AccountId: 011433970860
ContactId: a72befe4-127b-410d-8c1b-7079046815d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 687659 ms
Total Talk Time (AGENT): 300643 ms
Total Talk Time (CUSTOMER): 265340 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/a72befe4-127b-410d-8c1b-7079046815d8_20250529T20:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII]. I'm calling from a provider office.
[AGENT][POSITIVE] Good afternoon [PII]. I'll be happy to assist you. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] It's 247-76.
[AGENT][NEUTRAL] That sounds like a group number. Are you looking at the APL ID card?
[CUSTOMER][NEUTRAL] Uh, the card that I see here, it says, um, American Public Life.
[CUSTOMER][NEUTRAL] Um, and you're right, it says group num it says group number.
[AGENT][NEUTRAL] At the bottom of the card, there could be an inpatient hospital benefit certificate number and an outpatient. Do you see that at the bottom?
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Of the card
[CUSTOMER][NEUTRAL] Yes. Should I use the outpatient?
[AGENT][NEUTRAL] That's fine. That is their policy number.
[CUSTOMER][NEUTRAL] OK, so it will be 02035270 letter M for Mary, L for Louis, number 8.
[AGENT][NEUTRAL] All right. Thank you, [PII]. And what is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Uh, it's for [PII]. Uh, the date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, thank you. And [PII], how can I assist you with Annalis policy today?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Would like to know if you receive a claim from us because now that I'm looking at the, at the, at the correct uh policy number, uh, in my
[CUSTOMER][NEUTRAL] Would you might not have a status for a claim, but uh if you can check for me.
[AGENT][POSITIVE] Well, I can check that for you.
[AGENT][POSITIVE] It would be my pleasure. What is that data service, please, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what is the billed amount?
[CUSTOMER][NEUTRAL] $323.
[AGENT][NEUTRAL] Thank you, [PII], what is the facility name?
[CUSTOMER][NEUTRAL] Eye surgery associates.
[AGENT][NEUTRAL] Is that ESA?
[AGENT][NEUTRAL] Hollywood.
[CUSTOMER][POSITIVE] Yes, yes, yes.
[AGENT][NEUTRAL] Oh alright, thank you. Well, actually [PII], we did receive this claim we did place it on on the correct policy for you. The claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, the office visit is not covered under the patient's plan.
[AGENT][NEUTRAL] So there's no office visit benefits for the procedure [PII].
[AGENT][NEUTRAL] It is pending for additional information. We're needing their primary insurance explanation of benefits.
[AGENT][NEUTRAL] We're secondary.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] To their major medical.
[CUSTOMER][NEUTRAL] Your secondary, so you need from the primary.
[AGENT][NEUTRAL] That's right, and I can provide that claim number and policy number for you. I mean.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You've got the policy number. The claim number is 358.
[CUSTOMER][POSITIVE] Yes, please. I thank you.
[CUSTOMER][NEUTRAL] Uh, the
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, go ahead, claim number.
[AGENT][NEUTRAL] 358-8894.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's the claim number.
[CUSTOMER][NEUTRAL] 3583588894.
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[AGENT][NEUTRAL] And I can check to see.
[CUSTOMER][NEUTRAL] OK, so on the on
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] I was just gonna say we do have a um provider portal. I was just checking to see if y'all have an an an active account because you can actually upload the EOB directly on the policy.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] If y'all have an active account.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] I do see that
[CUSTOMER][NEUTRAL] What will be the website?
[AGENT][NEUTRAL] It's secured and that's SEC.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if y'all have that active account.
[CUSTOMER][NEUTRAL] Yeah, I see it here on the cards.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so for this plan, the office visit is not covered, and in order for you to cover the, the CPT code 92015, you will need the uh ELB from the primary.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Because, uh, you are the secondary.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Secondary to the policyholder's major medical.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And, uh, and
[CUSTOMER][NEUTRAL] When they revealed the claim, um,
[CUSTOMER][NEUTRAL] Should I leave it the way they have it as uh 24776 or should I go ahead and correct it to the, the, the certificate number that I gave you?
