AccountId: 011433970860
ContactId: fd35b710-9e06-4d87-a5a0-670460740fbf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 691390 ms
Total Talk Time (AGENT): 335117 ms
Total Talk Time (CUSTOMER): 198350 ms
Interruptions: 6
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/fd35b710-9e06-4d87-a5a0-670460740fbf_20250414T12:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. This is [PII]. How are you?
[AGENT][POSITIVE] I'm good, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing good, thank you. [PII], I need to check status on a claim.
[AGENT][NEUTRAL] Yeah, well, how can I help you?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, if you can please help me with status on the claim.
[AGENT][NEUTRAL] Sure, you're needing claim status for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number is um let me see, 02353163ML8.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Uh, you're welcome.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] That's not a guarantee of payment. What is your patient's name?
[CUSTOMER][NEUTRAL] My um date of birth, patient's date of birth is
[AGENT][NEUTRAL] Patient's name, name and date of birth.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that?
[AGENT][NEUTRAL] What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK. Patient is [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the
[AGENT][NEUTRAL] Date of service and total bill amount for her, please.
[CUSTOMER][NEUTRAL] 4 29 24 $4,907.
[AGENT][NEUTRAL] I'm sorry, 4,907. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that this, and what is the name of the facility?
[AGENT][NEUTRAL] The provided facility.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Um, yes, Baptist Outpatient Services.
[AGENT][NEUTRAL] OK, so yes, ma'am, I do see that that claim was received, uh, the.
[AGENT][NEUTRAL] Do you need the receive date and the process date or just the actual status on it?
[CUSTOMER][NEUTRAL] Um, the process data and status, please.
[AGENT][NEUTRAL] OK, so this name was received.
[AGENT][NEUTRAL] Back on [PII], processed on [PII].
[AGENT][NEUTRAL] The claim number is 3504186.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There was a $50 benefit paid.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] On check number 20018007.
[AGENT][NEUTRAL] And that was on the 721-97 code.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And the other code was denied, and the remark for the denial on that, it just states insureds major medical coverage provided full benefits, no benefits.
[AGENT][NEUTRAL] For this procedure.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Now let me ask you a question um.
[AGENT][NEUTRAL] And that check cleared on [PII].
[CUSTOMER][NEUTRAL] Oh, OK. And it was dated when? [PII] you said?
[AGENT][NEUTRAL] Uh-huh, and cleared on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, perfect. Now, I have a, OK, I have a question. Um, Aetna, because they originally we uh processed the claim in correctly.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um, the copay wouldn't have been $50. It would have been $500 300 dollars. So do I submit a corrected claim or just a new explanation of benefits?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, so you're saying it should have been 500 instead of 50?
[CUSTOMER][NEGATIVE] No, 300. It should have been 300 instead of 50, yeah.
[AGENT][NEUTRAL] And, OK.
[AGENT][NEUTRAL] OK, do you mind holding for me for a moment, please?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Uh-huh, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL, this is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. I just have a quick question. How are you today? First off, I'm good, thank you. So I have a provider on this line who they filed a claim back in the fall. We paid the $50 benefit on it, but she's saying that they filed it incorrectly. It was should have been a $300 copay instead of a $50 so she's.
[CUSTOMER][POSITIVE] Sure. Good. How are you?
[AGENT][NEUTRAL] And does she need to submit an entirely corrected claim with the EOB or just the EOB?
[CUSTOMER][NEUTRAL] Uh oh, you were breaking up. You cut out there for a minute. You had cut out there briefly.
[AGENT][NEUTRAL] I don't know what's wrong with this phone system. [PII], I'm sorry, it's this phone system I've called IT. They can't help me, so I don't know what to do. Um, OK, we process the claim.
[CUSTOMER][NEUTRAL] So I've missed some of what you said. OK.
[AGENT][NEGATIVE] OK, so we processed the claim back in the fall. We paid a $50 benefit on it. However, the provider is saying that they had initially filed it incorrectly or whatever, so that it should have been a $300.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What they submitted should have been for 3.
[AGENT][NEUTRAL] $100 so she's wanting to know should it have just some pilot.
[CUSTOMER][NEGATIVE] Uh oh, I lost you again. When you get to the $300 cut out.
[CUSTOMER][NEUTRAL] So she's, she's saying that she should have it there was $300 benefit that they submitted versus the $50.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, they need to submit. It should have been a 300, right. So do they need to submit a corrected claim, a new EOB or just another, the EOB showing?
[CUSTOMER][NEUTRAL] On the claim.
[AGENT][NEUTRAL] That it was 3. Yes, uh-huh, it is.
[CUSTOMER][NEUTRAL] And this is the provider, correct?
[CUSTOMER][NEUTRAL] Yeah, we need to correct the claim with that updated EO be reflecting that out of pocket changed, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I thought that's right, but I just wanted to double check it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, [PII]. Well, thank you so much and I hope you have a great day.
[CUSTOMER][POSITIVE] You're welcome. You too.
[AGENT][NEUTRAL] All right, thanks. Bye-bye.
[CUSTOMER][POSITIVE] You're welcome bye.
[AGENT][NEUTRAL] [PII], thank you very much for holding for me. So, on this one, we will need to receive a corrected claim along with the correct EOB. Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Perfect. Thank you so much, [PII], and you have a wonderful rest of the day.
[AGENT][NEUTRAL] You, oh.
[AGENT][POSITIVE] I hope you have a wonderful day too and [PII] just one more thing we have a portal that you can also access the EOBs for our um clients once we have processed the claim and our website for the portal is secured.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much. I wish it would work, that portal.
[AGENT][POSITIVE] Well, you're welcome
[AGENT][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] It would be great if it did, yeah.
[AGENT][NEUTRAL] Well, we don't, if there's not a claim on file, there wouldn't be anything found, and I don't know if you've done this, but I know that several people, um, have asked me about it, so I try to say when it asks for the patient account number, that's not their APL policy number.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That is the provider's account number for the member that you will submit on your claims.
[CUSTOMER][NEGATIVE] Right. But the only issue is that, yeah, that portal is still asking for the last 4 numbers of the Social Security. And since that is no longer hasn't been for years uh of valid or a form of HIPAA.
[AGENT][NEUTRAL] So I don't know
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] We don't
[CUSTOMER][NEGATIVE] I, uh, we don't obtain the social security numbers for patients anymore.
[CUSTOMER][NEUTRAL] So unless we have the social, so either way, the only other way is to get a claim number.
[AGENT][NEUTRAL] OK. I was
[AGENT][NEUTRAL] Right. So if you, so you can call us and get the claim, then they are making some updates on the portal, just so you're aware. Yeah. Um, so I do know that that's, that is something that is in the works, but it has not yet come to full fruition. So yes, you can call us and get the claim number and then you should be able to access it without having to have those, the social.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I hope they fix it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If you have the claim number, their first name, and date of birth, it should locate it if we have processed the claim.
[AGENT][NEUTRAL] You have, cause you have 3 different options. OK. Well, is there anything else, [PII], I can help you with this morning?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No, that would be it. Thank you so much.
[AGENT][POSITIVE] Well, you are welcome and again thank you for calling APL. I hope you have a wonderful day.