AccountId: 011433970860
ContactId: 3389de6e-e5a5-4b3b-9bf2-c2101248561c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2451560 ms
Total Talk Time (AGENT): 758840 ms
Total Talk Time (CUSTOMER): 1523319 ms
Interruptions: 24
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/3389de6e-e5a5-4b3b-9bf2-c2101248561c_20250305T20:18_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] For contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, ma'am. My name is [PII] calling for Doctor [PII] to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know if I can help you with the patient's information or provider's information?
[AGENT][NEUTRAL] Uh, well, the, the patient's information would be fine. Uh, [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Yeah, sure. The member ID number here is 13 consecutive 055459300.
[AGENT][POSITIVE] OK, my phone is cutting in and out. I'm so sorry. Do you mind telling me that just a little bit slower, please, sir?
[CUSTOMER][NEUTRAL] One for each
[CUSTOMER][NEUTRAL] Yeah, sure. Definitely. Uh, before that, ma'am, could you please spell your name for me?
[AGENT][NEUTRAL] Yes, it's [PII] And the first initial to my last name is [PII], yeah.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK, [PII]. Thank you very much. Uh, may I call you by your name? Is that OK?
[AGENT][POSITIVE] That's, that's great. What is, uh, just tell me the policy number again, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure, [PII]. So the member ID number is 13 consecutive 055459300.
[CUSTOMER][NEUTRAL] actually.
[AGENT][NEUTRAL] OK, let's see. I'm wondering, that's not actually one of our policy numbers. So how do you spell the insured's last name?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah. The insured uh last name is [PII].
[AGENT][POSITIVE] Thank you and the first name?
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And her date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Great. OK. I'm just gonna look that up. Um, and while I'm looking that up, if I could have a callback number please in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, sir. [PII]. You're welcome.
[AGENT][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] Now, is this for a dental policy or is it for a medical policy?
[CUSTOMER][NEUTRAL] Uh, it is, uh, regarding medical.
[AGENT][NEUTRAL] Medical, OK. Yeah.
[CUSTOMER][POSITIVE] take your time, no problem.
[AGENT][NEUTRAL] I'm still just checking.
[CUSTOMER][NEUTRAL] Could you please send you right back or whatever I mean you don't.
[AGENT][NEUTRAL] OK. I'm not finding her so I'm, I'm just, I'm still just checking. Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the recently submitted claim is on [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So do you have that claim on file?
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Uh, I'm not, well, I'm, I'm actually trying to find the patient right now. I, I can't even find the patient, so that's what I'm, I'm trying to, to find right now. Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me, let me just see if I can't uh
[CUSTOMER][POSITIVE] OK, OK, no problem, take your time.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I've got, let's see.
[AGENT][NEUTRAL] What I have is that for uh [PII] is um
[AGENT][NEUTRAL] It's a group um.
[AGENT][NEUTRAL] Uh, it might be a cancer policy. Let me just check here.
[AGENT][NEUTRAL] Uh, but it lapsed as of [PII], so, um, let me see if I can't find if that's not what your claim is. Let me see I have here.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK. OK. Um.
[AGENT][NEUTRAL] I don't have a claim for [PII], um.
[CUSTOMER][NEUTRAL] OK, you, you found that patient, right? [PII]?
[AGENT][NEUTRAL] Uh, I did find the, I did find the patient, yes, I don't have a claim for [PII]. Um, is there another date of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The date of service here is uh [PII].
[AGENT][NEUTRAL] [PII]. 0, that's great. OK, I'm sorry that you said [PII]. That's perfect. OK. Your claim number is 35.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 48
[AGENT][NEUTRAL] 121. Now,
[AGENT][NEUTRAL] And that's uh 358, excuse me, 354-8121. And it looks like we received your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On the [PII] and we process it on the [PII]. This is a group um cancer policy that uh lapsed.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] As of um [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you very much.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] This is a group cancel policy that lapsed as of [PII].
[CUSTOMER][NEUTRAL] Just a moment here. Uh, may I know the claim status first, [PII]? Could you please elaborate?
[AGENT][NEUTRAL] Yes, yes, the claim, the claim was denied, um.
