AccountId: 011433970860
ContactId: d746eb4b-c8db-446f-8009-9e1c79765fad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 470260 ms
Total Talk Time (AGENT): 233656 ms
Total Talk Time (CUSTOMER): 213178 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/d746eb4b-c8db-446f-8009-9e1c79765fad_20241230T13:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. um, I'm calling from Women's Care Florida, and, uh, my name is [PII]. I'm calling to inquire if you guys receive a claim, uh, before I send it back to you guys.
[AGENT][NEUTRAL] OK, [PII], so you're needing to check, OK, to see if we had did receive a claim and if so to get the status on it. Sure, I can help you with that. And what is your you're welcome. What is your callback number, please, [PII]?
[CUSTOMER][NEUTRAL] For one of our patients.
[CUSTOMER][NEUTRAL] Claim status.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, yes, [PII] and my extension is [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Yes, member's policy number is, I just had it, uh.
[CUSTOMER][NEUTRAL] OK, um, 02141412 MLE.
[AGENT][NEUTRAL] That would be ML 8.
[CUSTOMER][NEUTRAL] 8. I'm sorry. I
[AGENT][NEUTRAL] Or ML 7, not an E, yeah. OK.
[CUSTOMER][NEUTRAL] I'm, I'm looking, I'm looking at the number.
[CUSTOMER][NEUTRAL] And I'm still saying what I wanna say.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] Yeah, I can totally understand.
[CUSTOMER][NEUTRAL] Oh, it's, it's a long vacation.
[AGENT][NEUTRAL] I can understand that. OK. So on this policy, um, OK, I have located the member's information and anything, excuse me, any information that I did provide for you today, Priscilla would 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] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and total bill amount for her?
[CUSTOMER][NEGATIVE] Date of service [PII] and the bill charge amount was $898 even.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. Thank you. One moment.
[CUSTOMER][NEUTRAL] I'm
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so this claim was received, this claim was received on 624-2024.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it was processed. Do you need the process date?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 347.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3695.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] This claim does show as denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On here, the denial remark one is office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] The supplemental policy Priscilla doesn't cover office visits, and the other codes were all denied as this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now I can give you a website. We do have a portal in which you can set up a username and password, Priscilla, if you need a copy of COB.
[CUSTOMER][NEUTRAL] I, I
[CUSTOMER][NEUTRAL] Yeah, I did try to jump on the portal and it says patient account number and when I.
[AGENT][NEUTRAL] Mhm. That's the number that you all use on the claim to file for this claim.
[CUSTOMER][NEUTRAL] Right. When I put that number in, it's telling me, let me go back in there. Let me put the numbers.
[AGENT][NEUTRAL] What is the patient account number that you're using? If this is the provider's patient account number, not the APO policy number.
[CUSTOMER][NEUTRAL] OK. So the number I provided to you, the 0214.
[AGENT][NEUTRAL] I think that it's
[AGENT][NEUTRAL] It's the AP that's our policy number.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK, so patient's number is what? I'm looking at her card. Let me go back to her.
[AGENT][NEGATIVE] No, it's gonna be, no.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The provider.
[AGENT][NEUTRAL] The Women's care, whatever the patient account number you will.
[CUSTOMER][NEUTRAL] Oh, our provider ID.
[AGENT][NEUTRAL] I think that it says that, does it say that? I know they have been updating, but
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it
[CUSTOMER][NEUTRAL] No, it says patient's account number.
[AGENT][NEUTRAL] And then under it, does it not have a little parenthesis that says?
[AGENT][NEUTRAL] Something else.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, it says uh tax ID and then it says patient's account number.
[CUSTOMER][NEUTRAL] Patient account number must match the number you listed on the submitted claim form.
[CUSTOMER][NEUTRAL] The patient account number can be found in the following location you and then it gives you a description of the.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Forms where it would be documented.
[AGENT][NEUTRAL] OK, so they've done some updates that used to say this is not.
[CUSTOMER][NEUTRAL] And um yeah.
[AGENT][NEUTRAL] Let me look at something. Give me just a second.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It says account number.
[CUSTOMER][NEUTRAL] Let me look at her HIPA claim.
[AGENT][NEUTRAL] Yeah I thought it said provider's patient account number.
[CUSTOMER][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] On the
[AGENT][NEUTRAL] Need to play under claim status where it either gives you quick access or don't have a claim number.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I went on, I was looking, I looked on the back of her card, and the back of the card indicates um where to, it give me the address of
[AGENT][NEUTRAL] Yeah, it's
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. But what I'm saying.
[CUSTOMER][NEUTRAL] Uh, to check claims with you.
[AGENT][NEUTRAL] Yeah, what I'm saying that [PII] is the number that you all have for the member if you were gonna look the member up in your system, not with their not their APL number, the provider's account number, patient account number for the member.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] I got it, I got it.
[CUSTOMER][NEUTRAL] I got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, I got it I got it now. OK.
[AGENT][NEUTRAL] And if you want to verify what we received on the claim, I can do that with you.
[CUSTOMER][NEUTRAL] OK, would it be NFL 27.
[CUSTOMER][NEUTRAL] 574-54. I think that's.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, ma'am. That is what we show. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I got it there it is.
[AGENT][POSITIVE] Awesome. OK.
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] Oh, absolutely. And it's [PII]. Just if you need for document, it's [PII]
[CUSTOMER][NEUTRAL] Oh, it's crazy. Uh, like I said, it's been a long week, uh, holiday.
[AGENT][POSITIVE] Well, I hope it was a good one though.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You know, yes, it was. I'm not gonna complain. thank you. And do you happen to have a reference number to this call as well?
[AGENT][POSITIVE] Well, perfect.
[AGENT][POSITIVE] You will actually use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, well, can I help?
[CUSTOMER][POSITIVE] You have a wonderful [PII] and a [PII] [PII]'s as well, OK?
[AGENT][NEUTRAL] I hope you have a.
[AGENT][POSITIVE] Happy [PII] to you as well, and if that is all, Priscilla that I can help you with today, then thank you again for calling APL and I hope you do have a wonderful day as well.
[CUSTOMER][POSITIVE] OK take care bye bye.
[AGENT][POSITIVE] Yes, ma'am. You too. Thank you so much. Bye-bye.