AccountId: 011433970860
ContactId: de58c4fb-8261-4c84-9dff-1c855072e271
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 496390 ms
Total Talk Time (AGENT): 128916 ms
Total Talk Time (CUSTOMER): 188104 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/de58c4fb-8261-4c84-9dff-1c855072e271_20250418T12:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] I'm calling from Stewart Palmetto General Hospital, and I'm calling to check a claim.
[AGENT][NEUTRAL] Alright, I can help you with the status of the claim. What's the policy number and a good phone number, [PII]?
[CUSTOMER][NEUTRAL] My phone number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the policy.
[CUSTOMER][NEUTRAL] The policy number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1419053 ML 8.
[AGENT][POSITIVE] OK, thank you, give me one moment.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and what's the date of service and the total charge?
[CUSTOMER][NEUTRAL] It's [PII], um, the total charge is.
[CUSTOMER][NEUTRAL] $50,484.08.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what type of service was this for?
[CUSTOMER][NEUTRAL] Uh, this is for it says.
[CUSTOMER][NEUTRAL] Um, uh, outpatient surgical, cardiac cath lab.
[AGENT][NEUTRAL] What are the procedure codes on the claim?
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] I 35.0.
[AGENT][NEUTRAL] That's a diagnosis code. What are the procedure codes?
[CUSTOMER][NEUTRAL] Oh Jesus, here we go. OK, hold on just a second. I have to look at the clock.
[AGENT][NEUTRAL] Is it on a CMS 1500 form or UBO4 form?
[CUSTOMER][NEUTRAL] OK, let me look at the claim. Hold on just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I have uh C1769.
[CUSTOMER][NEUTRAL] I have several codes. 93,460.
[CUSTOMER][NEUTRAL] 93312.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] J 1644
[CUSTOMER][NEUTRAL] J 2003
[CUSTOMER][NEUTRAL] J 225,027,043,010
[AGENT][NEUTRAL] OK, I'm not
[AGENT][NEUTRAL] OK, yeah, I don't see that claim on file.
[CUSTOMER][NEUTRAL] It's um it says here.
[CUSTOMER][NEUTRAL] That it was built out on 313 to manage care and you guys, it went paper they sent it paper and you guys accepted it status accepted on [PII] claim status received.
[AGENT][NEUTRAL] What was it mailed?
[CUSTOMER][NEUTRAL] 3:14.
[AGENT][NEUTRAL] Where?
[CUSTOMER][NEUTRAL] Oh, where? Oh, I don't have the mailing address here.
[AGENT][NEUTRAL] Uh huh, did you say managed care?
[CUSTOMER][NEUTRAL] Yeah, is this managed care?
[AGENT][NEUTRAL] You're speaking with American Public Life. We're the secondary payer.
[CUSTOMER][NEUTRAL] Right, but they have you listed as managed care here.
[AGENT][NEUTRAL] OK, yeah, we're American Public Life and um we're secondary to the major medical plan.
[CUSTOMER][NEUTRAL] Right, and the medical, the, the medical, the plan is already paid from his, his uh primary.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And this is supposed to be built, you have, do you, this is your member here?
[AGENT][NEUTRAL] Yes, I show the patient.
[CUSTOMER][NEUTRAL] OK, well, maybe they have this his secondary listed as managed care, but the phone number that is on file is the number that I called you on. Maybe they just have the incorrect name.
[AGENT][NEUTRAL] OK, I mean he does have coverage with us and the claim can be submitted to American Public Life. Are you saying that this was a crossover claim or did your office mail it to APL?
[CUSTOMER][NEUTRAL] So this
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I it's saying that the claim printed and mailed on uh [PII].
[AGENT][NEUTRAL] Does it show the address it was mailed to?
[CUSTOMER][NEUTRAL] Uh, this claim is automatically copy from, um, nope, it does not. That's the other issue.
[AGENT][NEUTRAL] OK, so if it's already been sent or submitted to the primary, then we would just need a copy of the um itemized bill in the EOB and I can give you our mailing address.
[CUSTOMER][NEUTRAL] OK, hold on just a
[AGENT][NEUTRAL] Or fax number.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Do you have a claim on file for this member or?
[AGENT][NEUTRAL] No, it's not on file.
[CUSTOMER][NEUTRAL] OK, hold on just one second.
[CUSTOMER][NEUTRAL] OK, and what is the, you said mailing address?
[AGENT][NEUTRAL] I can give you the mailing address, the fax number, and the payer ID, whichever you prefer.
[CUSTOMER][NEUTRAL] Can you, can
[CUSTOMER][NEUTRAL] OK, so let's let's go with uh.
[CUSTOMER][NEUTRAL] Mailing address first and we would put attention to who?
[AGENT][NEUTRAL] American Public Life.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Just 1 2nd.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII] I'm, I'm sorry, [PII], what now? [PII]?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] State is [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh. [PII].
[CUSTOMER][NEUTRAL] [PII] mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, fax number?
[AGENT][NEUTRAL] 8877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942-3 attention claims.
[CUSTOMER][NEUTRAL] OK, and pay ID?
[AGENT][NEUTRAL] 608.
[AGENT][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] OK, now I have a question, so would this not come directly from the primary to you guys or would we have to submit it to you guys?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] You, you would have to submit it directly to us it's not a crossover claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I get a reference number for the call?
[AGENT][NEUTRAL] Mhm. My name and today's date, [PII] last name is [PII]. And did you have any other questions, [PII]?
[CUSTOMER][POSITIVE] I do not, thank you so much.
[AGENT][POSITIVE] Alrighty you're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] You too thanks.