AccountId: 011433970860
ContactId: 36498f70-46b6-42f4-b87a-0746fa4cbfb3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 772580 ms
Total Talk Time (AGENT): 311808 ms
Total Talk Time (CUSTOMER): 236250 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/36498f70-46b6-42f4-b87a-0746fa4cbfb3_20250131T21:08_UTC.wav
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[CUSTOMER][NEUTRAL] that
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, good afternoon. I'm calling from Rey Valley Dermatology. Um, I'm trying to create an account, um, on the website, and I'm having trouble doing it.
[AGENT][NEUTRAL] OK, and I'm sorry, your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Spell it for me.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and you're, are [PII] And did you say you're calling on behalf of a provider's office?
[CUSTOMER][NEUTRAL] And you said that your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you're trying to create an account on the online service center?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and is it regarding a patient's information?
[CUSTOMER][NEUTRAL] Um, yes, because we have submitted some claims and we haven't had a response since September.
[AGENT][NEUTRAL] What are you trying to do?
[AGENT][NEUTRAL] OK, so you're checking claim status then. OK, I can help you with that. What's the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the patient, let me check.
[CUSTOMER][NEUTRAL] I have 01.
[CUSTOMER][NEUTRAL] 868846
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. What were the last four digits? [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII], thank you.
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I have [PII], [PII].
[AGENT][NEUTRAL] OK, and tell me what website are you on? Give me the web address.
[CUSTOMER][NEUTRAL] Mm [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] has [PII].
[AGENT][NEUTRAL] OK, so the home page says, what do you see on the home page?
[CUSTOMER][NEUTRAL] The home page is.
[AGENT][NEUTRAL] Does it say online service center welcome?
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] No, it's just work for benefits that work for you APO.
[AGENT][NEUTRAL] OK, to the right do you see a login tab and a new user tab?
[CUSTOMER][NEUTRAL] Uh, there's a sign in.
[AGENT][NEUTRAL] Have you created an account before or no?
[CUSTOMER][NEUTRAL] No, that's what I was, uh, no, this is my first time trying to.
[AGENT][NEUTRAL] OK, and you logged, you logged into [PII]?
[CUSTOMER][NEUTRAL] Create one.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I click the new user.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what did you?
[CUSTOMER][NEUTRAL] And then I am a provider.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let me see, uh.
[AGENT][NEUTRAL] Now what is the date of service?
[CUSTOMER][NEUTRAL] The first.
[CUSTOMER][NEUTRAL] I have several, but the initial is [PII].
[AGENT][NEUTRAL] OK, because what you enter has to match what we're what's in our system as far as the tax identification number and the patient account number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So let me give you the current policy number, that could be the issue. Well, you gave me 186-8846. OK, that's the most current.
[AGENT][NEUTRAL] And you did say this is for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I don't show
[CUSTOMER][NEUTRAL] But it's asking me for a patient control number would that be the subscriber number?
[AGENT][NEUTRAL] It should say patient account number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, patient account number it's the member ID correct?
[AGENT][NEGATIVE] And then there should be no, there should be instructions below that.
[AGENT][NEUTRAL] It tells you what the patient account number is. So if you're filing a professional fee, the CMS 1500, you'll find the patient account number and box number 26 on your claim on the itemized bill.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's the number that it's looking for that.
[CUSTOMER][NEUTRAL] What if we what if we're trying to send it um electronically?
[AGENT][NEUTRAL] Then you would send it to the payer ID number which is 60801 but right now you're trying to do a claim status online, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I think we're talking about two different things. So the security, the two security questions is asking for the provider service tax identification number and then the patient account number that's on your itemized bill.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So it is, is it a CMS 1500 form or HIXA 1500 form?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Or is that a hospital bill?
[CUSTOMER][NEUTRAL] No, it
[CUSTOMER][NEUTRAL] No, it's not a hospital. It should be the CMS 500, I think.
[AGENT][NEUTRAL] 1500, OK. Uh, look in box number 26.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's kind of near the bottom.
[AGENT][NEUTRAL] I think it's a bit above the location of where the service was done.
[CUSTOMER][NEUTRAL] Let me
[AGENT][NEUTRAL] In box number 26.
[AGENT][NEUTRAL] And I don't see any claims for year [PII] for any.
[AGENT][NEUTRAL] So were they submitted electronically?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] They were supposed to be sent electronically, but I'm reviewing the charts and there's nothing.
