AccountId: 011433970860
ContactId: e96baac4-1c5a-444b-a487-31b7c4c21ae7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1932560 ms
Total Talk Time (AGENT): 787164 ms
Total Talk Time (CUSTOMER): 677907 ms
Interruptions: 13
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/e96baac4-1c5a-444b-a487-31b7c4c21ae7_20250204T18:58_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, I was transferred to your department to figure out if a patient had nephrology benefits under her plan.
[AGENT][NEUTRAL] OK, when you say nephrology, are you referring to an appointment or services related to? You're just needing benefit information basically? OK, yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] She.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] [PII] from Carolina Nephrology.
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's APO policy number?
[CUSTOMER][NEUTRAL] D 437 OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah, I can't look it up with that. That's an, uh, that's a 90 degree benefit number. There should be another number also on.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, that's who transferred me to y'all.
[AGENT][NEUTRAL] OK, on her ID card, she should.
[AGENT][NEUTRAL] I have another number?
[CUSTOMER][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] A policy certificate.
[AGENT][NEUTRAL] Is your patient [PII] the subscriber?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you have her full social?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK, I can look it up with that.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I provide for you will be a verification of benefits, [PII] and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I did look at a policy for her [PII]. She is a subscriber on this limited benefit plan.
[AGENT][NEUTRAL] And the policy is active with an effective date of [PII].
[AGENT][NEUTRAL] The policy number for her coverage with our company is going to be 0255.
[AGENT][NEUTRAL] 7447.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me just a moment for to.
[CUSTOMER][NEUTRAL] So this is still active with y'all?
[AGENT][NEUTRAL] It is. Yes, ma'am. It is showing as active.
[CUSTOMER][NEUTRAL] OK, her other policy expired, so that's why I wanted to.
[AGENT][NEUTRAL] At this time
[AGENT][NEUTRAL] I'm way, it is showing as active in our system.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have a question. I know that you were not finished talking. I'm sorry, but I have a question. uh, we're just confused because.
[AGENT][NEUTRAL] No, go ahead.
[CUSTOMER][NEUTRAL] It looks like we have sent it to the other policy before and they're.
[CUSTOMER][NEUTRAL] Was a payment made on it.
[CUSTOMER][NEUTRAL] So I think I'm confused on which one we're supposed to send it to.
[AGENT][NEUTRAL] OK, this, this policy, again, it's a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] So y'all are only hospital.
[AGENT][NEUTRAL] Yes. Now, she has an outpatient sickness.
[AGENT][NEUTRAL] Writer for for an office visit benefit that is $75.
[AGENT][NEUTRAL] Per visit and up to 5 visits per calendar year.
[AGENT][NEUTRAL] What type of claim are you filing? Yes, it does have a hospital confinement benefit.
[CUSTOMER][NEUTRAL] OK, we're professionals.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So, and we also were not aware that the patient's Medicare was primary. So this is a whole mess with her, um.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] So I'm just trying to figure out where I'm trying to straighten out her insurance so it's correct in the system, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And somebody had put in the other plan, the 90 degree plan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And payments have been made by them, but then whenever the lady told me that that was supposedly only wellness and annual exams, she transferred me to this department.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we don't have your ID number or that policy in her registration at all. We only had the 90 degree plan.
[CUSTOMER][NEUTRAL] So I just wanna see if I'm supposed to even add y'all in there or not for us.
[AGENT][NEUTRAL] Give me one second to. I mean, she does have an active let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm, what's the date of service that you said has been filed for her?
[CUSTOMER][NEUTRAL] Um, we have filed.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amounts for those dates of service?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] [PII] total was 29.
[CUSTOMER][NEUTRAL] $29.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] $29.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. I don't.
[AGENT][NEUTRAL] And tell me what's what is the tax ID number again for?
[AGENT][NEUTRAL] I'm just trying to look, yeah. Mhm.
[CUSTOMER][NEUTRAL] Our tax ID?
[CUSTOMER][NEUTRAL] 570
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 992
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, what was the billed amount for data service? You said 11:15 also?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] There was a $14 and a $26.
[CUSTOMER][NEUTRAL] It looks like they went out separately. I'm not sure why.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] Give me that total bill amount just one more time for the 11:15.
[CUSTOMER][NEUTRAL] 11:15 we build 22 things on it but it looks like they went out separate from what I can tell. One of them was [PII] and one of them was [PII].