[AGENT][NEUTRAL] On [PII] because uh the, the coverage uh had lapsed by by the time of the data service. Now, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] This is for an office visit and it wouldn't have been covered anyway, uh, because this is a cancer policy. It's, it's not medical. It's uh it's a strictly for um group cancer and, uh, but that, but that's what has happened. It was denied for that, for that being lapsed.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, thank you. OK, thank you very much, [PII], for this information. So as you, uh, mean to say that the claim is denied and the denied reason is, uh, the service is not covered under the uh patient's plan or the patient is out of date of service.
[AGENT][NEUTRAL] Well,
[AGENT][NEGATIVE] It's it's actually the reason that it was denied um Logan is because the policy lapsed by the date of service, but, but even if, even if the policy had been active, it wouldn't have paid out because it's this service isn't covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, it out, uh, why it is not, uh, going to pay it out because the service is not covered under the patient's plan or medical plan.
[AGENT][NEUTRAL] It, it, well, it's the reason it wasn't paid out.
[AGENT][NEUTRAL] was because the policy is, is lapsed. The policy lapsed. It did lapse in September, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] OK. Last in September and uh the date of service is [PII], right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, so the patient is not acting the service. That is correct. OK. Thank you very much. So the claim is denied because the patient is not active on date of service, right?
[AGENT][POSITIVE] That's that's correct. That is correct.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, thank you very much. Just a moment here. I don't note down the same here.
[AGENT][NEUTRAL] Is there anything else at all that I can help with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, just a moment. I have a document first. Uh, I have to, I need uh some specific information from you. OK, just a moment.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] She's
[CUSTOMER][NEUTRAL] And you.
[CUSTOMER][POSITIVE] OK, thank you very much. Just a moment.
[CUSTOMER][NEUTRAL] Are you guys
[CUSTOMER][NEUTRAL] OK, thank you very much, uh, [PII], for being on hold. Just a moment here. The system is loading. I just need specific information from you. Just a moment.
[CUSTOMER][POSITIVE] I really appreciate your patience. OK, thank you. Just a moment active service, OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So let me just reconfirm one more time here. Uh, so the patient is not active on data of service that's why the claim is denied, right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And the received date as you say is [PII], right?
[AGENT][POSITIVE] That is right. Uh-huh.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So sorry.
[CUSTOMER][NEUTRAL] [PII]. OK. And the process date is uh [PII], uh sorry, [PII].
[AGENT][NEUTRAL] Uh, the process date on this, um, let me see if I can get that.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The process date was on um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, can.
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, uh, [PII], I have a query here. I am, uh, just a confusion here about the received date. Could you please repeat that received date one more time?
[AGENT][NEUTRAL] Yes, the received date on this was, um, [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Dem [PII]. OK, thank you very much for correcting me. Uh, and, uh, the dinner is, uh,
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] It's
[AGENT][POSITIVE] That is, that is correct, yes.
[CUSTOMER][NEUTRAL] OK, thank you very much. And the process date is uh [PII], right? No, no, so sorry.
[AGENT][NEUTRAL] Uh, no, no, not [PII]. Um, the, the process, the process date is, is, uh, I'm sorry, I thought you said [PII], [PII], yeah, January.
[CUSTOMER][POSITIVE] OK. [PII]. Thank you very much.
[CUSTOMER][POSITIVE] Thank you very much for correcting me.
[CUSTOMER][NEUTRAL] OK, process date is just a moment. How to document the same here. Process date is [PII].
[CUSTOMER][NEUTRAL] So the process date and denial date both the same here, right?
[AGENT][POSITIVE] Uh, well, that, yes, that is correct, yes.
[CUSTOMER][NEUTRAL] That's OK. Thank you very much. Uh, what is the patient policy if you can term it?
[AGENT][NEUTRAL] The policy went into effect, um.
[AGENT][NEUTRAL] On uh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it lapsed [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And it las uh [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, thank you very much. So the uh patient's effective date is [PII] and termination date is [PII], right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][POSITIVE] OK. Thank you very much. When was the last year we updated?
[CUSTOMER][NEUTRAL] Yeah I I.
[AGENT][NEUTRAL] Uh, the last, the last update was that update on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, [PII]. So the last year we updated on [PII], right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] Uh, [PII], uh, do you see any other pair listed for this patient?
[AGENT][NEUTRAL] Uh, no, I'm sorry, I don't.
