AccountId: 011433970860
ContactId: dce08afd-bcc4-45a8-b596-5bbd940d4254
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 488609 ms
Total Talk Time (AGENT): 149775 ms
Total Talk Time (CUSTOMER): 193223 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/dce08afd-bcc4-45a8-b596-5bbd940d4254_20241230T19:41_UTC.wav
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[AGENT][POSITIVE] Thank you for calling. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I have a um I received a.
[CUSTOMER][NEUTRAL] Explanation of benefits from you all, um.
[CUSTOMER][NEUTRAL] That then on the back said please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] And I am not sure, uh, we had my husband was in the hospital.
[CUSTOMER][NEUTRAL] And we had several different.
[CUSTOMER][NEUTRAL] Um, medical charges obviously because we had, he had surgery, he was, um.
[CUSTOMER][NEUTRAL] Stayed overnight he had a couple of different things so I'm trying to what they have is that you guys were billed for 5,412, but I don't know what.
[CUSTOMER][NEUTRAL] EOB that would be on to send to you all so I'm just trying to see like what actually got billed.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can assist you with that information. Um first, can I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, my name's [PII].
[CUSTOMER][NEUTRAL] And my number is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need your policy number, please.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes ma'am, it's 02550852.
[AGENT][NEUTRAL] OK, thank you. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[CUSTOMER][NEUTRAL] Um, my husband is [PII], and our billing address is [PII].
[AGENT][NEUTRAL] OK, and please verify your email address.
[CUSTOMER][NEUTRAL] Uh, my email address is [PII].
[AGENT][NEUTRAL] OK. And please verify your husband's name. You already verified his date of birth.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK. And on that
[CUSTOMER][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] An explanation of benefits. Um, do you see a claim number? Hello, I'm still here. Hello?
[CUSTOMER][POSITIVE] Oh, great.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, it got, it cut out for a minute. Um, I, I gave you his name and then you were just gone for a second.
[AGENT][NEUTRAL] OK, I apologize. I'm not sure what happened.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][POSITIVE] OK, but we're good. OK.
[CUSTOMER][NEUTRAL] What can I, what, what?
[AGENT][NEUTRAL] Yeah, I need the claim number.
[CUSTOMER][NEUTRAL] What um what did
[CUSTOMER][NEUTRAL] OK, the claim number is 3542299.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and these are for, this is for, you see, date of service [PII], 24, and this is for the anesthesia charge.
[AGENT][NEUTRAL] So we need explanation of benefits for the amnesia charge and I'm showing that the providers some claim, so the provider also received the um explanation of benefits that you received and what normally happens is that they'll resubmit the claim with the requested information.
[CUSTOMER][NEUTRAL] OK, so you think that there's nothing I need to do right now?
[AGENT][NEUTRAL] Not, not at this point because like I said, the provider received the um EOB also and what they normally do because they want to get paid is um resubmit the claim with the requested information and we'll pay them directly. But um yeah, we don't never hear back from them. I guess you can give them about a month or so. You can check back if we never hear back from them and you can file the claim yourself. And what we'll need is the explanation of benefits um for the anesthesia charges for this surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well, and that's really funny because like I'm not even seeing.
[CUSTOMER][NEUTRAL] This JLR Medical group.
[CUSTOMER][NEUTRAL] With my
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Normal explanation of benefits.
[CUSTOMER][NEUTRAL] So like I have like I said I mean we have an explanation of benefits 14 pages long.
[AGENT][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And that
[CUSTOMER][NEUTRAL] JLR Medical Group that's on here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's why I was like I wasn't sure what it was because I'm not seeing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Any of that on.
[AGENT][NEUTRAL] Yeah, so you may wanna reach out to them and make sure that they have your information um for your primary insurance company cause obviously, they have the information for us. So make sure that they have the information from your primary insurance company so they can get a claim file with them and then they can send us the EOB so we can pay our portion.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK, yeah, because I'm seeing unless I'm just trying to look here like if it's just through.
[CUSTOMER][NEUTRAL] I mean there's the injections of different things that's like the different meds for his procedure.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Not the actual providers there's the pro for all, the fentanyl, citrate, like all of that stuff, pharmacy pharmacy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 54 0.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Anesthesia, hold on, it was.
[CUSTOMER][NEUTRAL] 144.
[CUSTOMER][NEUTRAL] OK, well I will um.
[CUSTOMER][NEUTRAL] So who
[CUSTOMER][NEUTRAL] Who did you request the explanation of benefits from the JLR Medical group or Baptist?
[AGENT][NEUTRAL] Um, the JLR Medical Group.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't even know who those people are. Good lord, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Alright thank you ma'am so at this time we will just keep up.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] See if we can
[CUSTOMER][NEUTRAL] Find out how we would even get a hold of them because I'm even showing that they're in [PII] and we're in [PII] so I'm not even sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, let me pull a copy of the image of the claim and see if there's a phone number on here. One moment.
[CUSTOMER][POSITIVE] Thank you, ma'am.
[AGENT][POSITIVE] Mhm, no problem.
[CUSTOMER][NEUTRAL] Because I'm not even seeing.
[CUSTOMER][NEUTRAL] Or do
[AGENT][NEUTRAL] OK, I'm showing that the phone number for the provider and this is on the claim, um, the phone number is.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, the phone number is [PII].
[CUSTOMER][NEGATIVE] He of course it's not reading now.
[CUSTOMER][NEGATIVE] What the heck
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. 667.
[AGENT][NEUTRAL] 0505.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] [PII]. OK, thank you very much.
[AGENT][POSITIVE] Yes. OK, you're welcome. Thank you for calling APL. You have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mm bye.