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Let me go back this a different.
[AGENT][NEUTRAL] We have 2 claims on file for her.
[AGENT][NEUTRAL] That are from your group.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, let me try.
[CUSTOMER][NEUTRAL] I have a claim number that was posted with one of the payments.
[AGENT][NEUTRAL] OK, what is that?
[CUSTOMER][NEUTRAL] 354.
[CUSTOMER][NEUTRAL] 0095
[CUSTOMER][NEGATIVE] That seems very short.
[AGENT][NEUTRAL] Can I please place you on a brief hold? I am so sorry, [PII]. Do you mind holding for me?
[CUSTOMER][NEUTRAL] No, that's fine.
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I haven't seen it yet, honey. I'm on my, I, I, I haven't even seen that. I had a text on my phone.
[AGENT][NEUTRAL] Is she, I'm, I've got a lady on hold.
[AGENT][POSITIVE] She's good. She's gonna make it.
[AGENT][NEUTRAL] I swear to [PII].
[AGENT][NEUTRAL] Pneumonia. Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. You've got to take her?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You have to take her out to Doctor [PII]'s.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Well, that's, that's wonderful. OK, honey, well, look, I will call you.
[AGENT][POSITIVE] Or or you call me back when you know anything any different, and I will I'll read that message. I, yeah, I hadn't even seen my phone thanks be to [PII]. I should been praying, OK.
[AGENT][POSITIVE] I love you cows, and you be very careful. Don't drive fast, you know.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, OK, so we can go do that with you? OK. All right, honey, well, that's good then. OK. Well, y'all just be real careful.
[AGENT][POSITIVE] Alright, baby, I love you.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEGATIVE] This is not 5.
[AGENT][POSITIVE] [PII], thank you so much for holding for me. OK.
[CUSTOMER][NEUTRAL] I found an EOB from y'all.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I, I was gonna look first at
[AGENT][NEUTRAL] Doing it in chronological order. You said there was one for 11:14.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 2024.
[AGENT][NEUTRAL] OK, for 2.
[CUSTOMER][NEUTRAL] Y'all paid $29 on that.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] This is American Public Life, correct?
[AGENT][NEUTRAL] Correct. What is the claim number that you have for the 11/14?
[CUSTOMER][NEUTRAL] OK, I'm wondering.
[AGENT][NEUTRAL] 2024 and you said that was $29 and what claim number do you show for that?
[CUSTOMER][NEUTRAL] 214, the claim number you said?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 354.
[CUSTOMER][NEUTRAL] 0082
[AGENT][NEUTRAL] Yeah, I do. I mean, I do see that. Let me pull something else up related to that data service. Just one second.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm having trouble with one of my screens, so I'm sorry for the delay.
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I guess the other plan, do they normally forward y'all claims if it's not for them?
[CUSTOMER][NEUTRAL] The 90 degree? No? OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Mm, no. Not to my knowledge.
[CUSTOMER][NEUTRAL] Because that's where we build it.
[AGENT][NEUTRAL] Well, you mail the claim. Did you mail them to a PO box, like, uh, I don't have it if you.
[CUSTOMER][NEUTRAL] 21704.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, so that's like the clearing house.
[CUSTOMER][NEUTRAL] With the D subscriber ID, OK.
[AGENT][NEUTRAL] That goes to the clearing house and then it gets dispersed.
[AGENT][NEUTRAL] From there.
[CUSTOMER][NEUTRAL] Got it. OK, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, I can't pull anything up for some reason on that.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] And you said the benefit amount on that was 29. Is that correct?
[CUSTOMER][NEUTRAL] For the 11:14?
[AGENT][NEUTRAL] Is that what you
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that claim number, and it, yes, and with that.
[AGENT][NEUTRAL] Yes, I can see that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well while we're on the phone, Medicare is primary, so what do we need to do about the two claims y'all paid on?
[AGENT][NEUTRAL] Oh, I have now that, um, well, now, this is not, we're not a major medical carrier.
[AGENT][NEUTRAL] Are you inquiring on like a refund back to us? I mean, this is a limited benefits plan.
[AGENT][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK, we just, we did not file the patient's primary insurance because this is what was handed to them at check in, so this is what they put in the system.