[CUSTOMER][NEUTRAL] OK, thank you very much. um, and may I know the time you're finding to submit correct?
[AGENT][NEUTRAL] Uh, the timely filing, uh, there is no timely filing to, uh, submit that, um, but you're going to want to submit it as appeal, uh, because it's, uh, um.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's just because the policy, the policy is lapsed and so you, you'll want to submit that as a as an appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, no problem. Uh, just for the documentation, I need the time to submit correct claim.
[AGENT][NEGATIVE] Uh, there is no timely filing. You can send it at any time.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] OK, no timely filing.
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][POSITIVE] We can submit anytime, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK, you can submit any time. May I know the mailing address to submit?
[AGENT][NEUTRAL] Yes, it's uh [PII].
[CUSTOMER][NEUTRAL] It's that.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that is in [PII]?
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]. Let me just reconfirm here, uh, the mailing address is submit claim is [PII]. Is that correct?
[AGENT][POSITIVE] Uh, that is correct, yes.
[CUSTOMER][NEUTRAL] I didn't.
[CUSTOMER][NEUTRAL] OK, I think, uh, the uh the zip code, could you please repeat that zip code one more time, please, [PII]?
[AGENT][NEUTRAL] Yes, the zip zip code is [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, thank you very much, [PII], for correcting me. So, uh, may I know the time you're filing to submit an appeal?
[AGENT][NEGATIVE] Uh, there's no timely filing.
[CUSTOMER][NEGATIVE] OK, no timely filing.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK. May I know the mailing address to submit an appeal? Is that the same one?
[AGENT][NEUTRAL] It, it's the same, same address.
[CUSTOMER][NEUTRAL] OK, which is [PII], right?
[AGENT][POSITIVE] Oh, that is correct, yes.
[CUSTOMER][POSITIVE] OK, thank you very much. Is there any specific form for PD?
[AGENT][NEUTRAL] Uh, no, no, there's not.
[CUSTOMER][NEUTRAL] OK. Thank you very much, [PII]. So the claim number as you mentioned earlier, is 354-8121. Is that correct?
[CUSTOMER][NEUTRAL] Or.
[AGENT][NEUTRAL] It's that
[AGENT][NEUTRAL] I'm sorry, do you mind repeating that, please?
[CUSTOMER][NEUTRAL] OK, sure, no problem. 354-812-1. OK, thank you very much. Um, just a moment here, OK.
[AGENT][POSITIVE] Yes, that is correct, yes.
[CUSTOMER][NEUTRAL] OK, uh, may I know, do you need, uh, deny you before your submission?
[AGENT][NEGATIVE] Uh, no, we do not.
[CUSTOMER][POSITIVE] OK. Thank you very much.
[CUSTOMER][NEUTRAL] Just a moment, I note it down the same here.
[CUSTOMER][NEUTRAL] Not so you don't need to deny you for resubmission, OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I know the call reference number for this? OK.
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as a reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I have a few more claims here. Could you please help me with those?
[AGENT][NEUTRAL] OK, and what is the next policy?
[CUSTOMER][POSITIVE] Please, OK, thank you very much. So you, uh, next member ID first, right?
[AGENT][NEUTRAL] Yes, uh, that's fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the next member ID here.
[CUSTOMER][NEUTRAL] Uh, just a moment. So the next member ID here is 1266272.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's name here is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And uh what is the date of service that we're looking for?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Date of service here is [PII].
[AGENT][NEUTRAL] OK, thank you. Is there a particular bill amount?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] $1,926 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so you said it's $1870?
[CUSTOMER][NEUTRAL] No, 1900. Just a moment, uh, I'm going to repeat it one more time. Just my system is loading $1,926 even.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. We have here.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's just
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm just checking.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] the.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not sure that I have anything that that build them out. I'm just checking here.
[CUSTOMER][NEUTRAL] OK, so the recently submitted claim is on [PII].
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Do you have the claim on file?
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I don't know
[AGENT][NEUTRAL] January [PII], let me just see.
[CUSTOMER][NEUTRAL] That is a submission date. That is not a date of service.
[AGENT][NEUTRAL] Oh, right.
[AGENT][POSITIVE] Right, no, I understand. That's what I'm, I'm looking forward to see.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I don't show anything for that build amount being submitted on [PII], um.
