AccountId: 011433970860
ContactId: f5fbd61b-645b-4294-9751-8e627bcc524f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386269 ms
Total Talk Time (AGENT): 131225 ms
Total Talk Time (CUSTOMER): 121991 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/f5fbd61b-645b-4294-9751-8e627bcc524f_20250507T13:09_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, good morning, [PII]. My name is [PII], and I was calling on behalf of a facility. I was calling to see if you received a underpayment appeal that we submitted, and I also wanted to check to see if the claim was processed using a network.
[AGENT][NEUTRAL] OK, well, I can definitely check on the claim for you and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Uh-huh. My direct number is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 2586493.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And the bird, um, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill or the claim number?
[CUSTOMER][NEUTRAL] Uh-huh, um, the claim number I have, let me pull it up over here.
[CUSTOMER][NEUTRAL] It is 3,561,840.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] we got
[AGENT][NEUTRAL] You said 3,561,840?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah, 3,561,840.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Oh, it's a different policy number. OK, hold on one moment.
[AGENT][NEUTRAL] OK, so I had to go into that policy. Sorry, it was a different policy number, but I have found it here. Let me just get everything.
[AGENT][NEUTRAL] In one spot. It's for data service [PII]?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So we paid out?
[AGENT][NEUTRAL] And when was the corrected claim sent?
[CUSTOMER][NEUTRAL] Well, it's not a corrected claim. We already received um payment on it, but it was underpaid, so I did submit an appeal, so I wanted to see if you all did receive that appeal, but I wanted to make sure that this claim was processed using the network. On our end it shows they used the multiplayer network, but I just want to make sure.
[AGENT][NEUTRAL] So the insured does have the hospital indemnity policy, so there's no network for that part, but they do have the um multi-plan, which is the PPO. So yes, I guess to answer your question, it was processed with multi-plan with the PPO network. Um, the appeal then, what, when did you send the appeal and the reason I'm asking is because I don't, I'm just trying to track it. I don't see anything here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let's see. It was mailed out. Let me go to the note.
[CUSTOMER][NEUTRAL] It was mailed on [PII].
[AGENT][NEUTRAL] F
[AGENT][NEUTRAL] OK. No, so that's the diagnostic test and that's not it. Hold on one moment.
[AGENT][NEUTRAL] this
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, I'm not showing that we received the appeal, um.
[AGENT][NEUTRAL] Yeah, I don't see the appeal here. There's 3 claims that came in after the date that you sent it in February, but I just checked them in there. It's not the same claim.
[CUSTOMER][NEUTRAL] OK. Um, is there any other way I can submit the appeal besides by mail?
[AGENT][NEUTRAL] Yes, um,
[AGENT][NEUTRAL] You can um send it electronically.
[AGENT][NEUTRAL] And I have the payer ID for you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See, on my end, I don't have that option. We can only send the claim electronically, but it doesn't give us the option to send the appeal. So you all don't have a fax number or email address I can submit it to?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] No, because this is going to IMA so they only have the PO box and the payer ID.
[CUSTOMER][NEUTRAL] OK. Mm. OK, I'll try to send it over again. Um, what's the address? I just want to make sure we do have the correct address.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah, that's the right one. OK, um, I'll try to resend it. OK, and can I please have a reference number for our call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. All right. Thank you so much, and I hope you have a wonderful day.
[AGENT][POSITIVE] You're very welcome, [PII], thanks for calling APL. I hope you have a great day as well.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.