[AGENT][NEUTRAL] Again,
[AGENT][NEUTRAL] OK, so I'll tell you what, why don't I do this, [PII] with that question, I'm gonna see if I can get one of the examiners who actually uses these types of claims on the line with us to see if they can give some better since, you know, you all have gotten kind of jumbled up on that end as to how it was entered in the system or and trying to sort that out so I just don't wanna give you any incorrect information on that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But you now have the correct policy number for her policy with APL in which we do have those claims.
[AGENT][NEUTRAL] You know, under. Now, let me look one thing before I get 11:15, you said that bill amount was two separate charges, right?
[CUSTOMER][NEUTRAL] Yes, there was a $26.01 and a $14.01.
[AGENT][NEUTRAL] OK, yeah. I, I need to get one of the examiners on the line with us so that they can look at this. And do you show the payment on that one?
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] To backtrack real quick, yes, I've got y'all listed now and her correct policy number so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Should I be putting that in the system and not using the one that I told you we were having?
[CUSTOMER][NEUTRAL] Or that I told you we put in when you said that's the clearing house.
[AGENT][NEUTRAL] You know, honestly, that member ID, I, I, that, honestly, I'm not sure because, and I'm not sure why, honestly, that their ID cards, because some of them only have.
[AGENT][NEUTRAL] The neck, like the wellness. Mhm. Yes. And then a lot of them.
[CUSTOMER][NEUTRAL] 90 degree.
[CUSTOMER][NEUTRAL] Yeah, that's what hers only had on it.
[AGENT][NEUTRAL] have both.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not sure why their ID cards only have just one number on it when they have both plans because you said what you had only has that other number and this lady actually has or has a policy with APL as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So what I'm gonna
[CUSTOMER][NEUTRAL] Yeah and the other one ended on [PII].
[AGENT][NEUTRAL] Yeah, and we still show her policy again, her policy in our system at this time is still showing as active. There is not a term date in our system.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] But if you will give me a moment, like I said, I'm just gonna join in one of the examiners on our call. You won't have to re-verify anything. I'll give them kind of an oversight or an overview rather, not an oversight, but an overview of exactly, you know, that you just have some more questions on how you all should be entering this information into your system.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that they can explain that to you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All right, so, um, is there anything else there, [PII], that I could answer for you before I put you on hold to join someone else in with us?
[CUSTOMER][NEUTRAL] Um, that's it. If I were to put y'all in though, I, I guess I do have one more question. American Public Life, where are those claims supposed to go? Is that the PO box in [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, for other types of plans, but not for this plan. That address you have for IMA is the correct address for the type of policy she has. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK, the one we had in there for [PII].
[AGENT][NEUTRAL] Correct, is where her claim, where claims on this policy do need to be mailed. So that is correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right, well, give me just one moment, [PII], thank you so much again and we have a portal that you should be able to print your EOBs from as well in case you were to need to do that and it's a self registering portal, you would go to [PII] to register for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right, well, give me one moment then I'll place you on a brief hold while I get someone else on the line with us.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] [PII], it's [PII]. Oh, why are you, oh girl. OK, I transferred it to the hospital now. I was trying to get one of the examiners on this call with us. Nope, I didn't select the right thing on the, on the menu.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Or maybe it just rolled to me.
[AGENT][NEUTRAL] Um, no. I mean, I selected the hospital indemnity queue cause it's still on our, hmm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But reme
[CUSTOMER][NEUTRAL] But we get their calls now.
[AGENT][NEUTRAL] I thought that if we had an issue where we needed to speak to an an examiner, we've selected whatever that other thing [PII] said. I just didn't do that.
[CUSTOMER][POSITIVE] I think the claim support the claim support.
[AGENT][NEUTRAL] Yeah, that's what I'm saying. When I went through AWS I just transferred it like I would always to get one of them on the line. So that's how I ended up with you. Let me, I haven't tried to transferred to call until now.
[CUSTOMER][NEUTRAL] Yeah, but did you transferred to claim support?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I think it goes to claim support because um it's.
[AGENT][NEGATIVE] Right. It's where it's supposed to go, which is what I was saying. That's not what I even selected. No, I, no, I did just like always since I haven't transferred anybody.
[CUSTOMER][NEUTRAL] You didn't hit claim support got it OK OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it. OK. Bye.
[AGENT][POSITIVE] OK, thank you, girl. Bye.
[AGENT][POSITIVE] God dang it.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. How are you?
[CUSTOMER][NEUTRAL] Fine, how are you?
