AccountId: 011433970860
ContactId: f9bf3042-6027-4da1-9766-07ea9e715c34
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 572289 ms
Total Talk Time (AGENT): 228824 ms
Total Talk Time (CUSTOMER): 181355 ms
Interruptions: 3
Overall Sentiment: AGENT=0.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/f9bf3042-6027-4da1-9766-07ea9e715c34_20250514T16:55_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], I'm calling from provider's office to check on a claim status for a patient.
[AGENT][NEUTRAL] Can I get your name?
[CUSTOMER][NEUTRAL] Sure, my name is [PII].
[AGENT][NEUTRAL] And can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it is 01417753, M as in Mary, L as in lion, and then the number 8.
[AGENT][NEUTRAL] OK, one moment while I pull that up for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] He is a minor, so I'm not sure if maybe his mom is on the policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, do you have the claim number or is it a date of service?
[CUSTOMER][NEUTRAL] I have a data service.
[CUSTOMER][NEUTRAL] July, I mean, I'm sorry, not July January [PII], 2025.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the billed amount was $5,0028.05.
[AGENT][NEUTRAL] And you said in 5 cents?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you guys are the secondary primary did pay on this claim.
[AGENT][NEUTRAL] OK, good. Yes, this is a med link, so it's secondary gap, so the primary will have to pay before we can process that claim.
[AGENT][NEUTRAL] And I am showing that this policy is active with an effective date of [PII].
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Let me check on that date of service for you.
[AGENT][NEUTRAL] Do you need the claim number?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just let me know when you're ready.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] I know, I'm ready.
[AGENT][NEUTRAL] It's 359.
[AGENT][NEUTRAL] 1035.
[AGENT][NEUTRAL] Give me one moment while I check it out for you.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] It looks like we paid $65 towards that.
[CUSTOMER][NEUTRAL] OK, I don't see any payment on the account.
[AGENT][NEUTRAL] And you said the, the total charge was?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, uh, the total charge, the charges were $5,0028.05 but since Primary paid, all we had to collect from you guys was the co-pay, I believe it was $250 or co-insurance. I'm sorry.
[CUSTOMER][NEUTRAL] $250. So you're saying you paid $69 or $65?
[AGENT][NEUTRAL] Let me double check real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I also don't see the $65 on the patient's account.
[AGENT][NEUTRAL] And who are you calling with?
[CUSTOMER][NEUTRAL] Uh, Jett Orthopedic Institute Surgery Center.
[CUSTOMER][NEUTRAL] So maybe that $65 is for the provider and not for the facility?
[AGENT][NEUTRAL] Um, who would the provider be?
[CUSTOMER][NEUTRAL] The provider would be Doctor [PII], uh, his name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm not seeing that, so maybe they had two different things going on that day. Let me double check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said the date of service was the [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, of this year.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm not showing a claim for that then, because the only claim I'm seeing is not for that provider.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, so you're not showing anything with do it?
[AGENT][NEUTRAL] I am not. No, ma'am.
[CUSTOMER][NEUTRAL] Do orthopedic?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][POSITIVE] Interesting. OK.
[AGENT][NEUTRAL] Um, it would also be helpful, um, if you ever need to, um, you can create an online account as a provider's office through our secure through [PII] and through that account you will be able to upload um claims and checks claim status as well and see if it was denied or paid um so that might be beneficial to you as well in the future um but for that data service of.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] [PII]. I'm not showing anything from that.
[AGENT][NEUTRAL] Facility
[CUSTOMER][NEUTRAL] OK. Um, I did try to use your site. However, when I would put the member's policy number, it said that it could not be found.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you try using using the patient account number?
[CUSTOMER][NEUTRAL] Uh, is that the one that I, uh, gave you, the one that starts at [PII]?
[AGENT][NEUTRAL] That would be the policy number. I, I believe the patient account number.
[AGENT][NEUTRAL] would be on your end.
[CUSTOMER][NEUTRAL] I don't have the patient account number.
[AGENT][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] Oh, on our end. Uh, so I would search your portal with our account? OK.
[AGENT][NEUTRAL] Let me double check and make sure.
[AGENT][NEUTRAL] And if you'd like, we also do have a user guide that I can um.
[AGENT][NEUTRAL] Email to you if that would be beneficial too so that and it can help you with some of this uh for the online portal but let me see.
[CUSTOMER][NEUTRAL] Patient. I'm just gonna attempt to do it right now to see what it tells me.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So it says no user was found with the information that was entered.
[AGENT][NEUTRAL] And you have, you guys, you do have a provider OSC account?
[CUSTOMER][NEUTRAL] Um, I am not sure what you're referring to.
[AGENT][NEUTRAL] So if you go to secured. [PII] and click on a new user, from there, you will go to a new user and you'll it'll show um give you some options and you want to be the medical or dental provider. Let me go through this with you so I can make sure that it's working properly. Um, OK.
[CUSTOMER][NEUTRAL] Sure, yeah, because I wanna see if we're getting the same error.
[AGENT][NEUTRAL] New user writer.
[AGENT][NEUTRAL] Yes, you will use the patient account number mismatched number listed, so it would have been whatever one you listed in the claim form. So let me see what that would be.
[CUSTOMER][NEUTRAL] Because I
[CUSTOMER][NEUTRAL] Oh, OK, let's see.
[AGENT][NEUTRAL] So it could be so whenever you click on new user and it asks for that patient account number it's giving um examples so for UBO4 it would be in box 3A patient CNTL number or if you have a CMS 1500 form, it would be in box 26.
[CUSTOMER][NEGATIVE] OK, so I did put in the claim that was sent, uh with the account number and it still gave me the same error.
[AGENT][NEUTRAL] I mean,
[AGENT][NEUTRAL] And it may be because we don't have your claim number, yeah.
[CUSTOMER][NEUTRAL] I mean I think
[CUSTOMER][NEGATIVE] Exactly that's what I'm saying maybe it's because you guys don't even have the claim. Is there a way I can like email or fax this claim since I can't use the portal?
[AGENT][NEUTRAL] Yes, ma'am. Go ahead and do that and let me know whenever you're ready and I can give you our fax number.
[CUSTOMER][POSITIVE] Sure, I'm ready.
[AGENT][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] [PII] perfect alrighty thank you very much.
[CUSTOMER][NEUTRAL] May I have a reference number for this call?
[AGENT][NEUTRAL] And we don't do reference numbers, but you can use my name and my last initial, so [PII] as in
[AGENT][NEUTRAL] Hospital and then today's date.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Got it. Thank you very much, [PII].
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that is all. Have a good rest of your day.
[AGENT][POSITIVE] Thank you for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Bye.