AccountId: 011433970860
ContactId: cfd88d69-c879-41fb-9998-9888a7bcbf8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 582309 ms
Total Talk Time (AGENT): 206617 ms
Total Talk Time (CUSTOMER): 268575 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/cfd88d69-c879-41fb-9998-9888a7bcbf8b_20250127T21:21_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling for.
[CUSTOMER][NEUTRAL] Southeast Orthopedic Specialist LLC, please be informed this call is being recorded and monitored for quality and training purposes. Surely I'd like to get the details regarding the claim.
[AGENT][NEUTRAL] OK, you need, you have one claim, [PII] that you're needing claim status for?
[CUSTOMER][NEUTRAL] Yes, just one thing I do have with me.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, we have a direct line, [PII]. The direct line number is [PII]. And your name spelled like [PII], right?
[AGENT][NEUTRAL] Actually, the last letter of my name is an [PII]
[CUSTOMER][NEUTRAL] OK, so it's [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And [PII], you will use my name along with today's date as your call reference number.
[AGENT][NEUTRAL] And any information?
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] That I provide for you will be verification of benefits and not a guarantee of payment. And [PII], if we do have the claim on file and you need a copy of the explanation of benefits for APL, you may print that by going to our website for our portal at [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your patient's policy number, please?
[CUSTOMER][NEUTRAL] Sure, the patient's policy number is?
[CUSTOMER][NEUTRAL] Just a moment. So, the patient's policy number you'll be having with me is 01947648 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And one moment please.
[CUSTOMER][POSITIVE] Sure, [PII]. I'll win.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and [PII], what is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII]. It spells like [PII]. And the last name spells like [PII]. And the date of birth for the member is uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Sure. And the date of service is [PII]. For the total charge amount, give me a quick moment on my end.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] So, the total charge amount is $106 even.
[CUSTOMER][NEUTRAL] So.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and you said the date of service is [PII], is that correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, we do not have a claim on file for her for this state of service.
[CUSTOMER][NEUTRAL] OK, so you didn't have a claim on file?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So yes, we submitted, let me verify the address that we submitted.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] No, ma'am. I don't
[AGENT][NEUTRAL] Oh, I'm so sorry, but no, ma'am, I don't even, no, ma'am, that is not our
[AGENT][NEUTRAL] Address
[CUSTOMER][NEUTRAL] Oh, OK. So, yes, could you please help me with the mailing address and the timely filing limit to resubmit the claim?
[AGENT][NEUTRAL] Yes. Our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] Yes, I'm here, [PII]. And uh let me uh verify the address that you provided. It's
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Could you please uh uh send me that ZIP code? What is it? [PII]. That's correct.
[AGENT][NEUTRAL] 4, no, no, no. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It's uh [PII], [PII], and [PII].
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And because this is a supplemental policy, [PII], you must also send us a copy of her primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK, so we have to submit the primary you'll be with the summation of UV, right?
[AGENT][NEUTRAL] With the claim, with the claim. Mhm.
[CUSTOMER][NEUTRAL] With the claim, OK, I got it. So primary claim with the EOB primary.
[AGENT][NEUTRAL] You would send your claim to APL and you will also need to include a copy of the primary insurance company's explanation of benefits for your service date.
[CUSTOMER][NEUTRAL] OK, OK, I got it. So may I know the timely filing limit?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][NEUTRAL] Uh, for the.
[AGENT][NEUTRAL] Their APL does not have a timely filing limit.
[CUSTOMER][NEUTRAL] OK, there is no time if I, I got it.
[CUSTOMER][NEUTRAL] So yes, uh.
[CUSTOMER][NEUTRAL] May I know the effective date and the term date for the member?
[AGENT][NEUTRAL] The policy has an effective date of [PII], and there is no term date. This policy is active.
[CUSTOMER][NEUTRAL] It's still active, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, may I know you're the primary or secondary for the member?
[AGENT][NEUTRAL] As I explained, we're the supplemental policy. That's why you have to send us her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, I got it.
[CUSTOMER][NEUTRAL] So, just a moment.
[CUSTOMER][NEUTRAL] So do you prefer uh mailing of uh claim with the EV or the electronically it's preferable?
[AGENT][NEUTRAL] Either would be fine.
[CUSTOMER][NEUTRAL] OK, so could you please help me with the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] So the pay ID is 60801, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] It's correct. OK.
[CUSTOMER][NEUTRAL] So, and the
[CUSTOMER][NEUTRAL] Call reference number is your name and today's date, right?
[AGENT][NEUTRAL] Uh-huh, that is correct. That is correct. And then again, once we have processed our claim, you may go to our portal that I gave you at [PII], and you should be able to uh check claim status for this claim.
[CUSTOMER][POSITIVE] Yes. Yes, right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Once it has been processed.
[CUSTOMER][NEUTRAL] OK, so it's [PII].
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][POSITIVE] Yes, [PII], thank you for your wonderful assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] Well, you're very welcome. You too, [PII]. Well, and if that's all I can help you with, thank you again for calling APL and I hope you have a nice evening.
[CUSTOMER][POSITIVE] Yes, have a great day bye.
[AGENT][NEUTRAL] Uh-huh. You too. Bye-bye.