[AGENT][NEUTRAL] The policy.
[AGENT][NEUTRAL] Yeah, that would be the best. Now for the EOB you can actually fax just the EOB referencing the policy certificate number and the claim number. We don't have to have the HIPA again since we already have it on file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK. And so the, the correct uh policy uh is uh 02035270 ML 8.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. OK. And can I have a reference for this call, please?
[AGENT][POSITIVE] Absolutely, it's going to be my name and today's date, and I spell my name [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] First initial, last name, [PII].
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Aha.
[CUSTOMER][POSITIVE] OK. Thank you so much for your help today. I appreciate it.
[AGENT][POSITIVE] It's been my pleasure. Now did you want me to give you the fax number to our claims department if y'all wanna fax the EOB?
[CUSTOMER][NEUTRAL] Uh, it's the [PII].
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][POSITIVE] Oh OK. Yes, I got it already. I thank you.
[AGENT][POSITIVE] Well, [PII], it's been a pleasure to assist you with that claim status today. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] I appreciate your help today. Thank you so much. Um,
[AGENT][POSITIVE] My pleasure. You have a lovely evening.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, [PII], I'm sorry to interrupt you.
[AGENT][POSITIVE] Not a problem.
[CUSTOMER][NEUTRAL] Um, are you, are you, will you be able to see only one more claim for me?
[AGENT][POSITIVE] Sure, I could be happy to. Is it for the same patient?
[CUSTOMER][NEUTRAL] It's said
[CUSTOMER][NEUTRAL] Uh, no, it's a different patient.
[AGENT][POSITIVE] OK, yes, I would be happy to, let's see.
[AGENT][NEUTRAL] Let me get ready for that next.
[CUSTOMER][POSITIVE] I thank you, I'm getting to it.
[AGENT][NEUTRAL] Me too. That's, that's fine.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, the system's.
[CUSTOMER][POSITIVE] Uh, when you're ready you let me know I'm ready.
[AGENT][NEUTRAL] I'm ready, [PII].
[CUSTOMER][NEUTRAL] When you're ready.
[CUSTOMER][NEUTRAL] OK, on this one I have a policy certificate number. Uh, it says 02543839.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. And what is that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh [PII], uh [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And what is the data service for [PII]?
[CUSTOMER][NEUTRAL] Uh, it's um
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is that bill amount?
[CUSTOMER][NEUTRAL] 2:58.
[AGENT][NEUTRAL] Same provider, ESA Hollywood.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] All right, [PII], that claim we did receive on [PII] and processed on [PII].
[AGENT][NEUTRAL] And this claim was denied because office visits are not covered for the guidelines of the patient's plan.
[AGENT][NEGATIVE] So it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEGATIVE] The bed is not covered.
[AGENT][NEUTRAL] That's right. The policy, and I can check your policy. Some of our policies cover procedures and treatments in office, um, but not the office visit, and that is the same for this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK. For the
[CUSTOMER][NEUTRAL] For the reference number, I can use the same one you gave me for the previous one.
[AGENT][NEUTRAL] Yes, ma'am. And would you like this claim number, [PII]?
[CUSTOMER][POSITIVE] Yes, yes, please, yes.
[AGENT][NEUTRAL] The claim number for [PII] is 360.
[AGENT][NEUTRAL] 0127.
[CUSTOMER][NEUTRAL] And what day was the process?
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on that account,
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] You have those on that um APL portal you can if you need the EOBs you can get those EOBs from the portal as well, especially since you have the um claim numbers it'll be easy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Mhm. Well, [PII], you got anything else for me? I'm happy to help you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you. Thank you. You've been very helpful today. I appreciate that.
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] My pleasure, [PII]. Thank you for calling APL. I hope you have a lovely evening.
[CUSTOMER][POSITIVE] Same, thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.