[AGENT][NEUTRAL] I'm all right, thank you. Um, other than I have a provider on the line.
[AGENT][NEUTRAL] Questioning um with questions on the two claims we have on file for this member.
[AGENT][NEUTRAL] The policy number is 255.
[AGENT][NEUTRAL] 7447 for part one [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the, the lady on the line that I'm speaking with, her name is also [PII].
[AGENT][NEGATIVE] But it's the two claims. They're trying to get this member's information in their system correct. She said they had it everywhere. I mean, it was all messed up.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] What kind of information is she?
[AGENT][NEUTRAL] I've given
[AGENT][NEUTRAL] She's got questions on like, well, I've got questions on this claim because it looks like we pay benefits to the insured.
[AGENT][NEUTRAL] And to the provider on the same claim number.
[AGENT][NEGATIVE] And I don't understand how we do that.
[AGENT][NEUTRAL] On both of these claims.
[CUSTOMER][NEUTRAL] Uh, let me look at them. Let me pull up one.
[CUSTOMER][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] And of course, she doesn't.
[CUSTOMER][NEUTRAL] In both claims it's for the same provider?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But she doesn't know anything about that.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, so on this first claim that was paid out, so yes, any since we pay, it only covers the $75 indited amount since on the bill they're charged amount for each CPT code, one line was only $18.01 line was only $11. So in that instance it would be a split pay, we would only be able to pay the provider the only $29 and the difference of that benefit goes to the insured.
[CUSTOMER][NEUTRAL] So that's why it was split pay that. That's why we only paid $29 to the provider because that was the total charge amount paid. I mean total, total, total charge amount that incurred from the provider and then the $46 was paid to the insured.
[AGENT][NEUTRAL] OK. So, OK.
[CUSTOMER][NEUTRAL] So which we will only address since it's the provider call and we will only let them know yeah.
[AGENT][NEUTRAL] Right. You're only gonna, correct. And then she's got some questions on the number that she needs to use, that they need to have in their system for this number because she's saying this lady also is Medicare Primary.
[AGENT][NEUTRAL] And I told her that this is a separate, you know, this is not a major medical insurance. This is a hospital indemnity limited benefit plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Mhm. Yeah, that's correct.
[AGENT][NEUTRAL] But as far as how they need to enter it or, you know, because like 99.9.
[AGENT][NEUTRAL] And 5% of these people who have our coverage and IMA only have a card that has that ID number for IMA, not APL cards.
[AGENT][NEUTRAL] So what number does she need to use when filing a claim? That's one of them. She has IMA's address, but does she need to use the
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] The D number or does she need to use our policy?
[CUSTOMER][NEUTRAL] So yeah, claims, yeah, claims will all go to I yeah, claims will always go to IMA you'll give them that mailing claims address, but it will be our policy number which is listed on the.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Card that was issued as well.
[AGENT][NEUTRAL] Yeah, but they don't ever have that car.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Because we don't mail these automatically. So that's all these, these policies are a nightmare, is what they are.
[CUSTOMER][NEUTRAL] So it'll be our
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] They're a nightmare.
[CUSTOMER][NEUTRAL] So I can help her if you want to transfer her to me, but yeah, uh yeah, it would be our policy number that she would use to input it um for her coverage with us.
[AGENT][NEGATIVE] Oh, no.
[AGENT][NEUTRAL] OK. I think [PII], I mean, I was just gonna join her in. I wasn't gonna release the call, just to hear how you explained it to her. Again, I haven't mentioned anything about, you know, seeing that part of the benefits were paid. No, I haven't mentioned any of that. Um, it was just like, it's that threw me, but as far as entering in the system and verifying which number, I explained to her that IMA that is the correct address because it goes to their clearing house.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How those payments were paid to the, yeah.
[AGENT][NEUTRAL] Before, you know, it comes to us, which is correct, right? OK. All right, so I just want you, yup, so if you'll just kinda, I guess, then just validate what I said and then let she asks you something else.
[CUSTOMER][POSITIVE] Correct. Mhm. Yeah, that's correct what you told her.
[AGENT][NEUTRAL] That I'm, that I don't know she's gonna ask you, but I'm gonna stay on the line.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, that's fine. And what was her name?
[AGENT][NEUTRAL] OK, so let me join her in her name is also [PII], same as the insured.
[CUSTOMER][NEUTRAL] Oh yeah, that's right, you did say that.
