AccountId: 011433970860
ContactId: 8a92e7e1-4ac0-421d-a175-f543a23027ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 735440 ms
Total Talk Time (AGENT): 221395 ms
Total Talk Time (CUSTOMER): 317406 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/8a92e7e1-4ac0-421d-a175-f543a23027ce_20250131T17:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I am trying to, well, I wanna verify if our plan is active and on a patient of ours, but I'm also trying to find out on the website. I'm, I'm trying to basically either set up a new user for provider or to see if I had um because when I go to check.
[CUSTOMER][NEUTRAL] Um, and
[CUSTOMER][NEUTRAL] I can't find myself, but I'm pretty sure I verified something online before claims uh I don't know if you can help me with those things, to be honest.
[AGENT][NEUTRAL] Um, yes, ma'am. I could further assist you. Um, first, could I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, I need the member's policy number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so this particular patient's policy number is, hold on a bunch of them I was trying to.
[CUSTOMER][NEUTRAL] Um, find somebody, um, hers is 02465633 [PII]
[AGENT][NEUTRAL] OK. And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I found her in our system and you need claim status?
[CUSTOMER][NEUTRAL] No, no, no, on her, I just wanna find out about policy status and what it covers. She was in for her well woman in um my office GYN.
[AGENT][NEUTRAL] OK, just let me um advise you that verification of coverage does not guarantee payment of claims. Um she does have a new policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Her new policy number is 01659591.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Policy number OK.
[AGENT][NEUTRAL] Mhm. And the effective date I'm showing was [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] Active and what does it cover?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And you said this is for services done in the office?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK, for office treatments, we cover up to $7900 per calendar year and that's for the coinsurance and the deductible after the primary insurance process is declined, and for the copay co-pay for the office visit, we cover up to $4 per calendar year and we cover up to $50 for the office visits.
[CUSTOMER][NEUTRAL] Let's see for office visits. So,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The maximum amount that you pay is $50 for an office visit.
[CUSTOMER][NEUTRAL] It's not like if she had a she had a $200 if she had a $200 deductible for her primary Blue Cross Blue Shield, so she's being billed $200 you will cover $50 of it and she's still responsible for $150.
[AGENT][NEUTRAL] Right, for the, for the copay.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, we'll cover 50 of it um that goes towards the copay and the remaining that falls under, under the 7900. So the copay.
[CUSTOMER][NEUTRAL] Oh, so you'll cover the, I see what you're saying, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You you break it up into two separate things.
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] OK, because you're confusing me with the co-pay and the office visit because it's if it's deductible, it's not a co-pay for the visit, but then you'll break it up as in $50 of it is a co-pay.
[CUSTOMER][NEUTRAL] And the balance of it goes towards that $7900 allowable.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and you'll do that up to 4 times in a year?
[AGENT][POSITIVE] Right, that's correct.
[CUSTOMER][POSITIVE] OK, perfect. And so right now, she has
[CUSTOMER][NEUTRAL] All of it available?
[AGENT][NEUTRAL] Let's see, one moment.
[AGENT][NEUTRAL] Um, yes, ma'am. It's all available.
[CUSTOMER][NEUTRAL] OK, um, and are you able to help me with the website?
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK. Yes, ma'am. Are you there on the website now? You went to um [PII]?
[CUSTOMER][NEUTRAL] Yes, and it says hashtag log in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm sitting at the screen that says log in and I can pick either the log in or new user but in all honesty I can't I, I got a new computer through my um you know I'm working remote and it I don't have anything saved so I thought I had through my email address was as my username but I it's not so.
[AGENT][NEUTRAL] OK, well, let's start from the beginning. Could you go to [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and um click on the button that says register here.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Do you see that button?
[CUSTOMER][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] What is it X and you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me start over. Let me just start over. [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm sorry, say what it was, say it once again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And there should be a button that says register here.
[CUSTOMER][NEGATIVE] I'm not getting it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] No, I'm saying the site can't be reached. I don't know what just happened.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEGATIVE] The where I was before, which says [PII] but it does have a backslash found login and when I remove that it still brings me to the same page. It gives me, it's a like a bluish and white screen and it's a one box and it says log in or new user question mark.
[AGENT][NEUTRAL] OK, click on new user.
[CUSTOMER][NEUTRAL] OK, and that I did this before and I'm a medical provider.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And then I click next and it was asking me for a tax ID number which I put in [PII] and then it was asking me for patient account number and every patient that I pulled up in my in my um practice has, you know, the number with the ML in it and every I tried like 5 patients and it wouldn't find any patients but I guess I could try this new number that you gave me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And when you put the number in there, are you using the ML part? Because we don't need that portion. We just need the portion before the ML.
[CUSTOMER][NEUTRAL] I was using that but even if the number you just gave me 01659591 for this patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] When I click next it says to me no user was found that information no user was found with the information that was entered. Please try again if this error persists call, you know, [PII] whatever.
[AGENT][NEUTRAL] Mm. And it's still giving you that message now?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK. OK, what I can actually do is send you over to customer service and see if they can further assist you if you don't mind holding.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with in the claims department?
[CUSTOMER][NEUTRAL] That, that patient, did I write that number down though on that patient? Um, are you out of her or are you still in her [PII]?
[AGENT][NEUTRAL] I'm still in here. Yeah, you, yeah, you can verify it.
[CUSTOMER][NEUTRAL] Did I
[CUSTOMER][NEUTRAL] I did so it was 01659591.
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] And there's no group number or is there a group number?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Or does it not need it on the claim?
[AGENT][NEUTRAL] OK. Well, I'm showing that the group number is 16944.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect yeah if you can transfer me that would be great because I wanna try to set up so I don't have to call.
[AGENT][POSITIVE] OK, well I thank you [PII] for calling ATL and I'll get you transferred one moment please.
[CUSTOMER][POSITIVE] Uh, OK, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Ferring
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Um, hey, [PII]. This is [PII] in the claims department.
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] Hey, I have a provider on the line. She's having issues with um the website. Um, I assisted her with her claim and I tried to assist her with the website, but she keeps getting the same error message. Could you try to further assist her?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I will try to we really don't, um, I will try we don't help providers in customer service, so I'm not sure.
[AGENT][NEUTRAL] Oh, OK. Oh, I didn't know that. OK.
[CUSTOMER][NEUTRAL] I'm just not sure how.
[CUSTOMER][NEUTRAL] You know, is, is it the
[CUSTOMER][NEUTRAL] Like vendor number that kind of thing.
[AGENT][NEGATIVE] No, she says that um she's not able to pull up the policy. She keeps getting the same error message.
[CUSTOMER][NEUTRAL] Oh, I bet the policy is not out there.
[AGENT][NEUTRAL] Yeah, well, I have, I pulled up the policy. It's active.
[CUSTOMER][NEUTRAL] I don't, um, I will talk to her, um, and just see, uh.
[CUSTOMER][NEUTRAL] You know, it sounds like on her end though.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I, I'll talk to her.
[AGENT][NEUTRAL] OK, are you sure? I mean.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, as long as that's hurts too and not, you know, it's like cause.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, OK, yeah.
[AGENT][NEUTRAL] OK. Her name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And her callback number is [PII].
[CUSTOMER][POSITIVE] OK. OK. Thank you.
[AGENT][NEUTRAL] And, and the policy number that we were looking at is um 01659591.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Thanks, [PII]. Here she is.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][POSITIVE] Mhm. Thank you.