AccountId: 011433970860
ContactId: a7063474-f80e-416d-b391-660983f9b1d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 490100 ms
Total Talk Time (AGENT): 262966 ms
Total Talk Time (CUSTOMER): 146379 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/a7063474-f80e-416d-b391-660983f9b1d8_20250602T14:54_UTC.wav
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[AGENT][POSITIVE] And thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, good morning. I'm calling you because um I need to file a claim for a surgery that I had.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with filing a claim. Um, first, I'll need your name and a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] OK. My, my name is [PII].
[CUSTOMER][NEUTRAL] Oh, what else you said that you need? I'm sorry.
[AGENT][NEUTRAL] Um, I need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII] and now I need your policy number, please.
[CUSTOMER][NEUTRAL] Policy number will be payer ID number.
[AGENT][NEUTRAL] Um, it's the outpatient certificate number on the card.
[CUSTOMER][NEUTRAL] Uh, would be group number?
[AGENT][NEUTRAL] Do you see where it says outpatient certificate number?
[CUSTOMER][NEUTRAL] No, I don't have that in my cart.
[AGENT][NEUTRAL] OK, I can look it up by your social.
[AGENT][NEUTRAL] Or I can look it up by your name, um.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Because I have payer ID, I have insured, which is my name. I have coverage, group number, effective date and plan.
[AGENT][NEUTRAL] Do you see where it says um inpatient or outpatient services or?
[CUSTOMER][NEUTRAL] Oh, yes, yes, yes, yes, yes. So which one do you need, inpatient or outpatient?
[AGENT][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] All right. Uh 02419.
[CUSTOMER][NEUTRAL] 483
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima. 8.
[AGENT][NEUTRAL] OK. Thanks again, [PII]. No problem. Please verify your first and last name and your date of birth.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. Thank you. Now, please verify your address and your email address to make sure we have the correct information on file.
[CUSTOMER][NEUTRAL] Uh my address will be [PII].
[AGENT][NEUTRAL] OK. And please verify your email address.
[CUSTOMER][NEUTRAL] Uh, my email address, I think it will be [PII].
[AGENT][NEUTRAL] OK. Yes, ma'am. And um normally, your provider will file the claim. Um if they don't file the claim, you can file the claim yourself. Um, which way do you prefer?
[CUSTOMER][NEUTRAL] Oh, I'm gonna have to do it myself because that already is, it happened a month ago.
[AGENT][NEUTRAL] OK, well, the provider can um still file the claim as long as you had coverage on the date of service um we'll receive the claim and process it.
[CUSTOMER][NEUTRAL] And how that works?
[AGENT][NEUTRAL] Um, what you would do is contact your provider and um let them know that you have insurance with us. Give them your policy number, um, and I can give you that number. It's basically the outpatient benefit number that you just gave me. That's your policy number and give them our phone number. And what they'll do is call us and verify your benefits and we will let them know that you
[AGENT][NEUTRAL] Policy is active and um let them know how much is in your account for the um services that was provided to you and let them know how to file a claim and what they would need to do is send us the EOB from your primary insurance company along with the claim form and we can get that um claim filed and paid for you if you have coverage for it.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So, yeah, you can try it first.
[CUSTOMER][NEUTRAL] You know what if I want.
[AGENT][NEUTRAL] Go ahead. I'm sorry.
[CUSTOMER][NEUTRAL] So I, what if I, I try to do it myself, I cannot do it myself?
[AGENT][NEUTRAL] Um, yes, ma'am. You can file the claim yourself and what you would need to do is mail us the information. You can file the claim online or you can fax it to us. And the information we'll need is the explanation of benefits from your primary insurance company for the date of service um that you're calling about. And we would also need your diagnosis code and you can get
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Your diagnosis code from the provider's office, you would need to get a statement or either the a letter or some type of documentation from your provider's office with your diagnosis code on there. And your diagnosis code is the code for the illness or the injury, the reason why you're seeing the doctor. And you'll send that um to us uh along with the EOB from your primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I do have the explanation of benefits already, so I just need to request a letter from my, my doctor, basically, with the code of, you said the code of what?
[AGENT][NEUTRAL] Yes, ma'am, with your.
[AGENT][NEUTRAL] Diagnosis code is the code for the illness or the, yes, or the injury, the reason why you're seeing the doctor. And um you can either fax that to us, you can mail it to us or you can file the claim online. Which way do you prefer?
[CUSTOMER][NEUTRAL] Diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, online.
[AGENT][NEUTRAL] OK, let me give you our website where you can go and set up your policy.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, our website is secured. That's [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Uh-huh. [PII].
[AGENT][NEUTRAL] And once you go there, you'll see a button it may say new user or it may say register here. You'll click on that button.
[AGENT][NEUTRAL] And then you'll let the system know that you're an individual.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And once you submit that information that you're an individual, you'll follow the um guidelines to set your policy up online. And once you set your policy up online, you'll see um where you can file claims.
[AGENT][NEUTRAL] And from there you'll go from there. It'll basically ask you to upload the documentation um that I just told you that we need from the provider's office and that's how you'll file your claim.
[CUSTOMER][NEUTRAL] OK, so when I go to your web page I just create an account and from there I'll file the claim where it says file a claim or.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right?
[AGENT][POSITIVE] Yes, ma'am. Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] OK, so I just need to get a letter from my doctor with the diagnosis code and a letter that explains uh what the illness I had, cause it is a, it was a surgery.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Um, yes, ma'am. And, um, yes, ma'am. We'll basically need the diagnosis code, um, while you're having the surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so I'm gonna do that. Do I have a time limit to file this claim?
[AGENT][NEUTRAL] Um, no, ma'am. There's no timely filing limit as long as you had coverage on the date of service and I'm showing that uh the effective date on your policy was [PII] and your policy is still active.
[CUSTOMER][NEUTRAL] Yes, and I had the surgery on December last year, so.
[AGENT][NEUTRAL] OK. Yes, ma'am. And there's no timely filing limit.
[CUSTOMER][POSITIVE] OK. Thank you very much.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's all I need. Thank you, ma'am.
[AGENT][POSITIVE] OK. I thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Mhm. You're welcome. Bye.