AccountId: 011433970860
ContactId: e7ffb492-d027-400e-8694-bbca66a90938
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243419 ms
Total Talk Time (AGENT): 101021 ms
Total Talk Time (CUSTOMER): 82420 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/e7ffb492-d027-400e-8694-bbca66a90938_20250311T16:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh yes ma'am. My name is [PII]. I'm calling with Popple Bluff Regional Medical Center. I had a question about a claim.
[AGENT][NEUTRAL] OK, I can verify claim status for you, Ms. [PII], and what is the policy number, please?
[CUSTOMER][NEUTRAL] Yes, ma'am. That is D like Delta 43,302,180.
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. Do you have the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII], last name [PII], birthday [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] [PII]. OK, thank you, ma'am. Give me one quick moment, please.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you say you're calling about a claim that was processed for?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, and this was medical?
[CUSTOMER][NEUTRAL] It was, yes ma'am. I just have, I have two different EOBs and one shows an adjustment and the other doesn't. I'm just trying to clarify if there was one made or not.
[AGENT][NEUTRAL] Uh, what was the date of service?
[CUSTOMER][NEUTRAL] It's from [PII].
[AGENT][NEUTRAL] OK, and I apologize, I didn't ask earlier, but do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Oh it's OK. [PII] it's direct.
[AGENT][POSITIVE] OK, thank you, ma'am. And give me one moment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] And what was the name of the provider's office again?
[CUSTOMER][NEUTRAL] Poplar Bluff Regional Medical Center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, looks like we paid 250, so I'm assuming that one that you show where it was repriced, that could have came from IMA and the insured had a policy with us at APL and for that CT we paid 250, which marks their benefit for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did you guys make an adjustment of $2,502.25?
[AGENT][NEUTRAL] Uh, we wouldn't make adjustments. The type of policy insurer has that's just a limited indemnity plan. I'm assuming the adjustment may have been from IMA or from, um, what is it 90 degrees.
[CUSTOMER][NEUTRAL] Oh OK so they do price for you guys?
[AGENT][NEUTRAL] Uh, if they go to a multi-plan provider, then claims can be repriced, but uh we just process it according to their policy with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yes ma'am, we, we're with, uh, network with multi plan. I just needed to know if that adjustment was correct or not because we have the first EOB we have shows that, but then, um, we called you guys and we got you to fax us an EOB and it doesn't show that amount. That's why I was calling. I just didn't know if we needed to leave that to patient responsibility or if that was a legit adjustment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, I understand, but we wouldn't make adjustments. I believe it's with IMA or 90 Degree and they'll be able to verify as far as any adjustment. We just pay that 250.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, can I get a reference number from you name?
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Uh, we don't give reference numbers. No, you're fine, uh, but if you like, you may use my name it's [PII].
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for your help, ma'am.
[AGENT][POSITIVE] Alright, you're welcome, Ms. [PII]. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Yes ma'am you too bye bye.
[AGENT][NEUTRAL] Bye.