AccountId: 011433970860
ContactId: 12f23067-5136-44ac-a184-9718892da9cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2405020 ms
Total Talk Time (AGENT): 543000 ms
Total Talk Time (CUSTOMER): 991383 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/12f23067-5136-44ac-a184-9718892da9cc_20250218T16:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi, good afternoon, [PII], and my name is [PII] as well. It's a pleasure talking with you. And sir, can I have your last name, uh, first initial for documentation purpose?
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Thank you, sir. Uh, so here, I have a claim with me which got uh
[CUSTOMER][NEUTRAL] I mean, paid. So I would like to know about uh some clarification regarding this claim. Would you be able to help me with that?
[AGENT][POSITIVE] I'm happy to check on a claim for you today. Do we have the patient's policy number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, I do have it. So it is uh 01907885.
[AGENT][NEUTRAL] All right, thank you for that. Let me pull this up one moment.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] May I have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and the date of service?
[CUSTOMER][NEUTRAL] You're welcome. And the date of service is [PII].
[AGENT][NEUTRAL] And the build out.
[CUSTOMER][NEUTRAL] $241 even.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] So the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $241.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim is processed [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the claim number for this is 341.
[AGENT][NEUTRAL] 5656.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's a single check. Do you need the check number?
[CUSTOMER][POSITIVE] Yes, I do need it.
[AGENT][NEUTRAL] Check number is 1834789.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 89. OK, great. And may I know what was the allowed amount? What uh what was the paid amount for this claim?
[AGENT][NEUTRAL] The paid amount was $241.
[CUSTOMER][NEUTRAL] So the uh full allowed amount was paid, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great. Uh thank you so much for that information. And uh
[CUSTOMER][NEUTRAL] Is there any additional payments made on this claim?
[AGENT][NEGATIVE] Not for that, this particular claim, no.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK. Great. Thank you so much. So, uh, yeah, great. Thank you for that information. And so you said this claim, uh, I mean, this payment was a single check, right?
[CUSTOMER][POSITIVE] Mm. OK, great. Thank you so much. And uh may I also uh know whether this uh check was cashed or not?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][POSITIVE] Mhm. No issues. Take your time.
[AGENT][NEUTRAL] That shows it was cashed.
[CUSTOMER][NEUTRAL] OK. May I know when it was cashed?
[AGENT][NEUTRAL] We don't have a clear date.
[CUSTOMER][POSITIVE] OK, great. No issues. Thank you so much for that information. And I do have a few more clients with me. Would you be able to help me with that too?
[AGENT][NEUTRAL] Is it the same patient or different?
[CUSTOMER][NEUTRAL] Different patient.
[AGENT][NEUTRAL] Uh, yeah, we can check those, sir. Give me just one moment to note this account we can move on to the next.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][POSITIVE] OK, no issues. You can take your time, [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] Mm
[AGENT][POSITIVE] I'm ready for the next policy when you are.
[CUSTOMER][NEUTRAL] Yes, I'm ready. So the next policy number is 02136497.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII], and as for the date of birth, it's [PII].
[AGENT][POSITIVE] Thank you, data service.
[CUSTOMER][NEUTRAL] The service is number 7 of 2023.
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] $227 even.
[AGENT][NEUTRAL] This claim was received on [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] Uh, the claim was denied. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, this claim was denied. OK.
[AGENT][NEUTRAL] Claim was denied.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Not covered under this member.
[AGENT][NEGATIVE] It was denied on
[AGENT][NEUTRAL] Plan
[CUSTOMER][POSITIVE] I'm sorry. Yeah, I'm sorry to interrupt you like that.
[CUSTOMER][NEUTRAL] OK. Uh, so, uh, may I know, uh, why this, uh, was denied as non-covered as for the patient's plan? Is there any specific reason?
[AGENT][NEUTRAL] Patient's plan does not cover office visit fee.
[CUSTOMER][NEUTRAL] Uh, so, patient, uh, plan does not cover office visit?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. Great. Thank you so much for that information and uh um yeah, I'm ready for the dinner date.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, great. And uh may I also have the claim number?
[AGENT][NEUTRAL] Claim number for this is going to be 340.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3715.
