AccountId: 011433970860
ContactId: f8cddec4-5a78-4392-b728-2418ac4525a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1359699 ms
Total Talk Time (AGENT): 562769 ms
Total Talk Time (CUSTOMER): 418042 ms
Interruptions: 11
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/f8cddec4-5a78-4392-b728-2418ac4525a2_20250210T13:19_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you?
[AGENT][POSITIVE] I'm good and you?
[CUSTOMER][NEUTRAL] I am good. I'm calling with um Gastro Health and I have some questions on some claims.
[AGENT][NEUTRAL] OK, just so you have, is it for different patients that you have questions on the claims or just one patient and multiple dates of service?
[CUSTOMER][NEUTRAL] It's uh the 2nd. It's one patient in multiple dates.
[AGENT][POSITIVE] Yes ma'am. Well, I can help you with that. And who am I speaking with please?
[CUSTOMER][NEUTRAL] Uh, my name is [PII] and last initial is [PII]
[AGENT][NEUTRAL] OK, [PII], thank you. And your callback number?
[CUSTOMER][NEUTRAL] It is [PII] and that's correct.
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Uh-huh. The member's policy number is 02430719.
[AGENT][NEUTRAL] OK, thank you. So give me a moment uh to get the member's information all pulled up please.
[AGENT][NEUTRAL] OK, so any information, [PII], that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] It's [PII], I'm sorry, [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And [PII], if you could tell me what this plan is, is it, and does it pay to the patient or?
[AGENT][NEUTRAL] OK. Yes, ma'am.
[AGENT][NEUTRAL] OK. If benefits are, OK, so this is a supplemental or was a supplemental plan to her primary health care insurance designed to help with co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] How does that work?
[AGENT][NEUTRAL] So depending um so once the client when the client file with APO we also will have to have a copy of her primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it depends it depends on who the claim.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I um
[AGENT][NEUTRAL] Who files it? I'm sorry, who, who files the claim is typically who the benefits will be payable to based on the assignment on the claim.
[CUSTOMER][NEUTRAL] Yeah, you're fine. I know what it is to try to do two things at once. It gets challenging, doesn't it?
[AGENT][NEUTRAL] Ah.
[AGENT][NEUTRAL] Yes, of course it does. So.
[CUSTOMER][NEUTRAL] I can tell you were doing your thing, so anyway, um.
[AGENT][NEUTRAL] Yeah, so I mean that's how it works. Whoever files the claim typically is who the benefits would be payable to unless it's.
[AGENT][NEUTRAL] Listed differently on the
[CUSTOMER][NEUTRAL] OK, so we need to just kind of go through these and see what happened to them.
[AGENT][NEUTRAL] OK, now, she's had.
[AGENT][NEUTRAL] OK, so her policy, she's had multiple policies. The policy number that you gave me.
[AGENT][NEUTRAL] I was effective from [PII], um, we'll start that again. [PII]. Is that, are your dates of service in that date range?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] All of them are.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yup. Yup.
[CUSTOMER][NEUTRAL] So the first one is.
[AGENT][NEUTRAL] Alright, so what is the first day of service, yes, and total bill amount, please?
[CUSTOMER][NEUTRAL] 1120 [PII] 23 $16,600.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm. And you said it's 16,600. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, and I actually sent these in via fax.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this claim was
[AGENT][NEUTRAL] OK, they were received recently. These claims were received.
[AGENT][NEUTRAL] Or this claim rather was received on [PII].
[AGENT][NEUTRAL] And it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Yeah, that would be me.
[AGENT][NEUTRAL] The claim number [PII] is 3553226.
[AGENT][NEUTRAL] And the denial states this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Well uh
[CUSTOMER][NEUTRAL] It's an infusion. They generally are.
[CUSTOMER][NEUTRAL] Um, that's weird.
[AGENT][NEUTRAL] Under the supplemental policy, yes, under, let me look on something.
[CUSTOMER][NEUTRAL] That's weird hm.