[AGENT][POSITIVE] OK, so hold on just a minute. Thank you very much for doing this.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] This is still [PII] and I have one of our examiners on the line with us. [PII], can you also hear us?
[CUSTOMER][NEUTRAL] Yes, I can hear you.
[AGENT][NEUTRAL] OK, so I'm gonna let um let you speak with [PII] [PII], but I have given her some of the background on, on our call and that you're just trying to get your system information straight, um, and so she's just gonna verify some of the information that I've already given you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] So you, you would need to verify exactly which policy number you're needing to utilize in your system when filing a claim with us?
[CUSTOMER][NEUTRAL] Well, originally we were sending it to the 90 degree plan with that ID number, but the claim ended up being I guess dispersed she had stated at the clearing house to y'all, so that works out um but yes I mean do we need to put it in the system underneath the APL with y'all's ID number and not 90 degree with their ID number?
[CUSTOMER][NEUTRAL] So on the claim um form it looks like, yeah, it looks like on the claims you have filed it looks like, yeah, they do have a multi-plan so they do have a different member ID number as far as filing the claims, um you can utilize our policy number.
[CUSTOMER][NEUTRAL] When filing a claim,
[CUSTOMER][NEUTRAL] Through the clearing house as well, so if you submit the claim, you would use our policy number which is the 02557447.
[CUSTOMER][NEUTRAL] OK, but still send the claims to that PO box? Correct, so you will still need to file the claim with the [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so I will expire the other plan then and add this one because the other rep said that the 90 degree plan ended in January of.
[AGENT][NEUTRAL] She was transferred to us [PII] by IMA and they said that policy termed for them 15, but I explained that our policy is still active.
[CUSTOMER][NEUTRAL] OK yeah looks.
[CUSTOMER][NEUTRAL] Yes, it is still active, effective [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, and the other question is we filed these two claims, 2 dates of services.
[CUSTOMER][NEUTRAL] To y'all
[CUSTOMER][NEUTRAL] But it should have been sent to Medicare Primary because the patient has Medicare. We just were unaware at the time that her Medicare is her primary coverage.
[CUSTOMER][NEUTRAL] So do we need to refund you all these? OK, so if for that instance since this is not um our coverage is only a hospital indemnity plan and it and from the information that was submitted to us it looks like it was assignment of benefits so that's why benefits were paid directly to you um if benefits were already paid by their other insurance carrier and um then benefits will be due to the patient then you, then yes, we would need a refund in order to.
[CUSTOMER][NEGATIVE] Disperse the benefits to the insured directly.
[CUSTOMER][NEUTRAL] If they, if they've already been paid by their other insurance carrier.
[CUSTOMER][NEUTRAL] No, we haven't billed it yet we were gonna do that today um I'm just trying to figure out what we need to do with the money from y'all on these claims.
[CUSTOMER][NEUTRAL] So you have not filed the claim yet with their other insurance, correct? Right, that is happening today that's why I wanted to call because we were unaware of the situation. OK, so you don't know what they're gonna cover or not cover at this time then OK so then I would advise once those claims.
[CUSTOMER][NEUTRAL] are filed with them and you get the claim decision and if those claims were not covered by their other insurance, then the, you wouldn't owe us anything that you wouldn't send us a refund.
[CUSTOMER][NEUTRAL] But if they pay the amount in full, then at that time we can um you can return those funds to us and we can re um distribute those funds to the insured at that time.
[CUSTOMER][NEUTRAL] OK, and if any is out, let's say for example Medicare on their EOB states that the patient owes co-insurance or deductible.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Would we use the money that y'all sent for these to cover that and then call back and see what the difference would be or or how does that what I need to that is yes, we would need you would just need to submit us with that EOB and we can reprocess the claim according to that primary EOB from Medicare.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] I think that's all the questions I have then um what is y'all's phone number instead of me going through 90 degree? Sure, our number is [PII].
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] All right, and I think um if I could just get a reference number for the call. It'll be just my name and that's [PII] and that's [PII] in today's date. Is there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] That's it. OK, well thanks for calling APO you have a good day.
[CUSTOMER][POSITIVE] Alright thank you both so much. You're welcome bye. Thank you.
[AGENT][POSITIVE] Right. Thank you both.
[AGENT][POSITIVE] All right. You're welcome, [PII].
[AGENT][NEUTRAL] Bye-bye.