NEUTRAL] Do you have to register?
[CUSTOMER][NEUTRAL] OK, well I can do that [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With a
[AGENT][POSITIVE] Yes, ma'am, but make sure the word [PII] has a D on it. It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Oh, [PII], got you.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][POSITIVE] Got it. I'm trying to write down all these. I'm gonna start signing up for these little rascals.
[AGENT][NEUTRAL] All right. Well, Ms. [PII].
[AGENT][NEUTRAL] There you go.
[CUSTOMER][NEUTRAL] But see we still have to call and make sure you know if we got something like denied, you know.
[AGENT][NEUTRAL] Absolutely, and you can still do that. Mhm. Sure. No, you can still call, but the portal is also there, you know, if you needed a copy of an explanation of benefits or something like that, once you have a claim number, you should be able to print it from there if we've processed the claim.
[CUSTOMER][POSITIVE] Oh, well, I appreciate it, honey, you have a great day, bye.
[AGENT][POSITIVE] Well, yes, ma'am, you too. Bye-bye, if that's all I can help you.