AccountId: 011433970860
ContactId: e46baca1-b072-455a-be0b-ac1aaf9fc655
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 558159 ms
Total Talk Time (AGENT): 192941 ms
Total Talk Time (CUSTOMER): 224810 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/e46baca1-b072-455a-be0b-ac1aaf9fc655_20250115T15:43_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with the Balance and Air Center, Dr. Wayne Shy's office. We have a patient who has, um, American Public Life as their secondary insurance. Um, we've sent the secondary claim to you, um, but we still haven't seen anything yet, and it's getting old.
[AGENT][NEUTRAL] OK, and spell your name for me?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] Um, now I'm not the I'm the I'm the provider.
[AGENT][NEUTRAL] I know I need the patient's policy number.
[CUSTOMER][NEUTRAL] Oh OK, OK, OK, OK, I thought maybe for a second you're getting my name. OK, so the policy number is 0230134 and it's really tiny writing I think it says 6.
[AGENT][NEUTRAL] OK, what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Verify the patient's name and date of birth please.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK and so you're basically checking for claim status?
[CUSTOMER][NEUTRAL] Yep
[AGENT][NEUTRAL] OK, provide the date of service and the total bill please.
[CUSTOMER][NEUTRAL] Uh, so data service was [PII].
[CUSTOMER][NEUTRAL] The full bill service or claim was 3,658 69 cents.
[AGENT][POSITIVE] OK, thanks.
[AGENT][NEUTRAL] [PII], verify the patient's date of birth again for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did I say it wrong earlier?
[AGENT][NEUTRAL] No, no, no, no. You're fine, just verifying.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Because I can do that. I get, I do 5 things at one time.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] It's just
[CUSTOMER][NEUTRAL] And then I realize, whoopsie.
[AGENT][NEUTRAL] Is that professional charge for surgery?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] And what's the CPT codes on the claim or procedure codes?
[CUSTOMER][NEUTRAL] Uh, so we got 3 of them, uh, 69631.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 21235 and 69,990 which I'm I'm assuming it will be a zero charge for that that one usually is global in with the other one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show the claim was processed on [PII].
[AGENT][NEUTRAL] Uh, no payment was made on this claim. Uh, this, it cites that the maximum outpatient benefit, uh, for the calendar year is exhausted.
[CUSTOMER][NEUTRAL] Is there a way that you can forward me the EOB or fax it to me or something like that?
[AGENT][NEUTRAL] Um, it's automatically mailed the next day after the claim is processed and now can be downloaded from our online service center at secured, uh huh, secured.
[CUSTOMER][NEUTRAL] Oh really?
[CUSTOMER][NEUTRAL] What was
[AGENT][NEUTRAL] S [PII]
[CUSTOMER][NEUTRAL] Hang on, let me get there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] S E C U R E.
[AGENT][NEUTRAL] ED
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Secured
[AGENT][NEUTRAL] S E C U R E D, uh-huh. uh Aub, that's together, so that's A as in apple, M Mary, P [PII], U.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] B Bobby, [PII] Larry, I see.
[CUSTOMER][NEUTRAL] And the word?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Online service welcome but I have a user name.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So if you, so you'll click on the new user button if you've not created an account before and then select which role best describes you.
[CUSTOMER][NEUTRAL] Medical provider next.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so the tax identification number and the patient account number in box 26 of the claim would need to match what we have in our system. Can you verify that out loud when you enter it, please?
[CUSTOMER][NEUTRAL] Uh, the, uh, patient account number is [PII].
[AGENT][NEUTRAL] OK OK and the provider's tax ID?
[CUSTOMER][NEUTRAL] That'd be
[CUSTOMER][NEUTRAL] Yeah, next.
[AGENT][NEUTRAL] What is the providers
[CUSTOMER][NEUTRAL] All right, so then I can
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh I oh sorry 54102 [PII].
[AGENT][NEUTRAL] OK, so it should have taken you to the username, create username password.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh, I forgot if I did it that way.
[CUSTOMER][NEUTRAL] Ah, but you ever again.
[CUSTOMER][NEUTRAL] There we go. Alright, my email address.
[CUSTOMER][NEUTRAL] Good good text message phone uh we don't have text messaging can I leave that blank?
[AGENT][NEUTRAL] Um, I believe it's a required field, so just put your phone number there.
[CUSTOMER][NEGATIVE] Yeah, but I don't want you guys sending me stuff.
[AGENT][NEUTRAL] Well, if it's not a message phone, yeah, if it's not a cell phone, it won't if that's a landline.
[CUSTOMER][NEGATIVE] I don't want that.
[CUSTOMER][NEUTRAL] Oh, I see what you're saying, OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, sounds like you successfully created log in.
[AGENT][POSITIVE] Very good.
[AGENT][NEUTRAL] And so from there I can help you navigate to locate the EOB.
[CUSTOMER][NEUTRAL] Alright, so no.
[CUSTOMER][NEUTRAL] OK, hang on, let me log in here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] S
[CUSTOMER][POSITIVE] Perfect. OK, all right.
[AGENT][NEUTRAL] And so you're wanting to go go to the claim status and claim filing dashboard?
[CUSTOMER][NEUTRAL] I'm here.
[CUSTOMER][NEUTRAL] Claim status I'm here.
[AGENT][NEUTRAL] And then it should give you an option to do a quick access.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and so you would need to enter the claim number and I didn't give you that. I'll give you the claim number. I don't think I did.
[CUSTOMER][POSITIVE] OK, I'm ready for it.
[AGENT][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] And then you have the patient's first name and their date of birth.
[CUSTOMER][NEUTRAL] Search
[CUSTOMER][NEUTRAL] There we go, claim I hyperlink to that I guess.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Get file
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Do do do do starting down the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] This is well this is easy. Thank you.
[AGENT][POSITIVE] It is. Oh yeah, very, it's convenient.
[CUSTOMER][NEUTRAL] And so now this at all times. So if I ever just wanna look something up, I could look on the other side where I don't have the claim number and just search by the patient's name and.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Data service
[AGENT][NEUTRAL] Yeah, I'm finding out that most people do not provide their full social so it does require the cardholders so he's a dependent, so it would be whomever the cardholder is of this policy. It requires their full social social security number, um, so some providers may or may not have that.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Yeah, we don't usually, yeah, OK. Excellent. This is exactly what I needed. Thank you very much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, you're welcome.
[CUSTOMER][POSITIVE] Alright, I appreciate it.
[AGENT][NEUTRAL] You're welcome. Anything else, [PII]?
[CUSTOMER][NEUTRAL] No, so I can pass this on to the provider or to the patient though, right?
[CUSTOMER][NEGATIVE] Because you're not paying it because he's he's reached his out of hot pocket or something?
[AGENT][NEUTRAL] We do not determine patients responsibility. Uh, the most we get informed is that the maximum benefit is exhausted past that point.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Outpatient for this calendar year has been met, so that means at that point he's he's responsible for it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] You know, we cannot advise that would be the, you know, the provider's position at this time.
[CUSTOMER][POSITIVE] That's correct, yeah, right, right, right, right, right, OK, alright, that's, I appreciate that. OK, alright, thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Uh-huh.