AccountId: 011433970860
ContactId: a30b1ba9-f5ef-4891-91b0-f7465523541c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 738429 ms
Total Talk Time (AGENT): 338641 ms
Total Talk Time (CUSTOMER): 291700 ms
Interruptions: 7
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/a30b1ba9-f5ef-4891-91b0-f7465523541c_20250520T17:34_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good, thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII].
[CUSTOMER][NEUTRAL] Um, I'm calling to find out the status of, um, a claim for one of our patients.
[AGENT][NEUTRAL] OK, and you said your name is [PII]? Is that correct? And you're needing?
[CUSTOMER][NEUTRAL] Yes, and is your name spelled [PII]?
[AGENT][NEUTRAL] No, it's spelled [PII]
[CUSTOMER][NEUTRAL] OK, [PII], I always ask because I can always get that wrong.
[AGENT][NEUTRAL] Uh, yeah, it's spelled a lot of S, S as in Sam, and yours?
[CUSTOMER][NEUTRAL] And what's your last initial, Miss [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] [PII], OK, thank you. And so you have one patient that you're needing claim status on, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, I can help you with that. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] Members's policy number is.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] 02217767
[AGENT][POSITIVE] OK, thank you. Give me a couple moments for us to get the member's information pulled up.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][NEUTRAL] And any information, [PII], that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] And what is the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that is not what we have.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] That's what we have.
[CUSTOMER][NEUTRAL] [PII], it looks like [PII] but it's [PII].
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Yes, that's not the.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] First name of the policyholder.
[CUSTOMER][NEUTRAL] OK, give me a second. I'm gonna try and get into the other side and see if maybe her photo ID has another name on it.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] You fine?
[CUSTOMER][NEUTRAL] Oh, that's a him.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We have a photo ID of them and it just says [PII].
[CUSTOMER][NEUTRAL] No middle initial or anything.
[AGENT][NEUTRAL] The driver's license is spelled [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Which means he's probably not covered under this plan.
[AGENT][NEUTRAL] Well, again, some of the information that you're providing for me.
[AGENT][NEUTRAL] Matches, but the first name is not what you're giving me for sure.
[CUSTOMER][NEUTRAL] OK, um, can we verify maybe the last four of the social?
[AGENT][NEUTRAL] What is the last 4 of the social?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so according to our enrollment information, this member's name is [PII], not [PII].
[CUSTOMER][NEUTRAL] And his photo ID, his, his, um, his government ID is.
[CUSTOMER][NEUTRAL] Is [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now his email address does say [PII].
[CUSTOMER][NEUTRAL] [PII] so.
[CUSTOMER][NEUTRAL] Maybe he uses [PII] for short because he doesn't like his name I don't know.
[CUSTOMER][NEUTRAL] I'm I'm guessing at this point, I'm guessing at this point, [PII].
[AGENT][NEUTRAL] I don't, OK, we can match the social, right, we're matching the social and everything else matches, so we're just gonna um go with it. Let's see, hold on just one second.
[AGENT][NEUTRAL] And you said it's the driver's license that you're looking at?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Do you need the numbers off of off of his South Carolina driver's license?
[AGENT][NEUTRAL] No. Mm mm. Mm mm, no, ma'am. Hold on one second.
[AGENT][NEUTRAL] OK, and what is the data service, [PII], and total bill amount?
[CUSTOMER][NEUTRAL] OK, date of service is [PII] and the bill amount, um, the original bill amount was $432 even now it looks like part of the claim did process and make a payment, but there's an outstanding balance on one of the codes.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] So that's that's just just that one CPT code 73502 is the one I'm calling on for the balance of 195.
[AGENT][NEUTRAL] OK, so I do not have a claim on file for him for data service 12-11-2024.
[CUSTOMER][NEGATIVE] Which is weird because y'all made a payment.
[AGENT][NEUTRAL] With
[AGENT][NEUTRAL] I see that we made a $75 payment and that was on the one code. Uh-huh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right, mhm.
[AGENT][POSITIVE] 99203. That's correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But you don't have one for the CPT of 73502.
[AGENT][NEUTRAL] No, ma'am. We do not.
[CUSTOMER][NEUTRAL] OK, is it possible to fax this claim to you?
[AGENT][NEUTRAL] Let me look at this claim actually has to go to IMA first. I don't have a fax for them. We only have a PO box that the claims have to be sent to for their clearing house.
[CUSTOMER][NEUTRAL] Mm, OK, so would that be [PII]?