[CUSTOMER][NEUTRAL] OK, thank you. OK, thank you very much, [PII], for this information. Uh, could you please verify the date of service here is [PII] and the bill amount is $1,926 even. Is that correct?
[AGENT][NEUTRAL] That is correct, yes, and, and I'm not seeing anything on that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK, so the claim is not on file, right?
[AGENT][POSITIVE] That is right, yes.
[CUSTOMER][NEUTRAL] OK, thank you very much, [PII]. Just a moment. I need specific information from you for this claim. Thank you. May I know the patient is active on data service?
[AGENT][NEUTRAL] Uh, yes, the patient is active on that date of service. Uh, the policy went into effect on [PII] and it's still active. It was active in November as well.
[CUSTOMER][NEUTRAL] OK, so the effective date is [PII] and still active. There is no term date, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, just a moment and note um date.
[CUSTOMER][NEUTRAL] Do you like do.
[CUSTOMER][POSITIVE] Thank you very much. Just a moment, secretary.
[CUSTOMER][NEUTRAL] Yeah like that.
[CUSTOMER][NEUTRAL] OK. OK. uh, thank you very much, [PII]. Uh, you are a primary insurance or secondary insurance for this patient?
[AGENT][NEUTRAL] This is a secondary insurance.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Secondary insurance. Uh, may I know the preferred mode of submission?
[AGENT][NEUTRAL] Uh, you mean that, uh, and I'm sorry, I don't understand what you're asking. I apologize.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK. I mean, uh, I mean, uh, how can we submit the uh claim? Is it by electronically or by paper mail?
[AGENT][NEUTRAL] You can sit
[AGENT][NEUTRAL] You can do it, uh, electronically. Our, our electronic pay ID is 60.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 801
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Or you can mail it to the address, that PO box address that I gave you earlier.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so, uh, either way is possible, right? Electronically or buy paper mill, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] Uh, and the claim submission mailing address is [PII], right?
[AGENT][POSITIVE] Uh, that is correct, yes.
[CUSTOMER][NEUTRAL] OK, thank you very much, [PII]. Just a moment. I have to note it down here and the pay ID that you just gave me is [PII], right? OK. May I know the claim submission timely filing?
[AGENT][POSITIVE] That is right.
[AGENT][NEUTRAL] Uh, there's no timely filing, you can submit it at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just a moment. I did note down the same here. No claim submission timely filing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] We can submit it by any time. Thank you very much for this information, [PII]. And just a moment. I have to check is anything missing from my end so that I can get it from you.
[CUSTOMER][NEUTRAL] OK, security preferable question is specific. It's not specific. OK, time sorry filing is OK and payer ID. May I know the reference number for this one?
[AGENT][NEUTRAL] My name is [PII], and the first letter of my last name is [PII]. We're gonna use that today's date as a reference.
[CUSTOMER][POSITIVE] OK. Thank you very much, [PII]. I have a few more claims here. Could you please help me with that too?
[AGENT][NEUTRAL] Uh, yes, and what's the next policy?
[CUSTOMER][POSITIVE] Yeah, sure, thank you very much. So the next uh member ID here is 01719419.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's name here is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what date of service are we looking for for [PII]?
[CUSTOMER][NEUTRAL] Yeah, the data service here is [PII].
[AGENT][NEUTRAL] OK, thank you and is there a bill amount?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] $195 even.
[AGENT][POSITIVE] OK, thank you. Um.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, you're welcome.
[AGENT][NEUTRAL] Your claim, your claim number is 35.
[AGENT][NEUTRAL] 48
[CUSTOMER][NEUTRAL] Yeah, I
[AGENT][NEUTRAL] 187
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like we received your claim.
[AGENT][NEUTRAL] On the, uh, let's see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] On the um
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh, let's see, I find it, yes, on the [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] And we processed it on the, uh, [PII].
[AGENT][NEUTRAL] So we received it on the [PII], but we processed it on the [PII].
[CUSTOMER][NEUTRAL] I think that.
[AGENT][NEUTRAL] Now, the claim is for uh durable medical, which is not covered on this policy.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] So, that was not covered. Yeah.
[CUSTOMER][NEUTRAL] To reveal with, OK.
