AccountId: 011433970860
ContactId: f89acb07-03ff-465b-9d88-8c4ede1bd980
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 560090 ms
Total Talk Time (AGENT): 181318 ms
Total Talk Time (CUSTOMER): 171990 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/f89acb07-03ff-465b-9d88-8c4ede1bd980_20250213T16:20_UTC.wav
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[AGENT][NEUTRAL] Calling APL this is
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, good morning. My name is [PII]. I'm calling on behalf of the provider, Midwest Orthopedic Center. I just need to check claim status.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Um, you know what, I don't have a
[CUSTOMER][NEUTRAL] Policy number, mm let me see.
[AGENT][NEUTRAL] Do you have an ID card?
[CUSTOMER][NEUTRAL] Oh, here it is. I'm sorry. I have 025.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, let me repeat that. 02563037 M as in Mary, L as in Lima, and then number 8.
[AGENT][NEUTRAL] What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]. It's my direct line.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] with Taker.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Mm, showing a different date of birth.
[CUSTOMER][NEUTRAL] Oh, you don't have [PII]?
[AGENT][NEUTRAL] No, can you verify the address?
[CUSTOMER][NEUTRAL] What we have is [PII].
[AGENT][NEUTRAL] OK, I'm showing a different address also.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Any other information that I can provide?
[AGENT][NEUTRAL] I'm trying to verify. Give me a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have documentation with the date of birth on it?
[AGENT][NEUTRAL] Like a driver's license or something like that?
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Or is there a group number and name on the ID card?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The driver's license is not that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But we have the copy. Hm. Let me check if uh we have other documentation here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We don't have [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] is also [PII], just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] The ID card with you, it doesn't have the date of birth, right?
[AGENT][NEUTRAL] No, but it should have a group name and a group number on it.
[CUSTOMER][NEUTRAL] Oh, OK. Just a moment.
[CUSTOMER][NEUTRAL] Group number 15185.
[CUSTOMER][NEUTRAL] And what else do you need?
[AGENT][NEUTRAL] And the, the group name on, the group name?
[CUSTOMER][NEUTRAL] Is it the same with the plan name?
[AGENT][NEUTRAL] The group name should be kind of where the group policy number is.
[CUSTOMER][NEUTRAL] So, I have the, on the ID here's what I'm showing, insured.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So that's her name, coverage, individual group number 15185. Effective date [PII]. Plan Medlink, select group med supplement.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And then the in-hospital benefit cert number, outpatient benefit cert number, and then
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, that's the front
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Of the ID card.
[AGENT][NEUTRAL] OK, that's what I show on the ID card. OK. All right. And so, uh, and you may want to um check with the patient regarding the date of birth because that's one item that we have to verify, but because you verified the identification card that I have on file, I'm gonna go ahead and proceed with the claim status. What doctor's office are you calling on behalf of?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, Midwest Orthopedic Center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one second and then um what is the date of service that you're checking for?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And the total charge.
[CUSTOMER][NEUTRAL] And the billed amount, $240 even.
[AGENT][NEUTRAL] OK, I actually do not show any claims received for [PII] at this time.
[AGENT][NEUTRAL] So the claim is not on file.
[CUSTOMER][NEUTRAL] Um, but are you accepting claims electronically or it should be submitted by mail?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we'll request we we do require the primary explanation of benefits um I don't know if they, if you can uh submit attachments when you submit it electronically.
[AGENT][NEUTRAL] So I can give you both the payer ID number and the claims mailing address if you would like.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Alright, so the payer ID number is 60801.
[AGENT][NEUTRAL] And the claims mailing address?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, I'll go ahead and rebuild the claim and attach the
[CUSTOMER][POSITIVE] Primary EOD. Thank you so much, uh, [PII]. Is there a reference number for this call?
[AGENT][NEUTRAL] All right, [PII].
[AGENT][NEUTRAL] You'll use my name in today's date as your reference, [PII] [PII], you can also check claim status on the online service center at secured. I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Oh, OK. Do we need to register?
[AGENT][NEUTRAL] You can check your claim, yes, you'll have to, um, since it is a secured site, uh, you'll have to register the uh provider's tax identification number and the patient account number that's on the claim, the medical claim that was submitted to us, and then it's gonna ask you some security questions similar to what I asked so um.
[CUSTOMER][NEUTRAL] OK. So it's a [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. All right. I'll go ahead and do that and I will also inform the patient regarding the date of birth.
[AGENT][NEUTRAL] The date of birth and, and she would need to also contact us to update her um mailing address because it's different than what you provided.
[CUSTOMER][POSITIVE] I see. OK, great. All right. Thank you so much.
[AGENT][POSITIVE] Alright, thank you for calling APL [PII] have a good day.
[CUSTOMER][POSITIVE] You too. Thanks. Take care.
[AGENT][NEUTRAL] Bye-bye.