AccountId: 011433970860
ContactId: e960529d-1281-4509-a369-2c8854d98d1b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 762729 ms
Total Talk Time (AGENT): 187326 ms
Total Talk Time (CUSTOMER): 324635 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/e960529d-1281-4509-a369-2c8854d98d1b_20250423T19:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling uh regarding a statement received from Memorial Healthcare, um, that apparently was not paid by APL for some reason.
[AGENT][NEUTRAL] OK, do you have your policy number, [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah it's under.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 02230090
[AGENT][NEUTRAL] And what is your date of birth?
[CUSTOMER][NEUTRAL] Um, it's actually under my wife's account and hers is [PII].
[AGENT][NEUTRAL] And is this for the invoice you're calling on is that for yourself or is that for her?
[CUSTOMER][NEGATIVE] That's under her. I had originally phoned on this and Memorial had said that APL refused it due to um termination of benefits and then I called the hospital back and hospital um apparently called you guys back and it was refused um.
[CUSTOMER][NEUTRAL] As far as being an office call visit.
[CUSTOMER][NEUTRAL] And these are not office calls, these are actual follow up appointments to a procedure that was done at the pain clinic, um.
[CUSTOMER][NEGATIVE] And they're saying that you guys refused it uh due to the actual coding on it that they recoded and sent back to you guys so that it wasn't listed as office calls um so I need to find out what do here and why it's not covered.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do you have a good callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And then just need to verify your address.
[CUSTOMER][NEUTRAL] It's [PII], that's [PII].
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] And I have their statement guarantee number if you need that. I don't know how you go about looking this up.
[AGENT][NEUTRAL] What date of service?
[CUSTOMER][NEUTRAL] The total total amount.
[CUSTOMER][NEUTRAL] Pardon?
[AGENT][NEUTRAL] Uh, do you have the date of service?
[CUSTOMER][NEUTRAL] Data er
[CUSTOMER][NEUTRAL] Yes, there's actually 5 different data services. Um, one second here, I'll start with the oldest one.
[CUSTOMER][NEUTRAL] Looks like uh [PII] or 24.
[CUSTOMER][NEUTRAL] That was an office call and she paid the balance on that I believe.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] And what amount are they charging you for?
[CUSTOMER][NEUTRAL] Um, looks like $18.91.
[CUSTOMER][NEUTRAL] Actually no that is not an office call. I have another one that was an actual.
[CUSTOMER][NEUTRAL] Their their billing is so crazy I can't make head or tail of this but.
[CUSTOMER][NEUTRAL] There's uh.
[CUSTOMER][NEUTRAL] Start over here.
[CUSTOMER][NEUTRAL] You start getting things that are clear back in [PII] here.
[CUSTOMER][NEUTRAL] Yeah it looks like
[CUSTOMER][NEUTRAL] Yeah, looks like they're they're billing for $18.91 on that one.
[AGENT][NEUTRAL] OK, let's start there. um, let's see.
[CUSTOMER][NEUTRAL] And I'm pretty sure.
[CUSTOMER][NEUTRAL] That that one is already actually paid entirely.
[CUSTOMER][NEUTRAL] But I'm not
[CUSTOMER][NEGATIVE] It's a $141 charge and I think that that was an actual office call but I am not positive.
[AGENT][NEUTRAL] OK. Let's see.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, looks like.
[AGENT][NEGATIVE] Yeah, they billed for an office visit and then so that was denied. Did, did you say they said they were billing, rebuiling it?
[CUSTOMER][NEUTRAL] They said that they were rebuiling this and they got a call back from you guys apparently spoke to you on the [PII].
[CUSTOMER][NEGATIVE] And all of these charges were refused for some reason I I don't understand why.
[AGENT][NEUTRAL] Well, if if they bill with an office visit code because it's it's based on the coding that we receive.
[AGENT][NEUTRAL] Um, you don't have any.
[CUSTOMER][NEUTRAL] And that's what I'm trying.
[AGENT][NEGATIVE] There, there's no coverage for oxygen.
[CUSTOMER][NEUTRAL] They build that
[CUSTOMER][NEUTRAL] Is it I'm sorry, I couldn't hear you.
[AGENT][NEUTRAL] Uh, there's no coverage for the office visit itself. Now, treatments and procedures performed in office are covered under the policy, but the actual office visit.
[AGENT][NEGATIVE] is not covered.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so that one was billed as an office call correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can we go to the next one and verify?
[AGENT][POSITIVE] Yeah, absolutely. What's that date of service?
[CUSTOMER][NEUTRAL] The date of service was [PII] of 2024.
[AGENT][NEUTRAL] OK, let me look at this one.