[CUSTOMER][NEUTRAL] OK, uh, so you just said the received date, uh, you just gave me is [PII], right? And the process hit on [PII], right?
[AGENT][POSITIVE] That's correct, yes.
[AGENT][NEUTRAL] Uh, right.
[CUSTOMER][POSITIVE] OK, thank you very much. And it is the night, right?
[AGENT][NEGATIVE] It was denied because the policy does not cover durable medical.
[CUSTOMER][NEUTRAL] OK, durable medical is the uh uh insurance policy, right? Secondary one.
[AGENT][NEUTRAL] Well, this is a secondary insurance. Um, it covers, uh, medical services, not the durable medical. Not, not a, uh, a walking boot or anything like that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so, uh, that, uh, durable services could you, what do you mean by that, uh, [PII]?
[AGENT][NEUTRAL] Well, if you um got a medical exam or you got a shot or um if they take uh uh X-rays, that sort of thing, but uh durable medical uh is something like equipment, um, such as a walking boot or a CPAP machine, um, that sort of thing, and those are not covered. So the services, if the, if the doctor is, is seeing you for something and he, and he gives you like a shot or draws blood, something like that, those are services.
[CUSTOMER][NEUTRAL] right
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] But the uh durable medical is actually a product. It's a, it's um uh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I actually
[AGENT][NEUTRAL] Uh, equipment, and that, that the equipment is not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, thank you very much. Uh, let me just reconfirm you. The claim is denied and it is because it is not covered under durable medical, right?
[AGENT][NEGATIVE] It's not covered under the policy. Durable medical is not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, durable medical is not.
[CUSTOMER][NEUTRAL] Covered under the patient's policy or uh medical's policy?
[AGENT][NEUTRAL] Under patients, under the patient's policy.
[CUSTOMER][POSITIVE] OK, thank you very much for elaborating that on the patient's policy.
[CUSTOMER][NEUTRAL] OK, let me just reconfirm one more time. The claim is denied and it denied because it is not covered under durable medical, uh, and under not, uh, under durable medical and it's not covered under patient's policy, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you very much. Just a moment here. I need specific information from you.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, so it is not good on the patient's policy. Just a moment here.
[CUSTOMER][NEUTRAL] Finding out the specific required information.
[CUSTOMER][NEUTRAL] So the received date as you say is uh [PII] and process date is on [PII]. May I know the denied date is also the same as the processed one?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] No, which is [PII], right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK, thank you very much. Uh, which CBT is not covered as per patient's policy? Uh, which CPT code?
[AGENT][POSITIVE] That's correct. It's.
[AGENT][NEUTRAL] Uh, the CPT code on this one is um L as in Lima.
[AGENT][NEUTRAL] 3660.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So the CPT code L as in Lima 3660 is not covered as per patient's policy, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, thank you very much. Uh, really sorry, uh, [PII] for repeating all this information so many times. I just had to reconfirm it as per the, uh, as per the guidelines. Sorry for that.
[AGENT][NEUTRAL] Now, did you have another one? I can do one more claim for you.
[CUSTOMER][NEUTRAL] No, no, uh, I'm just, uh, talking about uh the repeating information. That's why I have a few more games, OK. OK. Thank you very much for understanding.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Well, I can do one more. Um, yeah, I can do one more. What's the policy number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, no, no, I have, uh, I need, uh, some more, uh, I have a few, I need a few more information here. Just a moment. Uh, may I know the time you're finding to submit a claim?
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEGATIVE] Uh, there's no timely filing.
[CUSTOMER][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] Soundly fine. Thank you very much. And mailing address to submit correctly claim is that the same as previous one?
[AGENT][NEUTRAL] Oh yes, it is.
[CUSTOMER][NEUTRAL] OK. So the address is [PII], right?
[AGENT][POSITIVE] Uh, that is correct, yes.
[CUSTOMER][NEUTRAL] OK, thank you very much. And may I know the timely filing to submit an appeal? No, right?
[AGENT][NEGATIVE] Uh, there's no timely filing on this, yeah.
[CUSTOMER][NEUTRAL] No family ailing.
[CUSTOMER][NEUTRAL] OK, for appeal too, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, thank you very much. And the mailing address to submit and is also the same, right?
