AccountId: 011433970860
ContactId: d18feac8-77f6-42f7-ac07-93309b8b3fad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 578119 ms
Total Talk Time (AGENT): 157616 ms
Total Talk Time (CUSTOMER): 218721 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/d18feac8-77f6-42f7-ac07-93309b8b3fad_20250521T16:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I am calling from Multi-care Health System, and I'm calling to get some information on some medical claims.
[AGENT][NEUTRAL] OK, I can help you with claim status and do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh yes, [PII].
[AGENT][NEUTRAL] OK, thank you. And the policy number for the patient?
[CUSTOMER][NEUTRAL] It's 025650007.
[AGENT][NEUTRAL] And patient name and date of birth.
[CUSTOMER][NEUTRAL] Uh, [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what is that date of service and bill charges?
[CUSTOMER][NEUTRAL] Um, I have several. The first one is [PII] for 480.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Uh, looks like we received it 33-2025, process 36-2025.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, looks like it's a place of service is why it denied. Um, treatment is covered in emergency room, urgent care facility, physician's office, or physical or occupational therapy, um, facility. Treatment in outpatient hospital is not covered by the policy.
[CUSTOMER][NEUTRAL] OK, outpatient.
[CUSTOMER][NEUTRAL] OK, can you fax or email a copy of the EOB for our records?
[AGENT][NEUTRAL] Uh, sure. What's your facts?
[CUSTOMER][NEUTRAL] It looks the one we had something on file uh.
[CUSTOMER][NEUTRAL] Well this one just says not covered but it doesn't say why patient has a secondary that we want to send these to.
[CUSTOMER][NEUTRAL] I believe so let's see, yeah.
[CUSTOMER][NEUTRAL] Uh, fax number?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is uh what's our fax number 253.
[CUSTOMER][NEUTRAL] 864.
[CUSTOMER][NEUTRAL] 2880 and you can put it attention and.
[CUSTOMER][NEUTRAL] Get there.
[AGENT][NEUTRAL] OK, and what was the other date of service?
[CUSTOMER][NEUTRAL] [PII], 0 wait.
[CUSTOMER][NEUTRAL] Uh, yeah, [PII].
[CUSTOMER][NEUTRAL] Of [PII] for 480.
[AGENT][NEUTRAL] Are these the same type of charges?
[CUSTOMER][NEUTRAL] Yeah, this one's, um, they're office visits, but they're showing.
[CUSTOMER][NEUTRAL] Uh, it's billed as an outpatient in our regional cancer, so I don't know if there's a difference.
[CUSTOMER][NEUTRAL] Um, place of service I need to check with our coding.
[AGENT][NEUTRAL] OK, yeah, if it was still a place of service 22, that's what would be the reason for the denial, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and I, I, again, I don't know on these things if that's the only way wherever this doctor is.
[AGENT][NEUTRAL] And what were the bill uh charges on that one?
[CUSTOMER][NEUTRAL] Um, on that 1 480.
[AGENT][NEUTRAL] And you need that one faxed as well?
[CUSTOMER][NEUTRAL] Yes, and I have a couple other ones.
[AGENT][NEUTRAL] OK, what was the other data service?
[CUSTOMER][NEUTRAL] 123 for 494.
[AGENT][NEUTRAL] OK, and then other data service?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 12:13 for 62.
[AGENT][NEUTRAL] OK, and next one.
[CUSTOMER][NEUTRAL] Uh, 12, let's see you got.
[CUSTOMER][NEUTRAL] Uh, 12:30, 13 2 13 of 2025.
[CUSTOMER][NEUTRAL] And that's for 490.
[AGENT][NEUTRAL] OK. Is that the last one?
[CUSTOMER][NEUTRAL] And I had well, I had requested, um, I just called uh last week and requested some um EOBs, but I don't know that I actually, I haven't received them yet.
[AGENT][NEUTRAL] OK. Have, have you registered on our online portal where you can pull the EOBs?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, I.
[CUSTOMER][NEUTRAL] Yeah, I think I have now that I think about it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me, I, now that you say that I'm thinking.
[CUSTOMER][NEUTRAL] Yes, but I don't know that I was able to get the EOBs. I think that was my problem.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] This is.
[CUSTOMER][NEUTRAL] I'm looking for my.
[CUSTOMER][NEUTRAL] And what does the IMA stand for?
[AGENT][NEUTRAL] Um, IMA is a third party.
[CUSTOMER][NEUTRAL] Wait, no, this is.
[AGENT][NEUTRAL] So this policy.
[CUSTOMER][NEUTRAL] OK, yeah, 3rd party, OK.
[AGENT][NEUTRAL] Yeah, they're a third party that has, so this policy or this plan, they have access to a few different types of policies. We administrate the hospital indemnity plan and then IMA is the TPA for 90 degree benefits which they have another limited policy through that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] That's IMA. This is MBA that I was looking at. I don't think I do have IMA is what is it just [PII] or what is it?
[AGENT][NEUTRAL] Uh, we're, we're APL.
[AGENT][NEUTRAL] So this this employer gives employees access through to a couple of different policies through APL and then IMA. We're APL, so it's [PII].
[CUSTOMER][NEUTRAL] APL.
[AGENT][NEUTRAL] That's our website where you can pull all the.
[CUSTOMER][NEUTRAL] Oh wait.
[CUSTOMER][NEUTRAL] OK, can you give me that website one more time?
[AGENT][NEUTRAL] And it's [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] See what I can find.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll see about uh new user. I think I have to get help with my.
[CUSTOMER][NEUTRAL] IT department to be able to log on to these or request it, so I will get them that information.
[AGENT][NEUTRAL] OK, I'll get these EOBs faxed to you, um, and then like I said, uh, you will need like the patient account number from the UBO4 or the uh 1500 claim form, um, and then, um, but I'll get these faxed over right now, so.
[CUSTOMER][POSITIVE] Cool.
[CUSTOMER][NEUTRAL] OK, so when I sign in I need our patient account number or you have a patient account number?
[AGENT][NEUTRAL] Oh, your patient account number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, there should be um instructions as a new user. It'll tell you which boxes on the claim that, um, for the patient account number, yeah.
[CUSTOMER][NEUTRAL] I can do that.
[CUSTOMER][NEUTRAL] OK, um, I'm an individual I'm a provider.
[CUSTOMER][NEUTRAL] OK, that sounds great and then [PII], do you guys use uh reference numbers?
[AGENT][NEUTRAL] Uh, reference number is just my name, um, [PII], first initial to last name, [PII] as [PII], and today's date. And anything else I can help with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, that will do it. Thank you so much for your help. You have a good day.
[AGENT][POSITIVE] Great, thank you for calling APL. You as well. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye bye.