AccountId: 011433970860
ContactId: a96f9856-9f75-4b0f-b5aa-f5abb55477ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1011500 ms
Total Talk Time (AGENT): 380097 ms
Total Talk Time (CUSTOMER): 234120 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/a96f9856-9f75-4b0f-b5aa-f5abb55477ff_20250124T21:11_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling from a provider's office and I'm calling just to see if you've received a claim that we've sent to you.
[AGENT][NEUTRAL] OK, so you're wanting to verify if we have received a claim that you submitted, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you. And Bro, what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] 02450113
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And [PII] any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][POSITIVE] OK, thanks.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] with air.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] [PII] for $220.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Where you
[AGENT][NEUTRAL] And you said the total bill amount is $220. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] But after primary pay $50 is um what was sent to you guys.
[AGENT][NEUTRAL] And which provider are you calling on behalf of?
[CUSTOMER][NEUTRAL] Virginia Eye Consultants, Doctor [PII].
[AGENT][NEUTRAL] OK, and so the 115 is the amount on the claim, is that correct?
[CUSTOMER][POSITIVE] Hm, yes, that is good.
[AGENT][NEUTRAL] That's what we show for her.
[CUSTOMER][NEUTRAL] Yeah, that's what the claim is showing, yeah.
[AGENT][NEUTRAL] So yes, this claim was received. Are you gonna need the received date and the process date or just the status on it?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] If I can have that information, yes, please.
[AGENT][NEUTRAL] OK. So, um, let's see. The received date was [PII]. It was processed on and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3544096.
[AGENT][NEUTRAL] And the reason for the denial, [PII], is office visits are not covered by this policy.
[AGENT][NEUTRAL] Now you can access a copy of the EOV if you need that by going to our portal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And secured.
[CUSTOMER][NEUTRAL] So I tried getting on the portal, but when I put in our tax ID number and then the patient account number is the patient account number their member ID number?
[AGENT][NEUTRAL] Mhm. Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, it isn't. I believe, well, it did say on the portal website that it was not their APL policy number or something to that effect.
[AGENT][NEUTRAL] That is your account. Let me look at what how it's worded.
[AGENT][NEUTRAL] Give me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, I does it say providers patient account number?
[CUSTOMER][NEUTRAL] Um, it just says tax ID and then it says patient account number.
[AGENT][NEUTRAL] Yes. So that's the account number that you all have. Do you want to verify the patient account number that was we received on the claim?
[CUSTOMER][NEUTRAL] Um, is that the [PII]?
[AGENT][NEUTRAL] We show it to be [PII].
[CUSTOMER][NEUTRAL] OK, let me see if I can get it to pull it with that.
[AGENT][POSITIVE] And you for sure should be able to get it with the claim number that I gave you.
[CUSTOMER][NEUTRAL] Yeah, it's still saying there seems to be a problem no user was found with the information provided.
[AGENT][NEUTRAL] OK, and what is the, OK, so and that's what you're getting with the claim number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 354-4096
[CUSTOMER][NEUTRAL] What was that number?
[AGENT][NEUTRAL] The claim number?
[CUSTOMER][NEUTRAL] Oh, let me try that one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 96.
[AGENT][NEUTRAL] 96. Uh-huh.
[CUSTOMER][NEGATIVE] Yeah, it's still saying oops, there's a problem. It's saying no user found with information entered.
[AGENT][NEUTRAL] OK, so let's do this again. So what is that verify the patient account number you're using?
[CUSTOMER][NEUTRAL] So the one that I just put in was the [PII], but then I've.
[AGENT][NEUTRAL] No, that's the claim number. Now, that's not the patient account number, that's the claim number.
[AGENT][NEUTRAL] 354-409-6 is the claim number. There should be a um area for the claim for you to enter the claim number.
[CUSTOMER][NEUTRAL] OK, so then I tried.
[CUSTOMER][NEUTRAL] So I think it's because I've never used your site, so I'm trying to register, so when I get to step 2 of registration, it asks for the provider's ID number and the patient's account number.
[AGENT][NEUTRAL] OK, so what it looks OK. So first off, what's the tax ID number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, and then the patient account number again?
[CUSTOMER][NEUTRAL] If that's the one that what we sent you, it's [PII].
[AGENT][NEUTRAL] OK, so let me look because on what is entered in our system it has 2 3s. It's, it's not a 101 so let me give me just a second to look at the.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, bear with me cause I'm gonna have to go about this a different way for some reason it's not loading.
[AGENT][NEUTRAL] The information that I'm trying to pull up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, so that is not what we received on the claim.
[AGENT][NEUTRAL] Well you're saying 101.
[CUSTOMER][NEUTRAL] Which boxes are you looking?
[AGENT][NEUTRAL] 26.
[CUSTOMER][NEUTRAL] OK, that's the one I'm looking at and it says 000.
[CUSTOMER][NEUTRAL] 10.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1336205
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct, and you were saying instead of it having 2 3s there?
[AGENT][NEUTRAL] You're giving me 1316205.
[CUSTOMER][NEGATIVE] OK, I just put this one in the website again and it's still not, it still says there's a problem, it's still not working.
[AGENT][NEUTRAL] OK. I'm not sure then what the issue is with the current patient account number and that same tax ID number that
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] We verified with each other.
[AGENT][NEUTRAL] And that claim number that I gave you and you're and you're entering let's say the last.
[AGENT][NEUTRAL] Again, let me go to see what all you have to enter to set it up.
[CUSTOMER][NEUTRAL] in [PII].
[AGENT][NEUTRAL] OK, so we did the tax ID number and the patient account number and you did include the zeros at the beginning, is that correct?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] OK, so once you enter the um tax ID number and then the patient account number and click next, it doesn't take you to a screen asking you um to set up a username and a password because it did for me.
[CUSTOMER][NEUTRAL] No, it's
[CUSTOMER][NEUTRAL] No, it says oops, there seems to be a problem. No user was found with the information that was entered. Please try again or call customer service and that's why I called customer.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so let's go, so did you create, did you click new user to start with or log in?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Cause I just did that and it's letting me try to create a.
[CUSTOMER][NEUTRAL] Uh, click
[AGENT][NEUTRAL] Profile
[CUSTOMER][NEUTRAL] OK, so I clicked on new user and then I said I'm a medical or dental provider.
[CUSTOMER][NEUTRAL] Let's just try to start over.
[AGENT][NEUTRAL] Uh-huh. Next.
[AGENT][NEUTRAL] And there's no spaces or anything on there.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] All right, let's try.
[AGENT][NEUTRAL] And then they're in the patient account number it's all of the numbers are together with no.
[AGENT][NEUTRAL] Hyphens or spaces.
[CUSTOMER][NEUTRAL] OK, I guess I'll just have to call your IT team because it's still not working, um, but for this patient.
[CUSTOMER][NEUTRAL] You said that office visits aren't covered under her policy, so what is covered under her policy so that we know what to tell the patient.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, so give me just a moment.
[CUSTOMER][NEUTRAL] Give me.
[AGENT][NEUTRAL] Yes, ma'am. I don't know. Maybe it's something on your end. Maybe it has something to do with your firewall because I just got completely out of it, opened a new tab.
[AGENT][NEUTRAL] And it's again it's wanting me to set up a username and a password.
[CUSTOMER][NEUTRAL] OK, like I said, I'll, there's a number on this website that you can call for your IT department, so I'll call them and see if I can figure it out.
[AGENT][NEUTRAL] OK, so on this policy.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] This is a supplemental policy to her medical, her primary health care insurance, and actually this policy is no longer active. This policy termed as of [PII].
[CUSTOMER][NEUTRAL] your
[AGENT][NEUTRAL] And she does not have any other active coverage with us beyond that point, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Now I can fax it for whatever reason that's not letting you set that up again I don't understand um.
[CUSTOMER][NEUTRAL] OK, I will just
[AGENT][NEUTRAL] Are you using Google Chrome? Are you using Chrome?
[CUSTOMER][NEUTRAL] Google Chrome, yeah.
[AGENT][NEUTRAL] Because yeah, it's, so I'm not sure because it is gonna let me set it up. I'm just not gonna go forward with doing that. But when I put that tax ID and patient account number in then it asked me to set up a username.
[CUSTOMER][NEUTRAL] OK, um, yeah, you can just.
[AGENT][NEUTRAL] So what is your fax number and I can send this to you?
[CUSTOMER][NEUTRAL] 804
[CUSTOMER][NEUTRAL] 217
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 6400.
[AGENT][NEUTRAL] OK, and does it need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] Um, you can go ahead and do attention broke just to make sure I get it.
[AGENT][NEUTRAL] OK. Just one moment. Now, do you have, do you spell your first name with, with or without an [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] You do put a knee or you do not?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK, alright, so one moment.
[AGENT][NEUTRAL] [PII], I'm sorry this is taking so long for this to load to fax.
[CUSTOMER][NEUTRAL] It's fine.
[AGENT][NEUTRAL] OK, [PII], I will send this to you. Are you in the office? Is this gonna come to you? I'm gonna have to restart one of my parts of my system to get it to pull up because it will not pull up to fax at the moment and I've tried several times.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine, you can just give.
[CUSTOMER][NEUTRAL] OK, that's fine. You can just fax it to me and I'll get it once it once it comes in. Can I just get a reference number for the call, please?
[AGENT][NEUTRAL] Sure, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Today's date? OK, alright, thank you so much have a good day.
[AGENT][POSITIVE] Yes, ma'am. You are welcome and thank you again for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too mm bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye