AccountId: 011433970860
ContactId: dd6de06c-df0e-4dd0-aa5b-7b6ded20c709
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 981799 ms
Total Talk Time (AGENT): 331518 ms
Total Talk Time (CUSTOMER): 353191 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/dd6de06c-df0e-4dd0-aa5b-7b6ded20c709_20250401T17:09_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, hi, [PII]. My name is [PII], and I'm calling from a provider's office to get claim information.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, yes, that is [PII].
[AGENT][NEUTRAL] OK, thank you. And what's the policy number of the patient?
[CUSTOMER][NEUTRAL] OK, that is 23463667.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And patient name and date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, sorry, my screen is moving slowly. Here we go. [PII] 11262.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] It's like I have a totally different name. Maybe I typed in the number wrong. Let me try the policy number one more time. I might have typed it wrong. What was that policy number?
[CUSTOMER][NEUTRAL] OK. 234 63667.
[CUSTOMER][NEUTRAL] And I have a claim number.
[AGENT][NEUTRAL] OK, uh, let's see.
[AGENT][NEUTRAL] What's the claim number on the uh hold on just a second I'm sorry.
[AGENT][NEUTRAL] OK, what's that claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, that is 3556682.
[AGENT][NEUTRAL] OK OK
[AGENT][NEUTRAL] It looks like I have 234 6376.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so the 7 at the end is not supposed to be there?
[AGENT][NEUTRAL] Uh, yeah, 234-637-6. Yeah, that's the policy.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me get, OK, let me get that. Well, I'm sorry, what was that claim number again? 354.
[CUSTOMER][NEUTRAL] Oh, hang on just a second get back to that screen.
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] Right, uh, my Epic is dragging. Um, let's see here. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, here we go. Let's see what's going on.
[AGENT][NEUTRAL] OK, did you have a specific question on that claim or?
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] I'm sorry, there's, there's quite a bit of notes in here, so I'll try to simplify it.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, it looks like.
[CUSTOMER][NEUTRAL] We originally got
[CUSTOMER][NEUTRAL] A denial it's posted in here in January that um an attachment was required. It says resubmit new claim with requested info.
[CUSTOMER][NEUTRAL] So, we did so on [PII].
[CUSTOMER][NEUTRAL] Um, we resubmitted the new claim with all the records.
[CUSTOMER][NEUTRAL] And uh let's see, submitted it on.
[CUSTOMER][NEUTRAL] The provider portal and we have a confirmation number OSC 92198 and I went to the portal.
[CUSTOMER][NEUTRAL] I don't know if you're having issues with the portal, but it nothing would pull up for me, so that's why I'm calling, um, because then it looks like it denied a second time and we got that information [PII] it's denying his duplicate, so I'm like, wait a minute, you said to send a new claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With the requested info, but now we're getting it denied as the duplicate, so I'm just trying to figure out what's going on.
[AGENT][NEUTRAL] OK, let me pull up what we actually received.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what were the total bill charges on that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see, that was $439.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it a um.
[AGENT][NEUTRAL] Is that a facility claim or?
[AGENT][NEUTRAL] A physician's claim.
[CUSTOMER][NEUTRAL] OK, let me see here it's.
[CUSTOMER][NEUTRAL] Well, yes. Uh, it's a physician claim for an inpatient hospital.
[CUSTOMER][NEUTRAL] Um, treatment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's 355-6682.
[AGENT][POSITIVE] Is that right? I'm so sorry.
[CUSTOMER][NEUTRAL] Um, oh, the claim, yeah, uh-huh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it looks like the.
[CUSTOMER][NEUTRAL] Yeah, the codes on it are for um.
[CUSTOMER][NEUTRAL] Inpatient care physician.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let's see what we got.
[CUSTOMER][NEUTRAL] 99232 and then 99222.
[AGENT][NEUTRAL] I see that we received, let's see this was 123 25.
[AGENT][NEUTRAL] Or actually, hold on, let me see, this is, yeah, 123 25 we received.
[AGENT][NEUTRAL] Add OK, that that was the original so you said you sent additional information on 129 25, is that right?
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Uh, it shows 123 25, a claim, a new claim with the requested information was submitted. I have a confirmation number from the portal.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But then it turned around and denied as a duplicate on [PII].
[AGENT][NEUTRAL] OK, let's see if we received.
[AGENT][NEUTRAL] OK, that's uh.
[AGENT][NEUTRAL] It will be
[AGENT][NEUTRAL] Well, I don't, I don't show additional information received.
[AGENT][NEUTRAL] I I see where you're talking about we received.
[AGENT][NEUTRAL] Um, let's see, we received this on 123-25.
[AGENT][NEUTRAL] But I don't show.
[AGENT][NEUTRAL] Let's see, I don't show anything after that, but let me double check this one.
[AGENT][NEUTRAL] No, that's not it. OK.
[CUSTOMER][NEUTRAL] Um, yeah, that, that was it. That was what was requested.
[CUSTOMER][NEUTRAL] Yeah, because it originally denied needing, um, it says.
[CUSTOMER][NEUTRAL] You know, that it needed additional information that wasn't.
[CUSTOMER][NEUTRAL] And so that's when we sent the medical records and the claim.
[CUSTOMER][NEUTRAL] And then it's denying you the, so you're saying you don't see the medical records in there?
[AGENT][NEUTRAL] Now, I see the medical records attached to this claim, um, and what, what is on the medical records, it looks like.
[AGENT][NEUTRAL] But I've got a receive date of [PII].
[AGENT][NEUTRAL] Um, the medical records, I think, let me see if I see a diagnosis. Do you have the actual claim like the UV or the CMS 1500?
[CUSTOMER][NEUTRAL] Uh yes, let me, I'm gonna look at it. I click in here.
[AGENT][NEUTRAL] That would probably be because I'm not seeing I I see all of these records.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But I don't think there is an ICD 10.
[AGENT][POSITIVE] It's got lab results.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I'm looking at the claim. There's 123 ICD 10.
[AGENT][NEUTRAL] OK, yeah, on the actual plane.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, cause what we got is just records.
[AGENT][NEUTRAL] We didn't get
[AGENT][NEUTRAL] An actual claim form.
[AGENT][NEUTRAL] We just got the medical records.
[CUSTOMER][NEUTRAL] Oh, OK, yeah.
[CUSTOMER][NEUTRAL] OK, I'm just basing it off of what the notes say in here. It was another, another rep, not, not me. Um, it just says.
[CUSTOMER][NEUTRAL] Yeah, so you're saying because the claim wasn't attached, that that's why it's being denied?
[AGENT][NEUTRAL] Wait, I see the.
[AGENT][NEUTRAL] Claim, hold on.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Yeah, because when they do it on the portal usually the claim is right there, you know.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean, I don't know. I, I, I just got access to the portal today, so I'm not familiar with.
[AGENT][NEUTRAL] Let me pull up the policy, um.
[AGENT][NEUTRAL] That might help. Let's see, so physicians.
[AGENT][NEUTRAL] OK, so the 99222, so the the you're checking on the do not the amounts for the physician charges, correct?
[CUSTOMER][NEUTRAL] Yes, yes, cause we're the um physician group. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, cause it doesn't look like there's coverage for the physician. There is coverage for hospital admission, hospital confinement, ICU.
[AGENT][NEUTRAL] Um, surgery in a hospital, surgery center, surgery in a physician's office.
[AGENT][NEUTRAL] They cover physicians' office visits.
[AGENT][NEUTRAL] But not the physician charges for an outpatient um hospital visit.
[AGENT][NEUTRAL] Uh, so it's indicating that it's non-covered for the um.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] For the physician charges, those are non-covered benefits. Our EOBs are kind of confusing because I don't know if it references each line of what's what it's denying. Let me see.
[CUSTOMER][NEUTRAL] Yeah, that that's that's what we didn't see that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] uh
[CUSTOMER][NEUTRAL] OK, so then this is gonna be the patient responsibilities is what you're saying?
[AGENT][NEUTRAL] Um, well, we got, this is a supplemental policy, so we don't determine patient responsibility. We just process according to what's covered under the policy.
[CUSTOMER][NEUTRAL] OK, now I'm confused because we don't have any other plan listed for this patient.
[AGENT][NEUTRAL] Right, so you would determine what patient responsibility is.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] Yeah, it
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then I'm confused again because if this is a supplemental policy, usually it will deny it, if you don't have the EOB from the primary.
[CUSTOMER][NEUTRAL] So, uh, yeah, we don't have any other coverage.
[AGENT][NEUTRAL] This, this is it.
[AGENT][NEUTRAL] Yeah, this is an indemnity policy, so we don't require an EOB um we don't coordinate benefits on this plan.
[AGENT][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, that's, that's why, um, let me make sure and check something else. Yeah, it's a hospital indemnity policy, so it basically has a list of XYZ procedures and this is what the policy pays.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] There's no coordination of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does that help?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, that helps. Um, so.
[CUSTOMER][NEUTRAL] We will, yeah, we've just got to um.
[CUSTOMER][NEUTRAL] Contact the.
[CUSTOMER][NEUTRAL] The patient and find out what the where we should send this.
[CUSTOMER][NEUTRAL] Um, OK. And then, let's see, I just have to make sure.
[CUSTOMER][NEUTRAL] Um, yeah, since the EOB doesn't
[AGENT][NEUTRAL] Do you want me
[AGENT][NEUTRAL] Well, I have the EOB. It's got, um, it's got it out here as non-covered procedure for the 9922299232. Do you want me to fax that over to you?
[CUSTOMER][POSITIVE] Oh yes, that would be wonderful.
[AGENT][NEUTRAL] OK. What's your fax number?
[CUSTOMER][POSITIVE] OK, yeah, my fax is the same as my phone number. It's [PII], and you don't have to put attention. It'll come directly to you.
[AGENT][NEUTRAL] OK, this is
[AGENT][NEUTRAL] OK. How do you spell your name, [PII]?
[CUSTOMER][NEUTRAL] Um, [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, I'll get this faxed over, um, and then that way you can have that for your records, um, but yeah, this is just a, it's an indemnity policy, so we don't do any coordination or determine patient responsibility, so.
[CUSTOMER][NEUTRAL] Got it. We don't see a whole lot of indemnities anymore.
[AGENT][POSITIVE] I know, I know they are pretty, uh, not, not quite as common.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. Yeah, I remember years and years and years ago, that's all we had was indemnity, Medicare, Medicaid, and self-pay.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, yeah, I know, yeah.
[CUSTOMER][NEUTRAL] When life was simple.
[AGENT][POSITIVE] Yeah, exactly.
[CUSTOMER][NEUTRAL] Yeah, and then.
[CUSTOMER][NEUTRAL] Right, in the [PII] when it was really um or [PII] too. Let's see.
[AGENT][POSITIVE] Yeah, exactly.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, could I please get the first letter of your last name or do you give that out?
[AGENT][NEUTRAL] Yes, um, it's [PII].
[AGENT][NEUTRAL] And then today's date will be the references that yeah.
[CUSTOMER][POSITIVE] Oh, thank you. And do you oh.
[AGENT][NEUTRAL] Oh sure, go ahead.
[CUSTOMER][POSITIVE] Got it, got it, got it.
[CUSTOMER][NEUTRAL] No, I, I, yeah, you answer my question. Just name and date, OK.
[CUSTOMER][POSITIVE] OK, great. Well, I appreciate your help and um I'll just be looking for that you will be um so sometime today it will come over or how long does it usually take?
[AGENT][NEUTRAL] No,
[AGENT][NEUTRAL] Just give me, give me about 5 minutes and you should get it.
[CUSTOMER][POSITIVE] Oh OK. Wonderful. Thank you so much. I hope you enjoy your day.
[AGENT][POSITIVE] OK, thank you, [PII], for calling APL. Have a great day.
[CUSTOMER][POSITIVE] OK, thanks. All right.
[AGENT][NEUTRAL] Yeah