AccountId: 011433970860
ContactId: 293fea52-b300-4bc5-9d35-66f3a3e8764c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 639900 ms
Total Talk Time (AGENT): 230889 ms
Total Talk Time (CUSTOMER): 193751 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/293fea52-b300-4bc5-9d35-66f3a3e8764c_20250219T19:52_UTC.wav
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[AGENT][NEUTRAL] For contacting ATO, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office. I'm looking on a claim status. Can you help me?
[AGENT][NEUTRAL] Yes, sir. I can help you with the claim status. What's that policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02559264.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII]. Date of birth, [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. Um, and what is the date of service that we're looking for for [PII]?
[CUSTOMER][NEUTRAL] It's [PII] for $338 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Check.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like your claim number for this.
[AGENT][NEUTRAL] Is 356.
[AGENT][NEUTRAL] 1183.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it looks like the um claim itself.
[AGENT][NEUTRAL] Went out in the mail, uh.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] There is a check in the amount of $108.49.
[AGENT][NEUTRAL] The check number is 202.
[AGENT][NEUTRAL] 6943. It looks like it's going to [PII].
[AGENT][NEUTRAL] And uh so it is on its way to you.
[CUSTOMER][NEUTRAL] OK. May I know the payment amount?
[AGENT][NEUTRAL] It's $108.49.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] $8.49.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, one moment. So it's a single check for $108.49.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And what about the procedure code 99212?
[AGENT][NEGATIVE] And that is not covered under this policy.
[CUSTOMER][NEUTRAL] May I know the patient's plan name?
[AGENT][NEUTRAL] It's uh American Public Life, it is a gap insurance.
[CUSTOMER][NEUTRAL] OK. And the check number is 2026943.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK. And may I know the receive and process date of the claim?
[AGENT][NEUTRAL] OK, it's um
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] As I mentioned before, the claim was processed on [PII]. We received it on [PII].
[CUSTOMER][NEUTRAL] OK. And the check issue date is also the same, [PII]?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] Sent out date.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So it's here. And then you'll be also sent to the provider's office with the check?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Can you fax me the UBS ma?
[AGENT][NEUTRAL] OK. And what is that, uh, now you realized that it is still in the mail to you, so you will be getting another copy of it. What is your fax number, please?
[CUSTOMER][NEUTRAL] Yes, it's
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, I go, I will send that to you. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Yes, I have 2 more patients. Can you help me?
[AGENT][NEUTRAL] OK, and what is the next policy number, please?
[CUSTOMER][NEUTRAL] And call reference number will be same for the entire call.
[AGENT][NEUTRAL] Uh, yes, yes, it will be. My name is [PII], and the first letter of my last name is [PII].
[CUSTOMER][NEUTRAL] OK. And the next policy ID is 09 01912842ML8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And what date of service we're looking for for [PII]?
[CUSTOMER][NEUTRAL] It's [PII] for $721 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Checking.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like we received that claim on the [PII]. We processed it on the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me check here.
[AGENT][NEUTRAL] OK, your check, excuse me, your um claim number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's 355.
[AGENT][NEUTRAL] 7409.
[AGENT][NEUTRAL] There is a check that was issued on
[AGENT][NEUTRAL] Uh, the [PII].
[AGENT][NEUTRAL] It's actually the [PII] that we that we sent this out rather than the uh in February. So we sent it out on the [PII], we received it on the [PII]. Your check number is 202.
[AGENT][NEUTRAL] 493 9.
[AGENT][NEUTRAL] In the amount of $211.
[AGENT][NEUTRAL] In 2 cents. So we received it on [PII] and we processed it on [PII].
[AGENT][NEUTRAL] And you have a check in the amount of $211.02 that's coming to you.
[CUSTOMER][NEUTRAL] OK. And the cash date?
[AGENT][NEUTRAL] Uh let's see.
[AGENT][NEUTRAL] It looks like that has not been cast yet.
[CUSTOMER][NEUTRAL] So how many days we need to allow?
[AGENT][NEUTRAL] Uh, we need to allow at least 30 days for that to, to get to you before we can reissue the check.
[CUSTOMER][NEUTRAL] 30 business days.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] And the pay to address for this check?
[AGENT][NEUTRAL] I'm sorry, the, the what for the check? Uh.
[CUSTOMER][NEUTRAL] Uh, the address where the check has been sent?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And it's a single check.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] Let me check. Number is 2024939.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I have one last patient.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] It's 023-29711.
[AGENT][NEUTRAL] And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] For $150 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number for this.
[AGENT][NEUTRAL] It's 356.
[AGENT][NEUTRAL] 5653.
[AGENT][NEUTRAL] And it looks like that was processed. We received it on the [PII]. We processed it on the [PII].
[AGENT][NEGATIVE] Now the policy does not cover.
[AGENT][NEUTRAL] Office visits. So that claim was not paid.
[CUSTOMER][NEUTRAL] OK. So, this visit is not covered.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Can you fax me the EOB?
[AGENT][NEUTRAL] Uh, yes, to um 88, excuse me, 833-500.
[AGENT][NEUTRAL] 1068, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, yes, I can certainly do that.
[CUSTOMER][NEUTRAL] OK. And uh so when we will receive the EOB fax?
[AGENT][NEUTRAL] Uh, it, it should be within the next 24 hours.
[CUSTOMER][NEUTRAL] OK. And so the office visit is not covered under the patient's plan. So it's a patient responsibility.
[AGENT][NEUTRAL] Well, we, we can't tell you that. The only thing I can tell you is that, uh, is that the policy doesn't cover it.
[CUSTOMER][NEUTRAL] OK. And for the check sent to the provider's office also sent with the EUBs, am I right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK. And can you spell your name for me?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Uh, your last name sir?
[AGENT][NEUTRAL] It's [PII], and we're gonna use that as in today's date as a reference.
[CUSTOMER][NEUTRAL] Your name and today's date is the call reference.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][POSITIVE] Thank you so much for the information you provided.
[AGENT][POSITIVE] OK, thank you for contacting APO.
[AGENT][POSITIVE] Have a good