[AGENT][NEUTRAL] It's exactly the same.
[CUSTOMER][POSITIVE] OK, thank you very much, and there is no any specific form for it right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK, uh, the claim number you just gave it to me is 354-818-87, right?
[AGENT][POSITIVE] Uh, that's correct, yes.
[CUSTOMER][NEUTRAL] OK, thank you very much, uh, [PII] for this information and uh call reference number is your name and uh today's date, right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK, I, uh, could you proceed further for the next one?
[AGENT][NEUTRAL] I can do one more. Um, what is your policy number?
[CUSTOMER][NEUTRAL] OK, the 4th here is just a moment.
[CUSTOMER][NEUTRAL] So the policy number here is 00945668.
[AGENT][NEUTRAL] 668. OK. 945. OK, you said 0094.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK. Yes, perfect.
[AGENT][NEUTRAL] 5668, is that correct?
[AGENT][NEUTRAL] OK, great. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK. Before that, I just missed with one information for that previous claim, uh, here. Uh, [PII], uh, do you need deny for submission for denied claims? No, right?
[AGENT][NEGATIVE] Uh, no, no, I do not.
[CUSTOMER][NEUTRAL] OK, thank you very much. I just missed with that information. Just a moment. I'll note it down the same year.
[CUSTOMER][NEUTRAL] OK, not in the reservation.
[CUSTOMER][POSITIVE] You did. Thank you very much. So uh you need the uh patient's name here, right? For the next claim?
[AGENT][NEUTRAL] Uh, yes, uh, the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Patient's name here is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what's the date of service?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] D of service here is [PII].
[AGENT][NEUTRAL] And is there a particular bill amount?
[CUSTOMER][NEUTRAL] Yes, uh, $1,826 even.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] OK, for [PII]. Let me just check here and see what I've got.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sure, take your time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, it looks like your claim number on this.
[AGENT][NEUTRAL] It's 35.
[CUSTOMER][NEUTRAL] My name is.
[AGENT][NEUTRAL] 49
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] 333 and uh it looks like that policy um
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Excuse me, that uh claim uh was received.
[AGENT][NEUTRAL] On, uh, [PII].
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] 0
[AGENT][NEUTRAL] 2025.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And it looks like it was processed on [PII].
[AGENT][NEUTRAL] [PII]. So we received it on the [PII] and it was processed and paid on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 2025.
[CUSTOMER][NEUTRAL] OK, so it is, uh, the claim is paid, right?
[AGENT][NEUTRAL] Yes, yes, it is.
[CUSTOMER][NEUTRAL] OK, thank you very much. Just a moment here. I to document the same here and I get it, the information one by one from you so that you don't have to repeat it so many times. Just a moment here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you very much for understanding.
[CUSTOMER][NEUTRAL] just a moment. OK. OK, as you said, the received date is uh [PII], right?
[CUSTOMER][NEUTRAL] The
[AGENT][POSITIVE] Oh, that's correct, yes.
[CUSTOMER][NEUTRAL] OK, and the process date is [PII], right?
[AGENT][POSITIVE] Uh, that's correct, yes.
[CUSTOMER][NEUTRAL] OK, and the pay date is also the same [PII]. Perfect. OK. May I know the allowed amount?
[AGENT][POSITIVE] Uh yes, that, that is correct.
[AGENT][NEUTRAL] It's $166.05.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, thank you. May I know the pay amount?
[AGENT][NEUTRAL] Uh, it's $166.05.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Same.
[AGENT][NEUTRAL] Uh yes, uh-huh.
[CUSTOMER][NEUTRAL] As allowed, right? OK, so there is no any patient responsibility co-pay, co-insurance and de right?
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] Well, uh, this is it, uh, what we did was we paid the deductible, co-payment or co-insurance. So, um, uh, we paid the patient's responsibility.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Under that.
[CUSTOMER][NEUTRAL] OK. So it is uh uh process towards deductible?
[AGENT][POSITIVE] It's, yes, that's correct.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, so the claim is paid and processed towards deductible, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, thank you very much. Just a moment here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Because, uh, it is processed towards directively, so there will be a different information I needed from you. Just a moment here.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So the whole amount is processed towards deductible, right? OK, thank you.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, thank you very much, [PII]. One moment. So just have to repeat that information.
