AccountId: 011433970860
ContactId: d9378544-52b1-4c6c-8f4a-bb955051c4ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1382780 ms
Total Talk Time (AGENT): 530320 ms
Total Talk Time (CUSTOMER): 513901 ms
Interruptions: 12
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/d9378544-52b1-4c6c-8f4a-bb955051c4ad_20250211T21:02_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Hi, I have a claim with the provider of mine that I've been trying to get uh resolved. I called a few minutes ago and I was told by a representative there they haven't received it. I have the provider on the other line. She's listening in now. She asked us to merge the calls so that we could try to get this straightened out.
[AGENT][NEUTRAL] OK, so you're the insured on your
[CUSTOMER][NEUTRAL] Hi, how are you Ms. [PII]?
[AGENT][NEUTRAL] Uh, well, I'm fine. Uh, first off, let me get the insured's information pulled up first and verify some things, um, for security purposes. So, uh, for the insured, who am I speaking with, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, and [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And your policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 02455103
[AGENT][NEUTRAL] OK, thank you. So give me just a moment to get your information pulled up and once I do, I will have to verify several things with you for security.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. Zip code?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The phone number on file for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you and the last thing to verify is your email, [PII], and this does appear to be your work email?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Now what is the data service in question, [PII] that you all are working on?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK. All right, [PII], thank you. And you said that um who else is on the line with us?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] in regards to Northside Foresight Outpatient.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, for that date [PII], Doctor [PII].
[AGENT][NEUTRAL] What's the total bill amount?
[CUSTOMER][NEUTRAL] The total charge is 719,450.
[AGENT][NEUTRAL] I'm so sorry. I don't know what happened if it was on my end or yours, but it cut out and I wasn't able to hear the amount.
[CUSTOMER][NEGATIVE] Oh sorry.
[CUSTOMER][NEUTRAL] OK, it's 719,450.
[AGENT][NEUTRAL] OK, thank you. Alright, and [PII], do you authorize me to speak with [PII] regarding this data service?
[CUSTOMER][POSITIVE] Yes, please do.
[AGENT][POSITIVE] OK. All right. I'll be happy to. So [PII], how can I help you today?
[CUSTOMER][NEUTRAL] So, um, I think one of the reps had told me this, um, is it bi bisco bean thing?
[AGENT][NEUTRAL] Bisco bisco thing, um.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] That didn't see the claim on file but we I show where the claim was sent and it is showing about 1,28987. It was sent to her Cigna and then you all.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, what address was it mailed to because we do not have a claim on file for that bill amount for that data service.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, it's [PII] [PII]. Group number is [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so the zip code is wrong.
[AGENT][MIXED] Yes, but that zip code is wrong.
[CUSTOMER][NEUTRAL] OK, so it's not [PII]?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Um, you, I've heard a couple of different things, [PII], on the zip code. The zip code is [PII].
[CUSTOMER][NEUTRAL] OK, [PII], OK.
[CUSTOMER][NEUTRAL] Give me one moment here.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and then I have the um.
[CUSTOMER][NEUTRAL] The plan pay ID where it was sent because they normally send it electronically.
[CUSTOMER][NEUTRAL] So I tell you what that is and you tell me if you see it there it is F_301.
[AGENT][NEUTRAL] Sure. Yes ma'am.
[CUSTOMER][NEUTRAL] 800.
[AGENT][NEGATIVE] No, ma'am. That is not for my company.
[AGENT][NEUTRAL] I don't know whose that is, but that is not our payer ID. Our electronic payer ID is 60.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] No, that's our play plan ID for North that's ours when we bill it over.
[AGENT][NEUTRAL] OK. Our payer ID that it would need to be sent to 60801.
[CUSTOMER][NEUTRAL] That doctor.
[CUSTOMER][NEUTRAL] Give me one moment, hold on.
[AGENT][NEUTRAL] Which is which also should be on um Miss [PII]'s ID card.
[CUSTOMER][NEUTRAL] Yeah give me one moment.
[CUSTOMER][NEUTRAL] Hold on for me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You're gonna hear some music, OK, hold on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's skipping, are you still there?
[CUSTOMER][NEUTRAL] Yes, I am sorry, I've muted you so that you have background.
[AGENT][NEUTRAL] OK. I just want, no, that, no, you're fine. No, I just want, yeah, sure. I just wanna make sure you were still on the, we were all connected.
[CUSTOMER][NEUTRAL] Yeah, when you couldn't hear her very well I figured I'd mute.
[AGENT][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] When you couldn't hear very well, I figured you might have background noise and I figured I would mute.
[AGENT][NEUTRAL] 00, OK.
[CUSTOMER][NEUTRAL] But I'm here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][POSITIVE] Mhm. You're welcome.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Miss [PII].
[AGENT][NEUTRAL] Yes, ma'am. I'm here.
[CUSTOMER][NEUTRAL] Hello, um, OK, you are with the claims department, correct? Can you hear me?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] I'm with APL. Mhm. Yes.
[CUSTOMER][NEUTRAL] Right, is that the claims department?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] A customer service.
[AGENT][NEUTRAL] Oh, well, I'm part of the care team.
[AGENT][NEUTRAL] Which handles these types of inquiries.
[CUSTOMER][NEUTRAL] OK, is there.
[CUSTOMER][NEUTRAL] OK, is there a number to the claims department so we can get the insurance involved?
[AGENT][NEUTRAL] Well, this is
[CUSTOMER][NEUTRAL] Reach out to the claims department.
[AGENT][NEUTRAL] Well, I mean, I can help you. What are, what type of information are you needing?
[CUSTOMER][NEUTRAL] It's going to the insurance so you can help build claims too.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because that's what they're gonna need to see with the claims department.
[AGENT][NEUTRAL] OK, I'm gonna be able to provide you. Yes. So, right, I'm gonna be able to provide any information that they need to file a claim for this member.
[CUSTOMER][POSITIVE] So I'm trying to get us to the right department on my end.
[CUSTOMER][NEUTRAL] OK, I don't need that information. I need the actual claims department.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] OK, but there's not a claim on file.
[CUSTOMER][NEUTRAL] The one who actually does the billing to be without our billing.
[AGENT][NEUTRAL] OK, there's no billing done by yes ma'am, but there's no billing done by APL.
[CUSTOMER][NEUTRAL] The one who actually filed the claim.
[CUSTOMER][NEUTRAL] OK, so who does the file?
[AGENT][NEUTRAL] We are a supple, this is a supplemental insurance. This is a supplemental policy.
[AGENT][NEUTRAL] To Miss um [PII]'s primary insurance and this policy helps her with her co-pays, deductibles, and co-insurance amounts of coverage services. So the claim is initially filed with her primary insurance company, Nikita, and then with APL because we will have to have a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's what I was getting to. So Cigna didn't send you one. Cigna didn't send you all the cop. That's why I'm trying to get to the billing.
[AGENT][NEUTRAL] To review
[AGENT][NEGATIVE] No, they would not. No, ma'am, they would not. Correct. They would not do that.
[CUSTOMER][NEUTRAL] Really?
[AGENT][NEUTRAL] No, ma'am. It is whoever files the claim is then gonna have to they would file with Cigna and then with APL once the Cigna has come back because they will have to send us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In addition to the claim, they're also going to have to include the primary, a copy of the primary insurances EOB.
[CUSTOMER][NEUTRAL] OK, I just found it weird because any other insurance when it's dual insurance they normally send that EOB on over to the second party that's supposed to pay it.
[AGENT][NEUTRAL] No, ma'am, because this is, no, ma'am, because this is a supplemental, we're not a major medical carrier, so they are not gonna do that.
[CUSTOMER][NEUTRAL] OK, so you're OK, so question then with that being said, do you send the payment to the patient or do you send it straight to the hospital?
[AGENT][NEUTRAL] We're not a major medical carrier. Mhm.
[AGENT][NEUTRAL] It would be dependent on who files the claim.
[AGENT][NEUTRAL] And how the assignment of benefits are laid out. If the, typically if the facility files the claim, then the benefits will be paid to the provider. I said facility, but I mean, you know, to the provider. If the insured files it and there are benefits payable, then it would be paid to the insured. And then again, it goes back to how the assignment of benefits.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I marked on the claim.
[CUSTOMER][NEUTRAL] OK, give me one moment, hold on.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Do I need to remain on the call?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, alright, I'm just at work and I'm.
[CUSTOMER][NEUTRAL] We're supposed to be on another call.
[CUSTOMER][NEUTRAL] I mean it's helpful to hear, but.
