AccountId: 011433970860
ContactId: 8d89981a-29de-4a6b-972a-76f1cb84fa94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393630 ms
Total Talk Time (AGENT): 165035 ms
Total Talk Time (CUSTOMER): 128162 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/8d89981a-29de-4a6b-972a-76f1cb84fa94_20250211T20:49_UTC.wav
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[AGENT][NEUTRAL] APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from provider's office, checking on claim status and how are you doing today?
[AGENT][NEUTRAL] I'm good, [PII], and I can help you. What's the policy number?
[CUSTOMER][NEUTRAL] Which is starting from 00994160.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] And [PII] with date of [PII]. Could you please spell your name?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, the spelling of my name is [PII] First initial last name is [PII]. You'll use my name and today's date is reference for today's call. And what is the date of service in charge for [PII]?
[CUSTOMER][NEUTRAL] [PII] for $218 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, there was no payment made on this claim. Uh, the maximum office visits for the calendar year, which is 4, has already been used, um, showing the claim was processed under claim number 355.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This is
[AGENT][NEUTRAL] 1312.
[AGENT][NEUTRAL] I show a received date of [PII], uh, processed date of [PII].
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] To.
[CUSTOMER][NEUTRAL] Actually, this is for pathology, not for the office visits, right? This is for pathology courses.
[CUSTOMER][NEUTRAL] The services for CPT 88305.
[AGENT][NEUTRAL] You know, anything in the office is considered under the office visit benefit, so it doesn't matter if it was a treatment code or the office visit, the maximum is already used for the year.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] OK. Oh, maximum benefits has been exhausted, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Help me out with the maximum dollar amount has been exhausted or other visits has been exhausted.
[AGENT][NEUTRAL] 4 days per calendar year per person.
[CUSTOMER][NEUTRAL] How many days would be?
[AGENT][NEUTRAL] 4 is the maximum per calendar year.
[CUSTOMER][NEUTRAL] OK, 44.
[CUSTOMER][NEUTRAL] I do, yeah.
[CUSTOMER][NEUTRAL] Could you please fax a copy of your to my fax number just to bill the patient for the remaining balance amount as you stated.
[AGENT][NEUTRAL] You know, it's already been mailed to the address that's on your claim. It's now available to download on our online service center at [PII] and the patient also receives a copy of the explanation of benefits.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No. Yes.
[CUSTOMER][NEUTRAL] When I
[CUSTOMER][NEUTRAL] Yes. [PII], when I checked on your APL portal, when I searched with the patient's first name and the date of patient's last name and date of birth with the claim number, I was unable to pull the claim. That is the reason to ask you, asking you for the copy of EOB. Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, can we walk through the online service center together to see what might be happening? I don't I can fax it over to you, but I wanna make sure what's happening on your end as to why you can't download a copy of it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what site are you, uh, what, what's the website address that you're using, uh, [PII]?
[CUSTOMER][NEUTRAL] American Public Life APL.
[AGENT][NEUTRAL] So is it [PII]? Is that what you're using? OK and when, when you go to that site, where do you go?
[CUSTOMER][NEUTRAL] Yes, uh-huh, yes, uh-huh.
[CUSTOMER][NEUTRAL] It's asking for what we say.
[CUSTOMER][NEUTRAL] Asking for the username and the password. I enter the username and with the password, but when I searched with the first it's asking for the claim number. When it's searching with the claim number, we are unable to find with the patient's claim number and with this last name and the with the date of birth.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, slow down just a moment for for me. Let me catch up with you. I'm on the site as well. Give me just a second. I'm gonna pull up your claim number.
[AGENT][NEUTRAL] And so you have already successfully created an account?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] OK. OK. Give me 1 2nd.
[AGENT][NEUTRAL] And what tax ID number did you use?
[CUSTOMER][NEUTRAL] But it never asked for the tax ID we registered in the beginning, which is [PII].
[AGENT][NEUTRAL] And what's the patient?
[CUSTOMER][NEUTRAL] OK, if not, we'll ask you for the next, sorry, go ahead.
[AGENT][NEUTRAL] What were you going to say?
[CUSTOMER][NEUTRAL] No, if not, I'll call you back later because we need the copy of COB when we searched in your portal, we're unable to pull it up. If you forward the copy of COB, that would be, uh-huh.
[AGENT][NEUTRAL] Yeah and I was trying to figure out what the problem was and what error message you're receiving so I was trying to troubleshoot for you to help you get a copy of it from the online service center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so each time you go on if you're like if you do claim statuses for different providers which have different tax ID numbers you have to use the tax ID number associated with the date of service that you're calling on.
[AGENT][NEUTRAL] You'll have to create a new account for each tax ID number.
[AGENT][NEUTRAL] So if you're using an account with a different tax ID you're not gonna be able to pull up the claim because the tax ID number doesn't match.
[AGENT][NEUTRAL] The account that you're in.
[AGENT][NEUTRAL] That's what I was trying to explain.
[CUSTOMER][POSITIVE] OK. Thank you for the information. Bye-bye. Take care.
[AGENT][POSITIVE] Thanks for calling APL. Have a good day.