[CUSTOMER][POSITIVE] Those are generally covered. That's how they're definitely administered.
[AGENT][NEUTRAL] Correct. And it may be that it is covered by her primary insurance, but her supplemental policy did not have benefits for office treatment.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] OK, so I'll go ahead and.
[AGENT][NEUTRAL] Treatment rendered in the office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, that's a supplemental plan. OK, so I can bill that to her. OK, so the next one is probably gonna be much of the same, but I gotta get that information and claim numbers.
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] OK, sure, absolutely, sure.
[CUSTOMER][NEUTRAL] So [PII] and the total is $16,600 again.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that claim was also received. The received date on it was the same as the other and processed the same dates.
[AGENT][NEUTRAL] The claim number for this one is 355.
[AGENT][NEUTRAL] 3224 again the claim number is 3553224.
[AGENT][NEGATIVE] And that, yes, it was denied for the same reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and then the next one is [PII] $17,600.
[AGENT][NEUTRAL] OK, 319 for 176. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. That claim was also received on the same date and processed the same as the other two.
[AGENT][NEUTRAL] This claim number is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3553219. And yes, it was denied for the same reason.
[CUSTOMER][NEUTRAL] OK. Now,
[CUSTOMER][NEUTRAL] I'm gonna ask a question on these ones and let me know I forgot to even say anything can you send me or fax me an EOB of these?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We actually have a portal that you can create your it's a self registering portal, Sandy, where you can create your own user name and password. Now that you have the claim numbers you can print them all out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I have to have, OK, alright, and we'll get to that portal information.
[AGENT][NEUTRAL] Yeah. Mhm. Do you have another data service for her?
[CUSTOMER][NEUTRAL] Oh yes. 514 of 24.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the bill amount on that one.
[CUSTOMER][NEUTRAL] 17,600, they're all gonna be 17,600 now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Also received and processed the same dates as the other.
[AGENT][NEUTRAL] And this claim number is 3,553,220.
[CUSTOMER][NEUTRAL] And it's the same, OK. Well, I guess it's, I'm on a.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim uh claim uh just on a claim number mission.
[AGENT][POSITIVE] You're right
[CUSTOMER][NEUTRAL] See here.
[AGENT][POSITIVE] Well, we're ready to tackle that one. We're ready to tackle that task on that mission.
[CUSTOMER][NEUTRAL] All right. So,
[CUSTOMER][NEUTRAL] Let's see here, so the next one is 79 of 24.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 17 6 on this one as well.
[CUSTOMER][NEUTRAL] Yep, mhm.
[AGENT][NEUTRAL] No claim on file.
[CUSTOMER][NEGATIVE] So that didn't get received, huh.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So I'll have to send that one back, OK, I'll resend.
[CUSTOMER][NEUTRAL] How about 93 of 24?
[AGENT][NEUTRAL] 17 6 also. You said they were all 176, right, from here on out?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, not on file.
[AGENT][NEUTRAL] I don't know, maybe somebody called, I don't know. Oh, but you said you sent them.
[CUSTOMER][NEUTRAL] All that.
[AGENT][NEUTRAL] I don't know unless someone call, we were told and, you know, they were explaining that procedures done in the office weren't covered. I don't, I mean, I don't know but.
[CUSTOMER][NEUTRAL] Yeah, uh, let me
[CUSTOMER][NEUTRAL] Uh, that would be just me, but still, I would, you know, that could be such a thing too. If they're not covered, why are we even billing it?
[CUSTOMER][NEUTRAL] You know, we probably don't need to bill it.
[AGENT][NEUTRAL] And of course, that's entirely up to you, um, but I can just, I mean, let me, let me pull 11 just one second.
[CUSTOMER][NEUTRAL] So I'll just bill. I'm just gonna bill her.
[CUSTOMER][NEUTRAL] Oh, it might have been, let me see here, we may have just received payment. Let me see.
[CUSTOMER][NEUTRAL] Yes, that's what it is. September, yeah, we just got um payment for um September, October, and December.
[AGENT][NEUTRAL] From her primary.
[AGENT][NEUTRAL] Oh and, yeah, and because we have.
[CUSTOMER][NEUTRAL] Um, data the service, so let me see.
[AGENT][NEUTRAL] Yeah, because we have to have the primary EOB as well when we review claims if you all, you know, that may be why you had not um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Absolutely. So I think that's what this is.
[AGENT][NEUTRAL] submitted
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But yes. Um,
[AGENT][NEUTRAL] Yes. She did not have benefits for treatment in the office.
[CUSTOMER][NEUTRAL] And honestly, the patient should be submitting it.
[CUSTOMER][NEGATIVE] OK, I'm not even gonna.
[CUSTOMER][NEUTRAL] At this point, I don't even know that.
[CUSTOMER][NEUTRAL] Go ahead with the portal information.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are you ready?
[CUSTOMER][NEUTRAL] And see if I can even, sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] So the portal website is secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And you have to self register.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And when
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you'll do new user and then I'm a medical or dental provider.
[AGENT][NEUTRAL] When it gets to the next screen where you're filling in when it asks you like for a patient account number?
[AGENT][NEUTRAL] That's the account number that you all have in your system that we received on the claim, not their APL policy number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A lot of people get confused with that. It says providers patient account number, but.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They think they're referring to our policy number for the member.
[CUSTOMER][NEUTRAL] So we have to have a provider number.
[AGENT][NEUTRAL] So if you
[AGENT][NEUTRAL] You all have a patient account number for the member in your system on the.
[AGENT][NEUTRAL] Well, according to your claim, we receive.
[CUSTOMER][NEUTRAL] Yeah, we have yeah oh are you?
[AGENT][NEUTRAL] That's what it's asking you for.
[CUSTOMER][NEUTRAL] Right. And it would be
[CUSTOMER][NEUTRAL] OK. So we would put in our claim number.
[AGENT][NEUTRAL] Not not claim number, the patient account number that you all have in the system for your patient.
[CUSTOMER][NEUTRAL] 171254.
[AGENT][NEUTRAL] Do you want to verify?
[AGENT][NEUTRAL] Mm, that's not what we received on the claim. This one begins with two sixes.
[CUSTOMER][NEUTRAL] Which claim are you on?
[CUSTOMER][NEUTRAL] 26.
[CUSTOMER][NEUTRAL] Not the MPI or the tax ID.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What date of service is this?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, let me look at t[PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], now that you have a claim number you may not have to have that but.
[CUSTOMER][NEUTRAL] It starts with 26.
[AGENT][NEUTRAL] No, 26, 66.
[CUSTOMER][NEUTRAL] 066.
[CUSTOMER][NEUTRAL] Hang on. 661-2200.
[AGENT][NEUTRAL] Correct, that's what's on the, that was on the claim that was received for that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see what you're saying. We call that a claim number in the office.
[AGENT][NEUTRAL] Oh, OK. OK.
[CUSTOMER][NEUTRAL] Yeah, right, it, it should match, right?
[AGENT][NEUTRAL] Uh, alright, and OK, claim number, OK, but.
[CUSTOMER][NEUTRAL] Yeah, right, I know.
[AGENT][NEUTRAL] That's what that, that's the number that that's looking for.
[CUSTOMER][NEUTRAL] For you, claim number means something different than for us. um, I, yeah, and I never think about that the account number likewise.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] is something else. So, yeah.
[AGENT][NEUTRAL] But that's the number it's looking for.
[CUSTOMER][POSITIVE] Oh my gosh. Well, I think we got it, you know, I mean, we've got enough.
[AGENT][NEUTRAL] In our
[CUSTOMER][NEUTRAL] So I'm gonna go on here and see if I can pull it up.
[CUSTOMER][NEUTRAL] And uh a couple of them and then just.
[AGENT][NEUTRAL] Do you wanna try to do that while you're still, yeah, do you wanna do that while we're still on the call so that you don't have to go back to the due to the verification process and all that again?
[CUSTOMER][NEUTRAL] Let's see here, yep, that's fine. I'm an employer right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Dental provider next.
[CUSTOMER][NEUTRAL] OK, so this is [PII]. Is this primarily [PII]? Is that?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Mm, no. Yeah, we're everywhere.
[CUSTOMER][NEUTRAL] You're, oh gosh.
[CUSTOMER][NEUTRAL] We have multiple all over the country.
[AGENT][POSITIVE] We do have a huge
[AGENT][NEUTRAL] Uh-huh. And we have a huge block of our business, yes, so it's in the state of [PII] as a whole, yes.
[AGENT][NEUTRAL] And all of these plans are different. So just because like her policy doesn't cover office treatment, some do. Some cover office treatment but not office visits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so they're all, there's a very wide variety of plan options that their employers choose from.
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] And while you're trying to set that up. I'm just gonna work on making my notes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, let's see here.
[CUSTOMER][NEUTRAL] Nope.
[AGENT][POSITIVE] So far so good, [PII].
[CUSTOMER][NEUTRAL] Yup, so far I'm working on it here. It's.
[AGENT][POSITIVE] Well, that's good. OK, good. Just making sure it's
[CUSTOMER][NEUTRAL] I did get
[AGENT][NEUTRAL] Being friendly with you. It's too early on Monday for it to not be very, to not be friendly.
[CUSTOMER][NEUTRAL] I know, right? I'm trying to get my passwords to match.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That would be my, oh really? OK.
[AGENT][NEUTRAL] We all struggle with passwords this day and time because we have to have them for everything. And, you know, we can't have the same, and we can't have the same password cause if you have the same, it's easy, you know, they get one, they get it all, so.
[CUSTOMER][NEUTRAL] Um, let's see here.
[CUSTOMER][NEGATIVE] It's ridiculous.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] Oh this is crazy alright let me.
[CUSTOMER][NEUTRAL] Right this way.
[CUSTOMER][POSITIVE] Ah, OK, that worked.
[CUSTOMER][NEUTRAL] The submitting, so I'm just kinda waiting here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] Does it take a little bit once you hit submit?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You have, OK.
[AGENT][NEUTRAL] I mean, it shouldn't take, but, I mean, you know, uh, a second or two.
[AGENT][NEUTRAL] Not a very long time.
[CUSTOMER][NEUTRAL] It uh, it, it went. So, uh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] We are, we are good. It let me in and I'm back in and this is awesome. Thank you, thank you, thank you.
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] OK. Well, well, you are certainly welcome. You are very, very welcome. So is there anything else this morning, [PII], that I can help you with?
[CUSTOMER][POSITIVE] No, not at all. I appreciate it.
[AGENT][POSITIVE] Well, you are certainly welcome and thank you again for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You as well, and you're right. I just got into the first one and um it was just that easy, so thank you so much for um pointing me in the right direction here.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] A oh, absolutely. It was my pleasure. It was my pleasure. So if you can, if we need, we can help you with anything else, please give us a call and we'll be more than happy to at least try.
[CUSTOMER][POSITIVE] Alright, thank you, thank you, thank you, and you have a lovely day ahead.
[AGENT][POSITIVE] Thanks, [PII]. I hope you do too.
[CUSTOMER][POSITIVE] OK. Take care.
[AGENT][POSITIVE] OK, you too. All right. Yeah. Sure, you're gonna, yes, absolutely. Use my name along with today's date and the first initial to my last name if you need that is [PII].
[CUSTOMER][NEUTRAL] Oh, can I have a can I have a call reference number, [PII]?
[CUSTOMER][NEUTRAL] And it's T R A C S I T R A C Y O I.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] A. A.
[CUSTOMER][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Got you alright thank you.
[AGENT][POSITIVE] OK. Well, you're welcome, [PII], and thank you again for calling APL.
[CUSTOMER][POSITIVE] Mhm. Take care. Bye-bye.
[AGENT][NEUTRAL] Um, you too. Bye bye.