AccountId: 011433970860
ContactId: 1ccdc668-fddc-43ea-84da-193a27c0f82f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 450420 ms
Total Talk Time (AGENT): 186497 ms
Total Talk Time (CUSTOMER): 212537 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/1ccdc668-fddc-43ea-84da-193a27c0f82f_20250219T19:06_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, this is the first time that I have called, uh, APL before, um, but my name is [PII], and I just wanna follow up on a claim for um a medical claim.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you. What is the callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] OK, thank you. Um, that is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um, I think that might be the issue, uh, but I will give you what we have. Um, 02466519.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Um, [PII], date of birth [PII].
[AGENT][POSITIVE] Alright, thank you, and it would be my pleasure to assist you with that claim status. What is the date of service for [PII]?
[CUSTOMER][NEUTRAL] Um, data service is [PII], so [PII].
[AGENT][NEUTRAL] And what is the bill amount please ma'am?
[CUSTOMER][NEUTRAL] $238.
[AGENT][POSITIVE] Thank you, and the facility name please ma'am?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, week specialty physician group.
[AGENT][NEUTRAL] Is that WakeMed specialist specialist group? Alright, thank you. Alright, it actually looks like we have received that claim twice. The original claim we received on 5-8-2024.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the claim was actually denied because the charges submitted are not payable because services were rendered prior to the policy's effective date.
[AGENT][NEUTRAL] The effective date on the plan is [PII].
[CUSTOMER][NEUTRAL] Oh, OK, alright, um, and then when did that policy end?
[AGENT][NEUTRAL] On [PII]?
[CUSTOMER][NEUTRAL] 33124. OK. Um, and I know this is asking probably too much, but would you by chance know if this patient had any other coverage or even under like a different policy number?
[AGENT][NEGATIVE] For that data service they did not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Not with APL. Let's see, let me check one other thing, yeah, they did not with APL.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right, um, and that was the right ID number, right?
[AGENT][POSITIVE] Yes ma'am, that is the correct policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I tried to get on the APL web portal just to kind of do a new user, um, and I put in our tax ID along with the patient account number which is what I, that is that the same as the insured ID number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is not. It's going to be the patient account number with your facility listed in box 26 on the HPA. If you wanna go back to that website, I can actually provide that patient account number. I've got it in front of me so you don't have to look it up.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I, I actually have it. I have the claim image right here and that worked. I put that, um, account number. I didn't realize it was the one that starts with the P.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, it is. It's the facility patient account number.
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][POSITIVE] OK, well thank you so much uh for your help. um do you by chance, uh, uh huh.
[AGENT][NEUTRAL] And you can
[AGENT][NEUTRAL] I, I'm so sorry I didn't mean to interrupt you. Uh, you can get that EOB. There's an option for a quick reference since I gave you that claim number. All you need is the patient's name, date of birth, and the claim number, and it will pull up the EOB for you.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Oh, OK. How do I go about that?
[AGENT][NEUTRAL] So once you've created that account and I don't mind waiting if you want to go ahead and create that account.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, sure, let me.
[AGENT][NEUTRAL] Just tell me when you're ready.
[AGENT][POSITIVE] And take your time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Just about there.
[AGENT][POSITIVE] take your time. It's fine.
[CUSTOMER][POSITIVE] OK, alright, easy enough.
[AGENT][NEUTRAL] OK, and once you log back in.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, there.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Under the claim status.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're gonna use the first option, the quick access.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And put in the name and the date of birth and the claim number.
[CUSTOMER][NEUTRAL] OK, um, what was the claim number?
[AGENT][NEUTRAL] 345.
[AGENT][NEUTRAL] 3811.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3453811.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then [PII] and date of birth [PII] search oh it says zero claims oh it says first name oops, OK, [PII], oops that would be helpful putting the right information.
[AGENT][POSITIVE] It usually helps sometimes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, it does.
[AGENT][NEGATIVE] I'm guilty of that as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh awesome OK so yeah I was able to.
[CUSTOMER][POSITIVE] Um, get that pulled up here. All right, thank you so much for your help.
[AGENT][POSITIVE] It's been my pleasure. Is there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Um, do you by chance, uh, uh, give reference numbers?
[AGENT][NEUTRAL] It's going to be my name and today's date, and I spell my name [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the first initial and my last name is [PII].
[CUSTOMER][POSITIVE] Great thank you so much for your help.
[AGENT][POSITIVE] It's been such a pleasure to assist you with that claim status, [PII]. Thank you for calling APL and I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.