[AGENT][NEUTRAL] Because I think if you're
[AGENT][NEUTRAL] Yeah, I'm thinking if, if you send us the primary ELB which it doesn't appear that you have on the other ones because I'm showing we're requesting that, um, and it may not it may not be a claim from you but um what's the provider's office? What's the doctor's name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, OK, so these are not yours. Yeah, I'm not showing any, any, uh, 2024 claims for any.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you know how the claim was sent to us?
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] I know it was supposed to be sent electronically.
[AGENT][NEUTRAL] And you and to that 608-01 number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, which is right?
[CUSTOMER][NEUTRAL] What was the payer ID again?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, that's the, that's the payer ID we have.
[AGENT][POSITIVE] OK, which is right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] I can also give you the fax number.
[CUSTOMER][NEUTRAL] Yeah, can you go ahead and give me the fax number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 877.
[CUSTOMER][NEUTRAL] Can you speak again?
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 942 3.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well then I'll try to send it. What is the time of filing?
[AGENT][NEUTRAL] And there is no timely filing limit to submit a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, then I'll, I'll try to see if I can send them via um paper form and hopefully get a response or fax, yes.
[AGENT][NEUTRAL] Facts? OK.
[AGENT][NEUTRAL] Do you have a
[AGENT][NEUTRAL] OK. Do, do you have a copy of the major medical explanation of benefits as well?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I don't. Should I send it with it?
[AGENT][NEUTRAL] Cause the, the
[AGENT][NEUTRAL] Yes, because the APL policy is secondary to the major medical policy and we will need that EOB.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm. OK. Does it cover, uh, procedures?
[CUSTOMER][NEUTRAL] You you.
[AGENT][NEUTRAL] Um, in the office, what type of procedure?
[CUSTOMER][NEUTRAL] Like freezing, biopsies, I have CPT codes.
[AGENT][NEUTRAL] OK. OK. What's the cheap, what's the diagnosis?
[CUSTOMER][NEUTRAL] Uh, Bergari B uh B 08.
[CUSTOMER][NEUTRAL] 807.8. I'm sorry.
[AGENT][NEUTRAL] Give me that one more time.
[CUSTOMER][NEUTRAL] B as in boy 07.8.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me one of the procedure codes.
[CUSTOMER][NEUTRAL] 17,110.
[AGENT][NEUTRAL] OK, so a surgical removal.
[AGENT][NEUTRAL] So let me check to make sure there is.
[AGENT][NEUTRAL] Coverage for there is a treatment writer under the policy, which means treatment in the office can be considered um under the outpatient benefit and that amount is up to $2550 and that's per calendar year.
[AGENT][NEUTRAL] And of course the information provided is verification, not a guarantee of payment.
[AGENT][NEGATIVE] And I don't show any use for [PII].
[CUSTOMER][NEUTRAL] OK, yeah, OK.
[AGENT][NEUTRAL] And that's per covered person.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there's also a family maximum. Let me get that amount, but I don't see any 20.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Well you said those are for 24.
[AGENT][NEUTRAL] Let's see, let me see.
[CUSTOMER][NEUTRAL] Yes, 2024.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] How would you want them to.
[AGENT][NEUTRAL] The family maximum.
[AGENT][NEUTRAL] It is up to $7650 per calendar year for all covered persons combined.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] And they've not met that amount yet.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And so because we've not received the claims.
[AGENT][POSITIVE] I I don't wanna botch up your name because you pronounce it so pretty. It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, then you wouldn't, you wouldn't find them on the website because we've not received them.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And what was the total charge for [PII]?
[CUSTOMER][NEUTRAL] For the total charge was
[CUSTOMER][NEUTRAL] 295.
[AGENT][NEUTRAL] OK, I just wanted that for my note taking.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and did you have any other questions?
[CUSTOMER][NEUTRAL] No, I'm gonna try to send that paper wise through fax, and you said with the EOB of the the primary correct?
[AGENT][NEUTRAL] What, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Correct, that coincides with each date of service.
[CUSTOMER][NEUTRAL] OK, then yeah, I'll go ahead and do that then.
[AGENT][POSITIVE] All righty. Anything else I can assist with today, [PII]?
[CUSTOMER][POSITIVE] No, no, [PII]. Thank, thank you so much.
[AGENT][POSITIVE] All righty.
[AGENT][POSITIVE] Uh, you're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.