AccountId: 011433970860
ContactId: 71496d78-6a17-4732-8424-2b0249589b13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 545929 ms
Total Talk Time (AGENT): 247506 ms
Total Talk Time (CUSTOMER): 145446 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/71496d78-6a17-4732-8424-2b0249589b13_20250404T14:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling you from provider's office regarding live status.
[AGENT][POSITIVE] Well, [PII], it would be a pleasure to assist you with claim status. What is a good callback number, please?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] That's 02134927.
[AGENT][NEUTRAL] Thank you, [PII]. The patient's name and date of birth.
[CUSTOMER][NEUTRAL] That's [PII] [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][POSITIVE] It would be a pleasure to help you with claim status today. Do you have a claim number or date of service?
[CUSTOMER][NEUTRAL] The date of service is 1-7-2025.
[AGENT][NEUTRAL] 172025.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm checking for data service 172025.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me check something for you.
[AGENT][NEUTRAL] Is that a date range claim or just a single date?
[CUSTOMER][NEUTRAL] Single date.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the bill amount?
[CUSTOMER][NEUTRAL] That's $280 even.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] Ophthalmology consultant.
[AGENT][NEUTRAL] Is that the same as ophthalmology associates?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right, thank you. I can help you with that claim status. My pleasure. We did receive that claim on [PII].
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] 99
[AGENT][NEUTRAL] 20 I'm sorry 92004 was denied as offices it's not covered.
[AGENT][NEGATIVE] And the 92015 was denied as primary provided full benefits. Therefore, there are no benefits payable.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can provide that claim number if you would like.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That claim number is 356.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 958 6.
[CUSTOMER][POSITIVE] Thank you very much. Just a moment.
[CUSTOMER][NEUTRAL] Y 92004 denied as office visit not covered? Is it in the patient's plan?
[AGENT][NEUTRAL] For the
[AGENT][NEUTRAL] It is for the guidelines of the patient's plan.
[CUSTOMER][NEUTRAL] Which type of plan does the patient have?
[AGENT][NEUTRAL] Secondary gap policy.
[CUSTOMER][NEUTRAL] And why CPT 92015 is denied?
[AGENT][NEUTRAL] This policy pays to deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] According to the EOB that we received for that procedure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, there was nothing applied to the deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you very much for this information. Just for confirmation, the whole amount is $100 towards the patient.
[AGENT][NEUTRAL] That would be determined by the provider.
[CUSTOMER][POSITIVE] OK. Thank you very much.
[CUSTOMER][NEUTRAL] Can you please provide me the EOB of this one?
[AGENT][NEUTRAL] EOBs are obtainable on our provider portal at [PII]. I can help you create an account if needed, and you will have that EOB instantly.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. That's secure. [PII].
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Would you like for me to help you with an account so quick?
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, when you go to this site.
[AGENT][NEUTRAL] Go in as a new user.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Choose the last option, it will state that you're a medical or dental provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then you're the next um page you're going to enter your tax ID number.
[AGENT][NEUTRAL] And the patient's account number. When you get to that patient's account number, I can provide that for you so you don't have to look it up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Just tell me when you're ready.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEGATIVE] Actually, I'm unable to fetch this.
[AGENT][NEUTRAL] Did you go to [PII]?
[CUSTOMER][NEUTRAL] That's SE.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII]
[AGENT][NEUTRAL] No, no, no, it's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][POSITIVE] Thank you very much. Can you please spell your name as well?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And [PII].
[CUSTOMER][NEUTRAL] Thank you. And they call the, mhm.
[AGENT][NEUTRAL] I'm sorry, when it asks for the patient's account number, that is the account number with the facility listed in box 26 on the HIPA.
[AGENT][NEUTRAL] It's not the policy.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] OK. Is that, can you please cross-verify that with me?
[AGENT][NEUTRAL] Sure, the patient account.
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] Number, yeah, go ahead. Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OA 00, that's [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK. Thank you very much, ma'am. Call reference for this one, please.
[AGENT][NEUTRAL] Call reference number is my name and today's date, and I spell my name [PII] [PII] [PII], once you have that OSC, the portal created, you can have 24/7 access to claim status, EOBs, and you can also submit claim information online as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK. Thank you very much for this information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Have a great day.
[AGENT][NEUTRAL] Anything else?
[AGENT][NEUTRAL] Anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] No, ma'am. Thank you very much for this one.
[AGENT][POSITIVE] My pleasure and thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You as well. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.