AccountId: 011433970860
ContactId: eab69a02-4d06-4a52-826d-e6a67ac4917b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 543909 ms
Total Talk Time (AGENT): 187981 ms
Total Talk Time (CUSTOMER): 205161 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/eab69a02-4d06-4a52-826d-e6a67ac4917b_20250130T15:26_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in group billing. Uh, looks like someone spoke to this lady yesterday. Um, policy number 142356.
[AGENT][NEUTRAL] Could you give me a moment, [PII], cause I wasn't ready for a policy number if you don't mind.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yeah, I'm ready for it now.
[CUSTOMER][NEUTRAL] 142
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 356 3
[AGENT][NEUTRAL] And who am I speaking with on the who's on the phone, the provider or the insured?
[CUSTOMER][NEUTRAL] This, this is.
[CUSTOMER][NEUTRAL] The insured's wife, [PII], um.
[CUSTOMER][NEUTRAL] It looks like there was an MRI done. Um, it sounds like from what Ms. [PII] is saying, she's kind of getting a run runaround from um from the provider's office or something. I'm, I can't really tell. Um, but she's needing to check on the claim that she called about yesterday, um, claim.
[AGENT][NEUTRAL] Is it for herself or the spouse? Who's the claim for?
[CUSTOMER][NEUTRAL] It's, it's for her. It's for an MRI that was done for her.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and she's just, she's been told that um the claim's been paid, um.
[CUSTOMER][NEUTRAL] But the provider's office saying that it hasn't been paid and so she's um it, she paid for the MRI up front so then she filed the claim um to I guess get reimbursed and so that's, that's basically what I'm assuming it's the.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] Uh, one of them is the 341-3272.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And we were requesting.
[CUSTOMER][NEUTRAL] And it looks like
[AGENT][NEUTRAL] like we requested diagnosis or, or ELB or something.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah, and whoever she spoke to yesterday um said that they would review and call, call them back, but uh now the spouse is on the phone.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] And it could be that she's not aware that.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That she can't be just from the last part of this note. Maybe she's not aware that she, the EOB needs to be sent in for the reimbursement to happen.
[AGENT][NEUTRAL] 6487.
[AGENT][NEUTRAL] Mmm. You can send her over. I can speak with her.
[CUSTOMER][POSITIVE] Alright, here she comes. Thanks.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, how are you doing?
[CUSTOMER][POSITIVE] Hi, good morning.
[AGENT][NEUTRAL] Um, my name is [PII] and I'll be assisting you. So I spoke with the the individual that was on the phone with you prior to her transferring you to me. What is the actual date of service so that I can actually verify the claim that you're calling about?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The exact date, I do, I don't think I have that. I think it was like maybe 4 or 5 months ago.
[AGENT][NEUTRAL] So when you spoke to someone yesterday, did they verify which claim it was when you provided them the information because she said you're calling about claims, however, there's multiple claims on file and she didn't provide me with a lot of information. So do you, are you aware of the date of service to how much the claim was, the claim number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It was it uh
[CUSTOMER][NEUTRAL] It was the MRI it was like $300.
[AGENT][NEUTRAL] Cause you have multiple claims on file.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It does it say all of them says the MRI?
[AGENT][NEUTRAL] This was in January. This one was in January, which was a year ago. You said 3 or 4 months ago. So I'm not sure which one it is that you're inquiring about.
[CUSTOMER][NEUTRAL] OK, so it, it, it was probably, yeah, it was, it was probably January.
[AGENT][NEUTRAL] So a year ago claim? OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We've been trying to do this from actually day one.
[AGENT][NEUTRAL] What is your concerns about the claim?
[CUSTOMER][NEGATIVE] The claim is I paid Palm MRI and they said, they said Amed did not pay, so I just want to get my money back.
[AGENT][NEUTRAL] We're not admins.
[CUSTOMER][NEUTRAL] I know you are, but you guys are the one that says Ahmed paid it, and they said Ahmed did not.
[AGENT][NEGATIVE] See, that's why I need an actual date of service because there's multiple claims. I don't know what date of service to even type in to look.
[AGENT][NEUTRAL] To look it up, did they tell you a claim number from the provider's office?
[CUSTOMER][NEUTRAL] Uh, hold on.
[AGENT][NEUTRAL] 4428.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Uh, I have um
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is it E83 I.39?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That won't be ours. That's from someone else. Give me what other numbers do you have? Is just start with numbers.
[CUSTOMER][NEUTRAL] Yeah, they gave me [PII].
[CUSTOMER][NEUTRAL] OK, numbers? Oh, I have.
[CUSTOMER][NEUTRAL] All of them start with the letter CPT 7127.
[AGENT][NEUTRAL] Oh, those are from your primary sound like.
[CUSTOMER][NEUTRAL] And E83.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 039
[CUSTOMER][NEUTRAL] And then ICV 10.
[AGENT][NEUTRAL] None of those, those are ours, starting with the letter is not ours. It must be from your primary.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That's what they gave me.
[AGENT][NEUTRAL] Let me see if they gave you probably because they think that you're calling about the primary if the primary didn't make a payment.
[AGENT][NEUTRAL] I'm not sure. I don't know.
[CUSTOMER][NEUTRAL] Primary don't make a payment, do they?
[AGENT][NEUTRAL] I'm not sure. I have to find a claim that you're inquiring about first.
[CUSTOMER][NEUTRAL] Well, I pay them.
[AGENT][NEUTRAL] Um 1252534. So when you paid them what claim, what did you submit for the claim to be processed?
[CUSTOMER][NEUTRAL] I pay them cash up front.
[AGENT][NEUTRAL] Right, so I know, I get that, but you submitted the claim here to American Public Life to be processed for you to be reimbursed?
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Yeah, they have all that information.
[AGENT][NEUTRAL] So what did you submit here?
[CUSTOMER][NEUTRAL] Uh, let's see, that was uh paperwork.
[CUSTOMER][NEUTRAL] I don't know whatever the documents that you guys have asked for.
[CUSTOMER][NEUTRAL] Um, that's all I had.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I just fill out the necessary paperwork that they asked for, so I don't.
[AGENT][NEUTRAL] So here, it shows that admin put.
[AGENT][NEUTRAL] $50.50 dollars went towards your deductible.
[AGENT][NEUTRAL] Your co-pay and then.
[AGENT][NEUTRAL] $80 went towards your copay.
[AGENT][NEUTRAL] That was $130 went to your copay.
[AGENT][NEUTRAL] This was paid to the provider [PII].
[AGENT][NEUTRAL] 4428.
[AGENT][NEUTRAL] The providers submitted the claim.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I guess this is the correct one. I don't know.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Be very
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I I'm looking at the claims.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I