[CUSTOMER][NEUTRAL] OK [PII] date.
[CUSTOMER][NEUTRAL] OK, the finalized date is the process.
[CUSTOMER][POSITIVE] Just a moment. The system is loading here. I really appreciate your patience, [PII]. Just a moment, OK.
[AGENT][NEUTRAL] You can certainly.
[CUSTOMER][POSITIVE] Thank you very much for understanding.
[CUSTOMER][NEUTRAL] received this.
[CUSTOMER][NEUTRAL] 263.
[CUSTOMER][NEUTRAL] OK, and the process the amount is $166.05 right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK. And may I know what is the annual deductible amount?
[AGENT][NEUTRAL] The annual amount uh of their deductible, let me just check here, um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh.
[AGENT][NEUTRAL] Or the what the, the policy will pay, I should say.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So in this case with the policy, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So what we will do is we will pick up the, the deductible, co-payment or co-insurance.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Up to $5000 for calendar year.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, $5000. And, and how much patient made deductible?
[AGENT][NEUTRAL] Well, there, there's not a deductible on the policy. What we do is, I, I don't know what their deductible is on their major medical. Um, the only thing I can tell you is that they put this towards the deductible and that what we pay.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I, I don't know anything about their major medical policy.
[CUSTOMER][NEUTRAL] OK. So, so that is confirmed that the payment is processed towards deductible, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK, you don't have information regarding the how much patient made deductible, right?
[AGENT][NEUTRAL] That's correct, yes. I don't know anything about their major medical policy.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK. It's a detectable process in-network or out-network deductible?
[AGENT][NEUTRAL] Uh, I don't have that information either. I'm sorry.
[CUSTOMER][NEUTRAL] OK, no problem. No need to apology. Just a moment. I, uh, just for the documentation I'm asking, don't have that information. OK, uh, to which address UB was mailed to?
[AGENT][NEUTRAL] It looks like that was mailed to um.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII], zip code?
[AGENT][NEUTRAL] It's um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII] give me a second for you the address uh on which the um sorry the address on which the UB was mailed to is [PII], right?
[AGENT][POSITIVE] That is right.
[CUSTOMER][NEUTRAL] OK. Could you please send us the uh uh UB to our fax number?
[AGENT][NEUTRAL] Uh, yes, what is, what is your fax number?
[CUSTOMER][NEUTRAL] OK, thank you very much. Just a moment here. So the fax number, uh, fax number here is [PII]. Attention to the patient's account number.
[AGENT][NEUTRAL] 4825. OK, I can do that.
[CUSTOMER][NEUTRAL] OK, thank you very much. Could you please verify the patient's account number?
[AGENT][NEUTRAL] The patient's account number on here is um 23.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] 59
[AGENT][NEUTRAL] 75 V as in Victor, 26475.
[CUSTOMER][POSITIVE] OK, thank you very much. Perfect.
[CUSTOMER][NEUTRAL] So when we are going to expect that you will be at our end.
[AGENT][NEUTRAL] It should be sometime this evening.
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] I just got to mention the mention the same here uh it's the evening. OK, thank you very much, [PII]. Uh, so the patient's account number you just verified. OK, just a moment. I have to mention that to you. OK. And the claim number you just, uh, told me is 35493 consecutive streets, right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK 354-933-3 OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, let me just reconfirm here one more time. The claim is paid and processed towards it, right.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] Thank you very much. Mm, OK. May I know the uh call reference number for this one, your name and today's address, [PII]?
[AGENT][POSITIVE] That's, that is correct, yes.
[CUSTOMER][NEUTRAL] OK, uh, [PII], I have a few more games for you.
[AGENT][NEUTRAL] Oh, that's the last one I'll be able to.
[AGENT][NEUTRAL] I can put you, I can put you back in the queue, but I, I'm afraid that's, that's the most that I can do today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, could you please help me with some few more?
[AGENT][NEUTRAL] No, no, that's what I'm saying, [PII]. I'm, I'm gonna put you back in the queue and they should be able to help you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you very much, [PII]. Thank you very much [PII] for your assistance. Have a great day. Take care. Bye-bye.
[AGENT][NEUTRAL] OK, hold on just a second.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you very much. Hold on a second.