[CUSTOMER][NEUTRAL] That that is not an office call. I do know that.
[CUSTOMER][NEGATIVE] And it was a charge of $69.77 that they that you guys did not pay.
[AGENT][NEUTRAL] OK, you said [PII] 2024, is that right?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK. Sure.
[AGENT][NEUTRAL] OK, let's see what we've got here.
[AGENT][NEUTRAL] OK, this one.
[AGENT][NEUTRAL] We paid the provider 26764.
[CUSTOMER][NEUTRAL] Not seeing that at all.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And that was on, let me see what date that was.
[AGENT][NEUTRAL] 355. That was on [PII].
[AGENT][NEUTRAL] And let me see if they.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And you paid 267 on it?
[AGENT][NEUTRAL] Yes, 26764.
[CUSTOMER][NEGATIVE] Not even showing on their statement they're showing.
[CUSTOMER][NEUTRAL] Um, there's they're showing a payment made of 27909 with the adjustment prior to billing was 11114.
[CUSTOMER][NEUTRAL] But I thought that was paid by.
[CUSTOMER][NEUTRAL] That should have been paid by PHP correct?
[AGENT][NEUTRAL] Is PHP your primary?
[CUSTOMER][NEUTRAL] That is the primary, yes.
[AGENT][NEUTRAL] Oh, OK. Um,
[CUSTOMER][NEUTRAL] Because there was, uh, they're showing two billings on that day [PII] 1 was $293.01 was $167 for a total charge of $460 and then it looks like PHP paid 27909.
[CUSTOMER][NEGATIVE] Um, after an adjustment of 111 14, but they're not showing.
[CUSTOMER][NEUTRAL] They're showing a $69.77 dollars $69.77 balance there.
[AGENT][NEUTRAL] OK, I think we're missing, I think we're missing this one because what I have for 124 2024 is hospital charges for 5,54368.
[CUSTOMER][NEUTRAL] On that
[AGENT][NEUTRAL] Those are the only charges that I have.
[AGENT][NEUTRAL] So we might be missing
[CUSTOMER][NEUTRAL] OK, so you don't even have a.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] This is this is a clinic charge.
[AGENT][NEUTRAL] OK, yeah, it looks like we do not, yeah, we don't have those charges. We don't have any clinic charges for that date.
[CUSTOMER][NEUTRAL] On [PII]
[CUSTOMER][NEUTRAL] Don't
[CUSTOMER][NEUTRAL] Don't have any for that day for the clinic, OK?
[CUSTOMER][NEUTRAL] Um, can we go to the next one then?
[AGENT][POSITIVE] Yes, absolutely. What's that date?
[CUSTOMER][NEUTRAL] Uh, it's [PII] of 2024.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And that looks like a pro.
[AGENT][NEUTRAL] What amount was that for?
[CUSTOMER][NEUTRAL] $18.91.
[AGENT][NEUTRAL] Uh, 18
[AGENT][NEUTRAL] OK, it looks like we do have an office visit charge of 141.
[CUSTOMER][NEUTRAL] I'm gonna
[AGENT][NEGATIVE] Which was denied.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that that would be ability then correct.
[AGENT][NEUTRAL] Um, that's filled by here, let me pull that up real quick.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] OK, yeah, this is for the, the, the facility built for this outpatient or for the office visit. The code is an office visit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Good
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The next one that I have is [PII].
[AGENT][NEUTRAL] OK, yes, looks like the facility built another office visit which was non-covered.
[AGENT][NEUTRAL] The total charges were 140.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the last one if you can check is 99 of 24.
[AGENT][NEGATIVE] Uh, yes, facility bill for the office visit charge of $141 which was denied.
[CUSTOMER][NEUTRAL] OK, so those, those 4 are all offices then, but you don't have one for 124 of 24 for that dollar amount.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] The one that OK so it looks like they've got to probably rebuild that one to you guys then is that correct?
[AGENT][NEUTRAL] Yes, they can, but again, if it's an office, if they bill an office visit, it'll be denied, so.
[CUSTOMER][NEGATIVE] Yeah, but you haven't even received that and that was not an office visit for that one that was for a procedure.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, yes, yeah, if that's not an office visit, yes.
[CUSTOMER][NEUTRAL] OK, so you have a record of that.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, alright, I, I will get with them on that and have them rebuild that one and I'll take care of the office visit ones.
[AGENT][NEUTRAL] OK. Anything else I can help with today, sir?
[CUSTOMER][NEUTRAL] That should be all.
[AGENT][POSITIVE] OK. Well, I thank you for calling APL and I hope you have a good afternoon.
[CUSTOMER][POSITIVE] Thank you you too bye bye.