AccountId: 011433970860
ContactId: 6ef14c5c-921f-4718-b1ca-b68d29762dd0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 475709 ms
Total Talk Time (AGENT): 161956 ms
Total Talk Time (CUSTOMER): 237429 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/6ef14c5c-921f-4718-b1ca-b68d29762dd0_20250604T18:27_UTC.wav
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[CUSTOMER][NEUTRAL] Well I know we're gonna do.
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], yes, my name is [PII]. I have a question for you if possible.
[AGENT][POSITIVE] OK, I can help you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With with a question?
[CUSTOMER][NEUTRAL] Um, I can give you my, oh yeah, it's, um, I can give you my policy number. It's 1836605.
[AGENT][NEUTRAL] Yes, 18.
[AGENT][NEUTRAL] OK, and then Ms. [PII], what is your callback number just in case the call is disconnected.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, let me look up your policy real quick.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and then I'm also gonna need for you to please verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] Alright, my address is [PII]. Email address is [PII], and telephone number [PII]. I think that's everything.
[AGENT][POSITIVE] Yes, ma'am. Thank you. I appreciate you verifying your policy. What kind of questions do you have for me today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, it was for my daughter. Her name was [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And it was for the date of service of [PII].
[AGENT][NEUTRAL] OK. Uh, what year?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh, this year, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And do you, mhm.
[CUSTOMER][NEUTRAL] And um,
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] Do you have the claim number?
[CUSTOMER][NEUTRAL] I don't. I thought I did, but I don't.
[AGENT][NEUTRAL] OK, let me look it up real quick for you.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But I know it said like it was a surgical something, but there was no value beside it, you know? And so therefore they couldn't process it.
[AGENT][NEUTRAL] Yes, ma'am. OK.
[CUSTOMER][NEUTRAL] If that will help you out. It said, it said like surgical something it wasn't provided.
[CUSTOMER][NEUTRAL] I get to the school.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look real quick.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] That's OK. I'm pulling up the information now I think I've got that claim number so I can check it out for you, um.
[AGENT][NEUTRAL] OK, it's for North LA Orthopedic and
[AGENT][NEUTRAL] Orthopedic
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] It would, it would for North Louisiana orthopedic.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I do show that the claim was paid $296.
[CUSTOMER][NEUTRAL] OK, well, I know one point we had, uh, they sent something back, you know, when you look, uh, look at the breakdown and it said like it was a non-surgical value on one of them.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I just had that paper and I don't know where I just did it.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEGATIVE] I'm not seeing a non-surgical value. I'm seeing that it was paid and then the maximum benefit payable for this state of service was met.
[AGENT][NEUTRAL] With that payment.
[AGENT][NEUTRAL] I do see that the claim was sent in.
[AGENT][NEUTRAL] More than once, so we did have a duplicate chart a duplicate claim sent in.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, I do see that.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] The policy does not provide a benefit for services in which charges uh were not incurred.
[AGENT][NEUTRAL] No charges were incurred.
[CUSTOMER][NEUTRAL] OK, so that's the one I.
[CUSTOMER][NEUTRAL] That's the one it says like no charges were incurred, correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Does it say that on the, OK. And this is why I'm calling because this is, this has been a learning experience for me, OK? I, I, I have a degree in education and music, so insurance billing, mm mm, um, so what happened was, or what I have just found out from talking to [PII] who's probably sick of me right now on at the clinic, well, the place where it was done.
[AGENT][NEUTRAL] That that.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] They said that, like they, even though they put it down because it was through or the like, you know, the orthopedic surgeon did it, that separate surgical bill, that surgical, whatever, what is the terminology for it was sent out separately from Northern Louisiana Medical Center where the surgery actually took place. That's why I had like, you know, whatever coding for surgery then 00.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On there.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Which I didn't know that.
[AGENT][NEUTRAL] OK, so we have um.
[CUSTOMER][NEUTRAL] So they just
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] When they send it to us there's no um.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] No charge on procedure number 99024.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And I now have that charge because they sent it as a separate.
[CUSTOMER][NEUTRAL] Um, like a separate statement from the hospital. So Doctor [PII] has his own clinic, but he does his surgeries at like the local hospital. He's in network with that hospital and so because he did it there, that surgical charge.
[CUSTOMER][NEUTRAL] Came sent to me from the hospital, not from
[CUSTOMER][NEUTRAL] The ortho planning.
[AGENT][NEUTRAL] OK, so what you can do is you could just resubmit another claim for that those procedures if you've got um the itemized statement the EOB from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your primary, you can always send in oh I'm sorry you don't need the EOB and if you do have it you can send it, but you can always resubmit that portion.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. I guess I should have asked that. I always take the long way around to get to the point. So they gave me an itemized bill. OK, good. I was like, get to the point. I'm like, I'm trying. OK, give me a moment. My thoughts are on here. OK, so I have the itemized. They gave me an itemized bill with like the, I don't know, the data service, some other stuff, whole bunch of stuff CPT code cost that.
[AGENT][POSITIVE] That's OK. I do too.
[CUSTOMER][NEUTRAL] Is that what you need it?
[AGENT][NEUTRAL] Yes, all of that needs to be sent in with your um, can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All of that will need to be sent in with your um claim form.
[CUSTOMER][NEUTRAL] Yes ma'am, I can hear you now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well thank you so much.
[AGENT][NEUTRAL] You're
[AGENT][POSITIVE] Now I can help you with.
[CUSTOMER][NEUTRAL] No, no, ma'am, that's it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You have a wonderful day and thank you for calling APL.
[CUSTOMER][POSITIVE] Oh, all right. You have a good one and thank you.
[CUSTOMER][NEUTRAL] You too bye bye
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright yeah.