[CUSTOMER][NEUTRAL] 15. OK, great. And actually, we don't have any EOB here. Is there any possibilities that you could uh I mean uh fax me the EOB through?
[CUSTOMER][NEUTRAL] The fax number which I provide you?
[AGENT][NEUTRAL] Mhm, I can fax this to you. What's a good fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] And the attention is my name.
[AGENT][NEUTRAL] Should we mark
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's uh my name with my last initial.
[CUSTOMER][NEUTRAL] And uh can I also have the corrected client timely filing along with the appeal timely filing as well?
[AGENT][NEUTRAL] Uh, there's no timely filing for corrective claims. Appeals must be filed within 180 days of the decision.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 180 days from the right.
[CUSTOMER][POSITIVE] Thank you so much for the information.
[CUSTOMER][NEUTRAL] And uh OK. Uh, may I know uh how to, how do we submit the appeal?
[CUSTOMER][NEUTRAL] Is there any mailing address or mhm.
[AGENT][NEUTRAL] Oh, you can
[AGENT][NEUTRAL] Yes, there's a mailing address it needs to be filed in writing.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Appeal's mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for the information.
[CUSTOMER][POSITIVE] Let me document it here. OK. Great. Thank you so much for that information. So, [PII], I'm ready with my next claim whenever you're ready.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] OK. So uh the next um member ID is 01359407.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and as for the date of birth, it's [PII].
[AGENT][NEUTRAL] OK, and the date of service?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] In the build amount?
[CUSTOMER][NEUTRAL] $177 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, looks like.
[AGENT][NEUTRAL] Claim was denied, office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, and may I know, uh, what type of plan that, uh, the patient has?
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] OK, not covered.
[CUSTOMER][POSITIVE] Great. Thank you so much.
[CUSTOMER][NEUTRAL] So the patients who are having med link as they insure, I mean, plan, uh, they would not be covered by the office visits will not be covered, right?
[AGENT][NEUTRAL] Some of our meddling plans do not cover office visits. That's correct.
[CUSTOMER][NEUTRAL] Hey, I like
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, OK, thank you so much. And uh can I also have the claim number for this one as well?
[AGENT][NEUTRAL] 3302302
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great. I got it. And thank you so much for that information as well. And can you please also fax me this claims UOB as well?
[AGENT][POSITIVE] Mhm, absolutely.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. I really appreciate it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And can I also have the denied date for this claim?
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][POSITIVE] OK, no issues. Take your time.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Claim was denied on [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Great. So, uh, whenever you're ready, I'm ready with my next policy number here.
[AGENT][NEUTRAL] OK, just one moment, let me finish faxing the COB to you.
[CUSTOMER][POSITIVE] OK, no issues. Take your time.
[CUSTOMER][NEUTRAL] And how is your day going, [PII]?
[AGENT][POSITIVE] So far so good.
[CUSTOMER][POSITIVE] OK, great to hear.
[AGENT][POSITIVE] OK, sir. I'm ready for the next one when you are.
[CUSTOMER][NEUTRAL] Yes. So, uh, the next member ID is 01745957.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Patient name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and as for the date of birth, it's [PII].
[AGENT][NEUTRAL] OK thank you and data service?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You're welcome. And the date of service is [PII].
[CUSTOMER][NEUTRAL] With the amount of $184 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I apologize, sir. What was the date of service again for [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, no issues. So the date of service is [PII].
[AGENT][NEUTRAL] And it was for [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, let's see.
[AGENT][NEUTRAL] So it looks like the claim was denied. The services were rendered after the policy was active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, in this case, uh, can I have the patient effective one team date?
[AGENT][NEUTRAL] Effective date was [PII]. Patient plan terminated on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So it's correct. And uh can you check if there any um policies available or active for the date of service?
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] I don't see any other policies active.
[CUSTOMER][NEUTRAL] OK, so there's no other active coverages for the data service, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] OK, great. Thank you so much.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Then, uh, and may I also have the uh denied date?
[AGENT][POSITIVE] Uh, yes, absolutely. One moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Claim was denied [PII].
[CUSTOMER][POSITIVE] OK, great. Thank you so much. And I would need the UB faxed as well because I don't have any UBs here.
