AccountId: 011433970860
ContactId: 63f33e05-cdb9-4708-b609-cc428cc5c4f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 494250 ms
Total Talk Time (AGENT): 217219 ms
Total Talk Time (CUSTOMER): 190989 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/63f33e05-cdb9-4708-b609-cc428cc5c4f3_20250404T20:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] with West Orange Orthopedics and Sports Medicine.
[CUSTOMER][NEUTRAL] We have a patient that um has just provided us with y'all's insurance information and we found an old plan loaded and I wanted to verify it's the same phone number.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But the addresses are different.
[AGENT][NEUTRAL] OK, so you just wanna verify the claim address?
[CUSTOMER][NEUTRAL] So, I don't.
[CUSTOMER][NEUTRAL] Well, I wanna verify if the PO box not I need to know if I need to make a new plan, um, if the PO box 925 is still active. Let's see that's 925 Jackson.
[CUSTOMER][NEUTRAL] Mm, right.
[CUSTOMER][NEUTRAL] Jackson.
[CUSTOMER][NEUTRAL] C. Why am I not seeing the zip code?
[AGENT][NEUTRAL] Yeah, OK, so that PO box that 948 PO box is no longer um a good PO box number. Let me give you the good one.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, what about 9 to 5? Is that still a good one?
[AGENT][NEUTRAL] No, ma'am. Not the Jackson one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the.
[CUSTOMER][NEGATIVE] It's no longer good. OK.
[AGENT][NEUTRAL] Right, the claims PO box now is 248.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's in [PII], [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the zip code is [PII].
[CUSTOMER][POSITIVE] OK, perfect, and then we can.
[CUSTOMER][NEUTRAL] Let's see to check claim status or view EOBs register at OK.
[CUSTOMER][NEUTRAL] I'll send out an email for the girls in the front for that.
[AGENT][NEUTRAL] OK, would you like to send them to also and the um payer ID number?
[CUSTOMER][NEUTRAL] For billing.
[CUSTOMER][NEUTRAL] Uh, yes, payer ID, yes.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] OK, and the fax number on this card says [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and at that login site are you able to upload um claims or no?
[AGENT][NEUTRAL] No ma'am, so the way it works is the patient will have to have a claim submitted first without the online service center and because we use your um patient account number and then once you file your first claim, then you'll be able to go into the online service center and check the claim status with your patient account number that you assigned to the patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See here.
[CUSTOMER][NEUTRAL] Now he had told the girls up front that it only covers.
[CUSTOMER][NEUTRAL] Does not cover offices copays but covers.
[CUSTOMER][NEUTRAL] X-rays and injection coinsurance is secondary to his insurance. Is that correct?
[AGENT][NEUTRAL] OK, let me pull in the um benefits for this patient. Can I get his policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 02563952
[AGENT][NEUTRAL] OK, so that was 0256395?
[CUSTOMER][NEUTRAL] 263592.
[AGENT][NEUTRAL] 5
[AGENT][NEUTRAL] 92.
[AGENT][NEUTRAL] 6
[CUSTOMER][NEUTRAL] Yeah. Yeah. 02563952.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 639-52 OK and then what is your callback number, ma'am just in case the call gets dropped, I'll be right back.
[CUSTOMER][NEUTRAL] [PII] option 7 and then option 2.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you so much. Let me pull up that policy real quick.
[AGENT][NEUTRAL] OK, and what is the patient
[AGENT][NEUTRAL] The birth
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] My phone is, is, uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And my phone is having a little bit of.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] The phone is glitching a little bit so.
[CUSTOMER][NEGATIVE] Delay.
[AGENT][NEUTRAL] So we're gonna work with it. OK. And this is just to verify his benefits. It's not a guarantee of payment. He does have a supplemental insurance policy. Effective date is [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, it does help with deductible, co-pay and co-insurance. Uh, he does have an inpatient benefit amount of $4000 and he has an outpatient benefit amount.
[AGENT][NEUTRAL] Also a $4000. Um, let me see if he has office visits on this policy.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] He does have treatment in a physician's office.
[AGENT][NEUTRAL] I'm gonna pull the policy in itself to see if the physician's fee is, is covered under that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you know the mnemonic code to send electronically?
[AGENT][NEUTRAL] No, ma'am. I
[CUSTOMER][NEUTRAL] No, that's not to send electronically. That's the that never mind, that's eligibility.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] The number you, the payer ID you gave me is, yeah, I'm tired. Payer ID you gave me is to, to send.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's OK. That's
[AGENT][NEUTRAL] There
[AGENT][POSITIVE] There is um light at the end of the tunnel. It is Friday. Woo woo.
[CUSTOMER][NEUTRAL] Yeah, I know, I know.
[CUSTOMER][NEUTRAL] Oh, sorry. I've worked some long hours this week or two wee hours of the morning trying to keep
[AGENT][NEUTRAL] That
[AGENT][POSITIVE] Bless your heart.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] Keep things caught up. Mhm.
[AGENT][NEUTRAL] OK, so he has the treatment in a physician's office but does not include the physician's office visit fee.
[CUSTOMER][NEUTRAL] Does that, what does that even mean? Like.
[AGENT][NEUTRAL] So like if the physician charges an office visit fee, it doesn't cover the physician portion of it, it just covers like the treatment. So let me use an example.
[AGENT][NEUTRAL] It'll pay for what.
[CUSTOMER][NEUTRAL] Like an injection.
[AGENT][NEUTRAL] An injection or breathing treatment, uh, something that was done in the office, but we, it doesn't pay for the physician that did it for his fee.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Just for like if the X-rays done or injections are done, maybe casting, that type of thing. OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, for treatment. Yes, ma'am.
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, Miss, Miss [PII], is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Uh no, that's all. Thank you so much. Appreciate your help.
[AGENT][POSITIVE] You're very welcome. You're so very welcome. I hope you have a good weekend and you get to go home soon.
[CUSTOMER][POSITIVE] Thank you. All right. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thanks for calling ATL. Bye-bye.
[CUSTOMER][NEUTRAL] All right, bye.