AccountId: 011433970860
ContactId: ef0225fa-c06c-4958-85ae-dad39d43fdf2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 673380 ms
Total Talk Time (AGENT): 249950 ms
Total Talk Time (CUSTOMER): 265117 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/ef0225fa-c06c-4958-85ae-dad39d43fdf2_20250306T13:35_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm [PII] and I'm calling from provider's office to check on the status of a claim.
[AGENT][NEUTRAL] OK, I missed your first name?
[CUSTOMER][NEUTRAL] What's your first name? My name is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK OK thank you and you said you're checking your claim status?
[CUSTOMER][POSITIVE] Oh yes, that's right. Mhm.
[AGENT][NEUTRAL] OK, we can assist you. What's the policy number, [PII], and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yeah, sure. The policy number is 022604887 and the callback number is [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient of [PII] and date of birth for him is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information, [PII].
[AGENT][NEUTRAL] And can you provide the date of service and the bill amount?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh sure date of service is [PII] and the bill amount is $277 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the claim was received [PII].
[AGENT][NEUTRAL] Processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it looks like the payment was denied. Office visits are not covered under the patient's policy, and let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] Oh, thank you. One moment, please. Uh, so the office visit is not covered under the patient plan, right?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] May I know the patient's plan type?
[AGENT][NEUTRAL] Supplemental gap policy.
[CUSTOMER][POSITIVE] Supplemental care policy. Thank you so much for that. And may I get a claim number, please?
[AGENT][NEUTRAL] 3559549
[AGENT][NEUTRAL] And you can also check your status online.
[CUSTOMER][NEUTRAL] 954 9.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh-huh. Yeah, thank you so much. So you stated the claim number is 3559549. Is that right?
[AGENT][NEUTRAL] That is correct, and I was stating that you can also check your status online at [PII], and did you have any other questions?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, yeah, I have, can you please fax a copy of EOB uh to uh to my fax?
[AGENT][NEUTRAL] OK, so this explanation of benefits is attached to the check which was mailed from our office on [PII]. It is now available to download online. I can give you that website and then assist you with creating an account.
[AGENT][NEUTRAL] So it's already been mailed to your address.
[CUSTOMER][POSITIVE] Oh thank you so much.
[CUSTOMER][NEUTRAL] Oh thank you. So, uh, can I get that, please, uh, the uh valid address that we can.
[AGENT][NEUTRAL] So
[AGENT][POSITIVE] The website address is secured, that's [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] Oh, [PII]. Thank you. Just a moment, please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So, you said it's secure. [PII]. Uh, is that right?
[AGENT][NEUTRAL] Can you spell it out for me? Because I can't quite understand what you just said.
[CUSTOMER][NEUTRAL] Yeah, it is secure. [PII]. Is that right?
[AGENT][NEGATIVE] That's incorrect.
[AGENT][NEUTRAL] So secured at [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII]. So secured. [PII].
[CUSTOMER][POSITIVE] Oh thank you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, I got it. uh, so yeah, I've seen the page is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, can you please guide me how to register this?
[AGENT][NEUTRAL] OK, so you would enter that web address.
[AGENT][NEUTRAL] In your search engine
[AGENT][NEUTRAL] And it's gonna pull up the online service center.
[AGENT][NEUTRAL] It should say APL online service center welcome are you there?
[CUSTOMER][NEUTRAL] Yes. Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, I'm there. I'm just on the page.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So to the to the right should be two tabs one is log in, the other is new user. If you have not created an account before, you'll click the new user tab.
[CUSTOMER][NEUTRAL] I click that.
[AGENT][NEUTRAL] And can you tell me what you see on that next tab?
[CUSTOMER][NEUTRAL] Uh, I think that I'm an individual with an APL insurance policy and I'm an employer or a group who offers APL products, and I'm writing agent appointment with APL. I'm a principal of an agency. I'm a medical or dental provider.