[AGENT][NEUTRAL] My
[CUSTOMER][POSITIVE] I said um it's helpful to hear I'm just supposed to be on another call at work.
[AGENT][POSITIVE] Oh, I, I understand. I'm sorry about that.
[CUSTOMER][POSITIVE] That's right. If I can get it resolved, it'll be worth it.
[AGENT][POSITIVE] I can totally empathize with it being hard to do things, you know, for yourself when you work.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, I need a wife.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I need, I need a wife, I need a husband. I need a, I need a lot of things.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I would have them all doing different tasks. Yeah, I would have them all assigned different duties, just like when my kids were still at home and had chores.
[CUSTOMER][NEUTRAL] Personal shopper.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] But those days are gone. Those days are gone and my fur baby doesn't do chores. My, my fur baby supervises me, but that's about all she does.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Amen. Yeah, mine are all gone too. I'm, I'm the tour person now.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So since I wasn't who spoke to you earlier, [PII], was it?
[AGENT][NEUTRAL] That they had said they had filed a claim.
[AGENT][NEUTRAL] But, but we didn't have it. OK.
[CUSTOMER][NEUTRAL] Yes, they said they send it to you but obviously.
[AGENT][NEUTRAL] So it sounds like maybe it got a little misconnect, you know, there was some type of disconnect somewhere because the zip code was wrong and the payer ID she gave me was not for our company. It's not what's on your ID card.
[CUSTOMER][NEUTRAL] It's strange though.
[CUSTOMER][NEUTRAL] I just got an EOB yesterday where they paid where you paid another claim to the same hospital, so somebody over there has filled it correctly at some point.
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] For a different data service.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I mean, you know, that happens. What was the, do you remember what the data service was that we did process for you?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 7 1820, no, not that one.
[CUSTOMER][NEUTRAL] 4 1224.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Mhm. That was a $250 benefit that was paid on that claim.
[CUSTOMER][NEUTRAL] Yeah, the same provider.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am, we did. Mhm.
[CUSTOMER][NEUTRAL] Well, I don't, maybe not because that was for a different.
[CUSTOMER][NEUTRAL] The vision was under the same umbrella, but it wasn't in the same facility.
[AGENT][NEUTRAL] We yeah, we share that claim for that data service that we processed was um.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] An outpatient and your ER benefit for Northside Foresight.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] What is that lady? Good gracious.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And according to I just pulled up the claim that we had received for the 412 data service and on that one, [PII] they had our current payer ID on that one.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 00 which one is [PII]?
[AGENT][NEUTRAL] For a data service um for the same facility for 412 that we did process.
[AGENT][NEUTRAL] We did, I mean we did process the claim for the same facility.
[CUSTOMER][NEUTRAL] Let me
[AGENT][NEUTRAL] And the our payer ID is correct on the claim form.
[CUSTOMER][NEUTRAL] Now you are.
[AGENT][NEUTRAL] That we received.
[CUSTOMER][NEUTRAL] OK, so you, it was a Northside Foresight outpatient or Northside Foresight inpatient that you got a claim for.
[AGENT][NEUTRAL] Outpatient, out.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And was it the the same doctor?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] You were OK.
[CUSTOMER][NEUTRAL] And you also said you didn't get the 7-19 2024 bill as well?
[AGENT][NEUTRAL] Uh, we haven't discussed that. We discussed, oh, I'm not sure we have any, I haven't checked that for that data service. I've only checked before 10-2024 data service. What's the other data service?
[CUSTOMER][NEUTRAL] You already received that one as well?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 7 19 2024.
[AGENT][NEUTRAL] And the total bill amount on that one?
[CUSTOMER][NEUTRAL] $16,0036.
[AGENT][NEUTRAL] And, and again, Nikita's 7-19 2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am, we do not have a claim on file for her for that data service at all.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So I'm wondering is it different doctors that you all are contracted with are, are the different doctors still?
[AGENT][NEUTRAL] We're not contracted. Yes, ma'am. We're not contracted with any providers. Again, because we're not a major medical insurance. This is only supplemental.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] That's what my manager said, OK, that, OK, that's what the manager said when I was a whole there from the manager. You all aren't contracted with the, OK, so what's a good number for you, Ms. [PII], because that's, that is exactly what she said you are running contract with us.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, so the phone number for APL because there's not gonna be a direct number for me, [PII], but our number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I've given you the current you have.
[CUSTOMER][NEUTRAL] So it's up to that doctor.
[AGENT][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] To I say so it's pretty much up to the doctor that bills out on what they what they because this pay ID but this one that I have here is the same that the doctor has on the other one for July.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, but that's not our payer ID, so I, I don't know about that. I can see that on the claim that we received, uh, for this member for the data service that we did process for Northside Forsyth.
[CUSTOMER][NEUTRAL] Right, so I think their pay ID comes.
[AGENT][NEUTRAL] Our correct payer ID was on that claim. I don't know what that other number is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It has her Cigna and her APL and that information is correct on that claim.
[CUSTOMER][NEUTRAL] So I'm, I'm wondering.
[CUSTOMER][NEUTRAL] Well, I was thinking that I actually got the claim so I don't know.
[CUSTOMER][NEGATIVE] Why they didn't forward it on to you all because the the provider um.
[CUSTOMER][NEUTRAL] Since there's no contract, it's not gonna see the EOB, but I'm gonna get it to the insurance department. Is there a call reference number so when they call back they'll have that?
[AGENT][NEUTRAL] The call reference number would be my name along with today's dat[PII]
[CUSTOMER][NEUTRAL] OK, and that's [PII] or [PII]?
[AGENT][NEUTRAL] I, I spell it with an [PII], neither, [PII] Mhm. And is yours [PII]?
[CUSTOMER][NEUTRAL] OK, so yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, no, [PII]
[AGENT][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] And the date [PII].
[AGENT][NEUTRAL] Yes, so all we need is to have the claim because we do not have a timely filing limit. APL does not have a timely filing limit, so we just need to receive the claim along with the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] So it's gonna be bill it's gonna be going to the insurance department at the billing office, so they'll reach out to your office on that number you gave.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] And they'll go over the information with you.
[AGENT][NEUTRAL] OK, well, I was, OK, um, I don't understand about what the information, but I can, I was just letting you know if there was any way you could notate it. That is the, what we will have to have for a review.
[CUSTOMER][NEUTRAL] Yes, so that they will be able to go the payer ID with you for the these doctors.
[AGENT][NEUTRAL] Of a claim for this member.
[CUSTOMER][NEUTRAL] And tell you why that payer ID was used.
[CUSTOMER][NEUTRAL] So they'll be able to give you all that information or whoever answers the phone at the time when they make the call back.
[CUSTOMER][NEUTRAL] They will be able to give them that information.
[CUSTOMER][NEUTRAL] All they need to do is mirror the claim that was paid by APL, the claim that APL paid.
[CUSTOMER][NEUTRAL] They just need to bill it the same way.
[CUSTOMER][NEUTRAL] OK, so they're gonna be able to reach out to you and go to your office and go over that with you. I did send the information to them though, so you should be receiving a call.
[CUSTOMER][NEUTRAL] Or your office should be receiving a call.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So Ms. [PII], it is in the right step. I'm giving it to the insurance department here.
[CUSTOMER][NEUTRAL] So they'll be reaching out um there.
[CUSTOMER][NEUTRAL] OK, I mean it seems pretty simple. They just need to send the bill with my primary EOB to APL and they'll process it.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] They've done that on another bill. APL paid it so somebody there has.
[CUSTOMER][NEUTRAL] Handle the claim correctly for APL to give support and pay, so I don't know why these two are any different.
[CUSTOMER][NEUTRAL] OK, well they'll reach out and get the and go with the payer IDs that they have because they build the claim they actually file them. I don't, so I got it to the correct department, um, that if they can call me since I'm insured since they sent it to collections if they can't figure it out, can somebody please call me?
[CUSTOMER][POSITIVE] Yes, we'll keep you updated.
[CUSTOMER][POSITIVE] Alright thank you ladies.
[AGENT][POSITIVE] Well, you're very welcome. So is there anything else I can help you with?
[CUSTOMER][POSITIVE] Thank you have a great day. Did you get the um.
[CUSTOMER][NEUTRAL] No ma'am, it's [PII] did you write the.
[AGENT][NEUTRAL] This is [PII] is is.
[CUSTOMER][NEUTRAL] Reference number she said it was her name and the date of service so you have that as well? OK.
[AGENT][NEUTRAL] Yes, my name in today's date. Mhm. [PII].
[CUSTOMER][NEUTRAL] And that's your