[AGENT][NEGATIVE] No, no.
[AGENT][NEUTRAL] No, ma'am. Claims on this member's policy should go to IMA.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] And the payer ID for that, [PII] is 64556.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what I will do is I will go ahead and update this um.
[CUSTOMER][NEUTRAL] Claims address and I will put it in the mail.
[AGENT][NEUTRAL] Yes, ma'am. So it depends on the type of policies because we all, you know, some claims, I, I don't know about that multi-plan thing why it says that, but that address that you first gave me is the APL claims mailing address, but not all APL policies are mailed to that address. For example, like this one. This one has to go through IMA.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] First.
[CUSTOMER][NEUTRAL] OK and what's the APO?
[AGENT][NEUTRAL] American public life.
[CUSTOMER][NEUTRAL] At the KP I'm sorry.
[AGENT][NEUTRAL] American Public Life Insurance and our
[CUSTOMER][NEUTRAL] OK, OK, I'm like what is APL?
[AGENT][NEUTRAL] Yes, American Public Wealth. We're moving towards only using APL because some people get hung up on the American Public Life insurance and it's so much more than life. But anyway, the other, again, that first [PII], that is APL's claims mailing address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so and it needs to go to IMA.
[AGENT][NEUTRAL] For this particular member's policy, it will go to IMA first. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, OK, Ms. [PII], before we hang up, can I just have a reference number for this call?
[AGENT][NEUTRAL] Sure, you are going to use my name along with today's date, [PII], and then one last thing, once the claim has been processed by APO we do have a portal that you should be able to check claim status in.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so I, I went into the portal and I attempted to register, but then when I put in it asked for my my organizations um.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] As for my organization's tax ID which I put in then it asked for the patient, the patient account number which I put in and it said that I had to call this number and it wouldn't let me in.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, and the pay, and I just want to make sure too that when you, the patient account number, you were not putting the APO policy number in there where you, you were putting the account number that you all have for this patient?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, so it's because there's no claim on file for that bill's amount.
[AGENT][NEUTRAL] It's giving you that error that you can't check eligibility that's only if a claim has been processed, should you be able to use that and I will tell you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But a claim has been processed with that that's just it.
[AGENT][NEGATIVE] Not for this billed amount, no.
[AGENT][NEUTRAL] We don't have a claim for 4:30.
[CUSTOMER][NEUTRAL] But it doesn't ask for the bill amount.
[AGENT][NEUTRAL] Right, but there's not a claim with the information that you're entering. There's, we do not have a claim on file.
[CUSTOMER][NEUTRAL] So I guess what I'm trying to find out is even though the claim you don't have this claim per se, you do have a claim with the patient account number so is he that process.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What patient account number are you, are you using?
[CUSTOMER][NEUTRAL] The one that's on the claim that processed, give me one second, I will.
[AGENT][NEUTRAL] Like
[AGENT][NEUTRAL] Yes, ma'am. What is that? Uh-huh.
[CUSTOMER][NEUTRAL] I'm gonna look at that image of the claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's a different, it's a different ID number D43724747.
[AGENT][NEUTRAL] Well, that's not, that's their IMA medical ID. This would have been.
[AGENT][NEGATIVE] Um, this is not gonna.
[CUSTOMER][NEUTRAL] Well that's the one that pay, but that's the one that paid.
[AGENT][NEUTRAL] Right, but it's the account that's asking for the patient account number that Lexington Orthopedics has for the member in the system and it's not gonna be that number.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, so it's our number, got you.
[AGENT][NEUTRAL] Correct. I beli, yeah, I, um, they're, they're making some updates, [PII] in the OSC uh it used to say provider's patient account number, but I don't know if it's still worded like that.
[CUSTOMER][NEUTRAL] Now it let me into now it let me in when I when I put in our patient account number.
[AGENT][NEUTRAL] That is correct. Mhm. Yes, it's not their policy number or their ID number, it's their patient account number, patient account. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, our assigned patient got you alright.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for educating me and helping me. I really appreciate it.
[AGENT][POSITIVE] Oh, you're welcome. Yes, ma'am. Absolutely. It was my pleasure, [PII]. So is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No ma'am, that will be all for today.
[AGENT][POSITIVE] OK, well then, thank you again for calling APL and I hope that you have a wonderful afternoon.
[CUSTOMER][POSITIVE] OK thank you you too have a good rest of your day.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] OK bye bye.