[AGENT][NEUTRAL] OK, I'll send that to you now.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for your assistance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you have any answers you needed to check on today, [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yes, I do have 2 more with me.
[AGENT][NEUTRAL] OK, are you ready?
[CUSTOMER][NEUTRAL] Would you be able to assist me with that?
[AGENT][NEUTRAL] Yeah, are you ready to move on to the next?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So the next patient's policy number would be 01986725.
[AGENT][NEUTRAL] Thank you. And the patient name and date of birth, please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And then what's the date of service?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You're welcome. And the date of birth is [PII] with the bill amount of $184 even.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So it looks like the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, looks like the
[AGENT][NEUTRAL] Claim was denied, office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] OK. It's same as the previous denial recent, right, which is for, because the meli patient has the meddling, uh, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, great. Thank you so much. And as you said, the apple time filing would be 180 days from the date of denial, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, great. Thank you so much. And can I also have the denied date here?
[AGENT][NEUTRAL] Kle was denied [PII].
[CUSTOMER][POSITIVE] OK, great. Thank you so much.
[CUSTOMER][NEUTRAL] And uh what are the uh the information required? OK, great. Uh, for this claim also, uh, can I have the claim number?
[AGENT][NEUTRAL] Mhm, claim number is 3,269,580.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 80. Great. And uh can you also fax me these EOB as well?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Great. Thank you so much.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, I'm ready for the next one when you are.
[CUSTOMER][NEUTRAL] Yes. So, uh, the next member ID is going to be 015379887.
[AGENT][NEUTRAL] Thank you. And then patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you data services.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] The service is [PII] with the bill amount of $177 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was denied, office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the denial date was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the claim number?
[AGENT][NEUTRAL] Claim number is 3268059.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] 59. Great. Thank you so much. And uh I would like to have this EOB faxed as well.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that is on its way to you.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh actually, I have missed to uh get one information, uh I mean request one information for the [PII] patient.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] OK, no issues.
[AGENT][NEUTRAL] OK, in regards to [PII], what questions did you have?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Actually, I have missed to uh get the claim number. Uh is there any possibilities that you could uh give me the, I mean, provide me with the claim number?
[AGENT][NEUTRAL] What was the data service for [PII] again?
[CUSTOMER][NEUTRAL] OK. Now, sure, sir. So the date of service is [PII].
[AGENT][NEUTRAL] For the charge amount of 184.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Claim number on that is 336.
[AGENT][NEUTRAL] 0233.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great. Thank you so much. I really appreciate your patience and thank you so much for the information, [PII]. And may I also have, I may know how many clients you can provide me in a call? Because I do have a um mhm.
[AGENT][NEUTRAL] We can
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][POSITIVE] Because I do have a few other more clients with me.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] We can check as many as you need us to.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Oh, that's great thank you so much.
[CUSTOMER][NEUTRAL] Uh, so for the same patient, I do have, uh, the patient last which we have discussed is [PII], right? For that patient, I do have one more data of service with me.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Give me a minute. I'm pulling up that claim here.
[CUSTOMER][NEUTRAL] Yes, it's here.
[CUSTOMER][NEUTRAL] OK. I'm ready with the uh mem member ID.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] It's for [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, I have that still here. What's the date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was on [PII].
[AGENT][NEUTRAL] OK, and the bill amount?
[CUSTOMER][NEUTRAL] It is $7177 even.
[AGENT][NEUTRAL] The claim is received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It was denied. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK, same denial.
[CUSTOMER][NEUTRAL] And uh may I know when it was denied?
[AGENT][NEUTRAL] was denied [PII].
[CUSTOMER][NEUTRAL] Mhm. Great. And can I also have the claim number for this claim?
[AGENT][NEUTRAL] 3272723
[CUSTOMER][NEUTRAL] 327. I'm sorry, what was that?
[AGENT][NEUTRAL] 3272723.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][POSITIVE] 23. Great. Thank you so much.
[CUSTOMER][NEUTRAL] And I would also like to uh fax this UOB as well to me since I don't have any other UOBs in the system.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mhm. That one's on its way to you.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] I'm ready for the next one whenever you are.
[CUSTOMER][NEUTRAL] Yes, so I'm ready with that as well. So it is 01835841.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] Will you repeat that back to me one more time, Sarah 01.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, sure. It's 01835841.
[AGENT][NEUTRAL] Thank you. And the patient name and date of birth?
[CUSTOMER][NEUTRAL] You will.
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII]. As for the date of birth, it's [PII].
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] Yeah, yeah. It is [PII] with the bill amount of $131 even.
[CUSTOMER][NEUTRAL] So yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] for.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was denied, office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And uh what about the denied date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK. And uh what, how about the claim number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number is 335-0726.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] 0726. Great. Thank you so much. And I would like to uh request to fax these claims you will be as well, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that one's on its way to you also.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Do we have another one we need to check?
[CUSTOMER][POSITIVE] Yes, actually we do have uh 2 more with me.
[AGENT][NEUTRAL] OK, the next one.
[CUSTOMER][NEUTRAL] Sorry, actually, it's 3 more. Mhm, yeah. So the next one the member ID is going to be 02325835.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] It was number [PII].
[AGENT][POSITIVE] Thank you. And then the build amount?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes, sure. It is $227 even.
[CUSTOMER][NEUTRAL] What do I
[AGENT][NEUTRAL] A claim is received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, claim was denied, office visits are not covered under the member policy.
[CUSTOMER][NEUTRAL] OK. Great. in denial.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And may I also have the denial date for this claim?
[AGENT][NEUTRAL] That was on [PII].
[CUSTOMER][POSITIVE] Great. How about the claim number?
[AGENT][NEUTRAL] Claim number is 3404119.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Great. Thank you so much. And uh I would like to request you to uh fax me this EOB and the next, next two EOBs as well because it's going to be the same for the next patient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are we done with this patient [PII] or are we moving on to the next or?
[CUSTOMER][NEUTRAL] Yes, uh, we are done with the [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] OK, no issues. Take your time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, I'm ready for the next policy number when you are.
[CUSTOMER][NEUTRAL] Yes, sir, I'm ready too. So it is uh 021-86553.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Patient's name is [PII] and as for the date of birth, it's [PII].
[AGENT][NEUTRAL] OK, and date of service?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It is uh [PII].
[AGENT][NEUTRAL] OK, and the build amount?
[CUSTOMER][NEUTRAL] The amount is $325 even.
[CUSTOMER][NEUTRAL] These are the
[CUSTOMER][NEUTRAL] be invisible in the.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So it looks like the claim was received on.
[CUSTOMER][NEUTRAL] Friday.
[CUSTOMER][NEUTRAL] Mhm. Oh my [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $150.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] This was the maximum benefit payable for this state of service.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][MIXED] OK, maximum payable.
[CUSTOMER][NEUTRAL] And uh so uh there was an uh uh like uh how to say, there was a not payable amount of $175 in this claim. Is that the um contractual adjustment or provider right of thing or what about that balance $175?
[AGENT][NEUTRAL] As far as patient responsibility, that's up to the provider or facility we're not able to advise.
[CUSTOMER][NEUTRAL] OK. So, uh, this is a kind of a patient's responsibility?
[AGENT][NEUTRAL] We can advise on that [PII] that would be up to the facility or provider to build them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much. So that $150 was the maximum payable for the date of service, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, great. Thank you so much. And uh
[CUSTOMER][NEUTRAL] Uh, for this one, it's OK, and I got this. And for the same patient, I do have a different date of service with me. Would you be able to assist me with that too?
[AGENT][NEUTRAL] Mhm, what's the data service?
[CUSTOMER][NEUTRAL] It was on [PII] with the bill amount of $170 even.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] This claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $75.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, this was the max benefit payable for this state of service.
[CUSTOMER][NEUTRAL] OK, same thing.
[CUSTOMER][NEUTRAL] And the rest is, uh,
[CUSTOMER][NEUTRAL] Based on the provider's decision, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great. Thank you so much. And can I also have the claim number for this claim?
[AGENT][NEUTRAL] The claim number for this one is 321-4416.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great. Thank you so much. And uh sir, for today's call, I have got enough information from you. And thank you so much for that, [PII].
[AGENT][POSITIVE] You're very welcome. Have a good rest of your day.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Um, bye-bye.