[AGENT][NEUTRAL] And which one of those roles describe you?
[CUSTOMER][NEUTRAL] Uh, I'm a medical or dental provider.
[AGENT][NEUTRAL] OK, so you would highlight that circle?
[AGENT][NEUTRAL] And then click next
[CUSTOMER][NEUTRAL] Uh, yes, and then.
[CUSTOMER][NEUTRAL] Uh, and then while clicking and next I've seen that to enter the tax ID for my provider and then I have entered that.
[AGENT][NEUTRAL] What what tax ID number did you enter, uh, Tessa?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then the patient account number?
[CUSTOMER][NEUTRAL] Uh, the patient ID, is that right? That's an account number or?
[AGENT][NEUTRAL] So you're gonna see some wording down below the policy account number field and it's gonna tell you what the patient account number is and where you would located on your claim. Can you read that out loud for me?
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I've seen that it is 104.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, I have entered [PII].
[AGENT][NEUTRAL] Is that the patient account number on the claim that you sent? I'm showing something different.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Uh, have you phone [PII]?
[AGENT][NEUTRAL] It starts with it starts with 104.
[AGENT][NEUTRAL] Let me pull up the claim.
[CUSTOMER][NEUTRAL] Um, yeah.
[AGENT][NEUTRAL] And what box are you looking in on the CMS 1500 form?
[CUSTOMER][NEUTRAL] Uh, I've seen it is on.
[AGENT][NEUTRAL] What
[CUSTOMER][NEUTRAL] It's on 26th.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so what number did you see there?
[CUSTOMER][NEUTRAL] And then I click the next.
[CUSTOMER][NEUTRAL] I see there is 104-064-3443741.
[AGENT][NEUTRAL] OK, I show a different number, [PII], and it has to match what we have on the CMS form that I show have it shows 104.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] 062.
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] 74.
[AGENT][NEUTRAL] 6010 is what's on the uh form that we received.
[AGENT][NEUTRAL] Do you see that anywhere on the one that you have?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No, I didn't see that thing here.
[AGENT][NEUTRAL] Are you calling directly from MUSC physicians? Are you a third party billing company?
[CUSTOMER][NEUTRAL] But I have to, I have entered that.
[CUSTOMER][NEUTRAL] I'm, I'm calling directly from the provider's office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you'll need to use that patient account number.
[CUSTOMER][NEUTRAL] And yeah, I have entered that and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh God. Thank you so much. And then I'll, I'm getting my user word and my password there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'll stay on the phone until you create the account, OK?
[CUSTOMER][POSITIVE] Yeah, thank you so much for that. And uh can I also get the call reference number?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It's my name in today's date.
[CUSTOMER][NEUTRAL] Can you please spell your name?
[AGENT][NEUTRAL] [PII] last [PII] [PII].
[CUSTOMER][POSITIVE] Thank you so much. And for the same patient, I have another date of service, so can you please help me on that or?
[AGENT][NEUTRAL] The date of service?
[CUSTOMER][NEUTRAL] It's on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, I guess, that's [PII].
[AGENT][NEUTRAL] I don't show a date of service for oh you said [PII], OK.
[CUSTOMER][NEUTRAL] Yeah, yes, yes.
[AGENT][NEUTRAL] I do not show a claim for [PII] for [PII].
[CUSTOMER][POSITIVE] Oh, got it. Thank you so much. For this thing, can I get a, uh, patient affect you on termination date, please?
[AGENT][NEUTRAL] [PII], the policy is active, [PII], and anything else I can help out with today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh yeah, can I get a claim spelling address and the payer ID for this one, please?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Payer ID number is 60801.
[CUSTOMER][NEUTRAL] And can I get a timely filing limit for this month?
[AGENT][NEUTRAL] No timely filing limit to submit the claim.
[CUSTOMER][POSITIVE] Thank you so much for assessing [PII]. Have a good day. Bye-bye and take care.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a good day.