AccountId: 011433970860
ContactId: eab9155e-ee38-4ac1-aea1-0d06715019db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 404119 ms
Total Talk Time (AGENT): 116229 ms
Total Talk Time (CUSTOMER): 201674 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/eab9155e-ee38-4ac1-aea1-0d06715019db_20250129T19:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm calling from provider office for patient claim status.
[AGENT][NEUTRAL] May I have a callback number please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is 02419415 M as in Mary, L as in Larry, number 8.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] And you're calling in for status of claim. May I have the date of service and total bill?
[CUSTOMER][NEUTRAL] [PII] and total charges is $204.80.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And so for that claim it does show that we received it on 11-7-24.
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 352.
[AGENT][NEUTRAL] 85558. It process and it denied that office visits are not covered under the patient's plan. Is there anything else that I can assist you with today, ma'am?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. So this office visit or non-covered charges is the patient responsibility for that?
[AGENT][NEUTRAL] It is the provider's discretion.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] This is the first time of this patient is established, uh, not established patient, is a new patient. So they have their office visits and then the primary advet already paid and patient has a balance of co-insurance $60 and we have submitted to the APL and if the claim is, I mean, the claim is denied as a non-covered charges.
[AGENT][NEUTRAL] OK, so that will be the provider's discretion if they want to submit that bill to the insured, we can't tell the provider how to bill.
[CUSTOMER][NEUTRAL] OK. Uh, my point is I just want to know that when the EOB is showing as the patient responsibility as a non-coverageizer, so we're trying to see, uh, what's the EOB says since I don't have an EOB received from the APL.
[AGENT][NEUTRAL] The EOB will state that that is a non-covered charge that the office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you needing an EOB to be faxed to you?
[CUSTOMER][NEUTRAL] And I'm trying to get up.
[CUSTOMER][POSITIVE] Yes, ma'am. That will be fine. Uh uh perfect for me. And my fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I will get that fax submitted and that is spelled [PII], your name?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, I will get that submitted over to you. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, uh, I have one question. So I'm trying to get on to the APL provider portal and, and
[CUSTOMER][NEUTRAL] I, I don't know, uh, there's a like a, I tried, I got that the people was showing the create as like a new login user ID and password, but on the APL secure. [PII], and I am not seeing that.
[CUSTOMER][NEUTRAL] Um, create a new access. The only thing I see is the claim status, and I try to put the patient's name, date of birth, the last four digits of the Social Security number, but I don't have the provider's patient's account number to pull it. That's the only one box that I needed it. So how do I do that?
[AGENT][NEUTRAL] The patient account number is provided by that provider, so that would be the account number that you presented on the claim.
[CUSTOMER][NEUTRAL] OK, OK, got it.
[CUSTOMER][NEUTRAL] So we don't need to uh create the provider for the access and you just go into the secure. and [PII] and try to, try to put the EOB and is that what it is?
[AGENT][NEUTRAL] Yes, but you would have to have that that patient account number that is listed on either the UB or the HA 1500, whichever one that the provider submits in.
[CUSTOMER][NEUTRAL] Understood. And if I want to add, I have like a software like a tax ID number, I'm not working on this one clinic. So if I want to add uh a few uh tax ID number, how do I do that?
[AGENT][NEUTRAL] A few tax ID number for the portal.
[CUSTOMER][NEUTRAL] Yes, like I'm having it currently, like, for example, like one tax ID number from the integrat or sunset, and I want to add it from the like different uh practices and so I have, I have to add like different tax ID number.
[CUSTOMER][NEUTRAL] So I'm, I'm I'm like my point is, do I have to create the provider for the access for one tax ID number per each account or if I can have a master user and can add on to the, all the tax ID that I'm going to need it.
[AGENT][NEUTRAL] For this for this account you would have to use for each individual tax number that you're trying to submit a claim or review for or set up an account for.
[CUSTOMER][POSITIVE] OK. Understood, understood. Thank you very much, ma'am.
[AGENT][POSITIVE] You're welcome, and I do wanna thank you for calling American Public Life, [PII]. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You, do you have to call reference number as well?
[AGENT][NEUTRAL] The call reference, it will be my first name, [PII], which is spelled [PII] last [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you so much. You have a wonderful day as well.
[AGENT][POSITIVE] You're welcome. Thank you.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye