AccountId: 011433970860
ContactId: 0b50388b-9a30-4a98-af59-25bdc6816006
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604820 ms
Total Talk Time (AGENT): 181711 ms
Total Talk Time (CUSTOMER): 173668 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/0b50388b-9a30-4a98-af59-25bdc6816006_20250110T13:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. Uh, my name is [PII] and I'm calling from the provider's office. And sorry, your name is?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] And I'm calling today to help me regarding the claim status for a member.
[AGENT][NEUTRAL] OK, I can help you. What's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, the policy number is going to be 01930316.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it'll be [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it'll be [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thanks for verifying that information and you're checking claim status?
[CUSTOMER][POSITIVE] Yes, please, that's right.
[AGENT][NEUTRAL] The date of service in charge?
[CUSTOMER][NEUTRAL] Uh, it will be [PII] and the bill amount is $1,042 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You said September 1024?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] And it's for [PII]?
[CUSTOMER][POSITIVE] Uh yes, please, that's right.
[AGENT][NEUTRAL] Let me give you the current policy number.
[AGENT][NEUTRAL] That number is 244-027-0.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the procedure codes on the claim?
[CUSTOMER][NEUTRAL] The procedure code is, uh, I have 22, 9,921,420,550.
[CUSTOMER][NEUTRAL] Uh, that's with the modify F5 and the other one again with 59 and F3, and the last is J 0702.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I show the claim was received [PII], processed [PII] under this policy treat.
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] Oh, sorry, uh, the process date is [PII].
[AGENT][NEUTRAL] Correct. Under this policy, treatment in the office is not covered. Uh, this is a Metlink policy and so no payment was made on this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, uh, in this case, uh, like will it be again the patient's responsibility?
[AGENT][NEUTRAL] We do not determine patients responsibility.
[CUSTOMER][NEUTRAL] OK, so how do we go with this? Like, can we uh.
[CUSTOMER][NEUTRAL] Submit any uh I mean modifiers or how do we go with this uh claim?
[AGENT][NEUTRAL] There's, it's not covered under the patient's policy.
[AGENT][NEUTRAL] Treatment in the office is not covered under the patient's policy.
[CUSTOMER][POSITIVE] OK, thank you so much. And can you help me with the claim number, please?
[AGENT][NEUTRAL] That claim number is 351-6995 and [PII], you can also check your status on our online service center at [PII]. And did you have any other questions I could help out with today?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you just fax a copy of an EOB please?
[AGENT][NEUTRAL] Uh, it was actually mailed on [PII], uh, the next day, um, after the claim was processed and now available to download on that website at [PII], and I can help you create the account if you would like.
[CUSTOMER][NEUTRAL] Uh, sure, please. One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes, please. Can you help me with that name, please? Secured.
[AGENT][POSITIVE] Mhm. It's secure. Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII] that's all together.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you can search with but do the quick search using the claim number provided.
[AGENT][NEUTRAL] Uh, when you get to the site, let me know the homepage.
[CUSTOMER][NEUTRAL] Yeah, it's asking for the username and the password.
[AGENT][NEUTRAL] So you would, you would have to create a username and password.
[CUSTOMER][NEUTRAL] So do you have to uh
[AGENT][NEUTRAL] And so what steps did you take? Did you, did you select the role, the role that best describes you?
[CUSTOMER][NEUTRAL] Uh, so I, uh, entered that, uh, link, uh, that is at [PII].
[AGENT][NEUTRAL] It's a [PII].
[CUSTOMER][NEUTRAL] OK. Because
[AGENT][NEUTRAL] Is that the page you went to?
[CUSTOMER][NEUTRAL] Yeah, I entered as [PII] and uh I got the links as [PII].
[AGENT][NEUTRAL] OK, so the home page should say online service center welcome.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yes, please, that's right. So I have to choose the new user.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. OK, then, not a problem.
[AGENT][NEUTRAL] And which role did you select?
[CUSTOMER][NEUTRAL] So I chose as uh the um the provider.
[AGENT][NEUTRAL] OK and then um on the next page it's asking you to verify some information so the tax identification and the patient account number um that's on your claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It must match what we have in our system. So what tax identification number it did you use?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the tax identification is [PII].
[AGENT][NEUTRAL] OK, and then the patient account number inbox 26 on that claim, what did you enter?
[CUSTOMER][NEUTRAL] Yeah, one moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One minute.
[CUSTOMER][NEUTRAL] So I need to enter the, is it that uh new uh policy number which you gave?
[AGENT][NEUTRAL] No, it's a patient account number that's on the CMS 1500 form that was sent in by this office.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The item I bill.
[CUSTOMER][NEUTRAL] Uh, so I see that it is saying that new, I mean no user was found with the information.
[AGENT][NEUTRAL] OK, I'm asking you to verify the patient account number that's on the claim that was sent to us, it's in box 26.
[CUSTOMER][NEUTRAL] OK, I have 0.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Inbox. Yeah, I have [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And when you enter that it says.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, one
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, now it's asking to create your own account so I can enter my own uh
[AGENT][NEUTRAL] Create your own username and password.
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And I'll wait until you do that. I wanna make sure that you're able to create the account successfully or successfully create the account, OK.
[CUSTOMER][NEUTRAL] I sure please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] OK, I think, uh, there's some issue with the password. I'll create a new one and uh I will check with that. Thank you so much, [PII]. And can you help me with the call reference number, please?
[AGENT][NEUTRAL] Were you able to download the explanation of benefits?
[CUSTOMER][NEUTRAL] Uh, no, there's some issue with, uh, creating the password, so I'll, I'll do it a little bit later and I will check with it. So can you just help me with the call reference number, please?
[AGENT][NEUTRAL] You'll use my name in today's state as your reference, [PII] and first initial of my last name is [PII]. Any other questions?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Uh, no, [PII], that's it. Thank you so much. Bye-bye.
[AGENT][POSITIVE] Uh, you're welcome. Thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you, bye bye.
[AGENT][POSITIVE] Have a good day.
[CUSTOMER][POSITIVE] You too. Thank you.