AccountId: 011433970860
ContactId: 3d3010f6-a9bd-4414-b200-b07c5bbc5fdc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1152699 ms
Total Talk Time (AGENT): 326999 ms
Total Talk Time (CUSTOMER): 457039 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/3d3010f6-a9bd-4414-b200-b07c5bbc5fdc_20250304T13:56_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] And thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII], and we have the, this is, uh, your insurance is a supplemental insurance, and I have um questions to make sure that um in these things have been billed correctly to you to make sure things have been paid. Can you help me with that?
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with claim status. Um, first, let me get a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. Now, I need your policy number, please.
[CUSTOMER][NEUTRAL] Um, payer ID?
[AGENT][NEUTRAL] Um, the policy number is the outpatient certificate number on the card.
[CUSTOMER][NEUTRAL] Outpatient. um 02510727 M as in Mary, L as in Lincoln 8.
[AGENT][NEUTRAL] And please verify your name again and your date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. Now, please verify your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the claims that you're verifying there for you, right?
[CUSTOMER][POSITIVE] Yes, yes, that's for me.
[AGENT][NEUTRAL] OK, and what's the date of service and bill charges on the first client?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm not showing a claim on file for that date of service.
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] So they never billed it to you. OK. Um, how about service date [PII]?
[AGENT][NEUTRAL] OK, I'm not showing a claim on file for that date of service either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, but that's why I wanted to call you because I don't think they were billing this correctly. Um, how about.
[CUSTOMER][NEUTRAL] Oh, you, you don't have that, you don't have a claim at all for those dates, so that takes the anesthesia out of there. How about, oh my gosh, um,
[CUSTOMER][NEUTRAL] There's so many for this company. OK, how, mm.
[CUSTOMER][NEUTRAL] I guess we can go down individually with these things. OK, 56, 2024, all of these will be 2024.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, you, you started in we started with you in in July, so that wouldn't be one. OK, 7, 19.
[AGENT][NEUTRAL] OK. Yeah, the 5624 is not on file and you said the next one is 719?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hey, no, ma'am. I'm not showing that one either.
[CUSTOMER][NEUTRAL] OK, 7:23.
[AGENT][NEUTRAL] OK. Yes, I am showing a physical therapy um claim for that date of service. I'm showing that it was paid.
[CUSTOMER][NEUTRAL] OK, 7:26.
[AGENT][NEUTRAL] Yes, ma'am. That one was paid also, physical therapy.
[CUSTOMER][NEUTRAL] 7:29.
[AGENT][POSITIVE] Yes, physical therapy it was paid.
[CUSTOMER][NEUTRAL] 81
[CUSTOMER][NEUTRAL] I'm sorry there's so many of them here but I just wanna verify because I've had the hardest time getting them to do what they need to do.
[AGENT][NEUTRAL] OK, no problem. I understand. And yes, ma'am. 81 was paid also, physical therapy.
[CUSTOMER][NEUTRAL] 8, OK, 85.
[AGENT][NEUTRAL] Yes, it was paid.
[CUSTOMER][NEUTRAL] How about 87.
[AGENT][NEGATIVE] Yes, ma'am. Well, actually, let's see, 87. Actually, this one was not paid because it's showing that it was billed for an office visit. Office visits are not covered, but I do show the claim. It was denied.
[CUSTOMER][NEUTRAL] How much
[CUSTOMER][NEUTRAL] OK, OK. Let me show, put on the offices, how about 89.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, this one was paid physical therapy.
[CUSTOMER][NEUTRAL] 812
[AGENT][NEUTRAL] Yes, it was paid.
[CUSTOMER][NEUTRAL] 8:15
[AGENT][NEGATIVE] Yes, we did receive this one, but I'm showing that it denied because.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I'm showing, um, according to the, your primary EOB, um, your primary insurance did not cover the charge for 8:15. And if your primary um insurance denies the charge, then we denied also as your secondary.
[CUSTOMER][NEUTRAL] Office visit?
[CUSTOMER][NEUTRAL] Uh, we're not gonna write that down. [PII] denied, so you denied, denied, so they did.
[AGENT][NEUTRAL] Right, for 8:15.
[CUSTOMER][NEUTRAL] Right, I'm, I'm making my notes so that I can discuss this with them.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Denied. OK, good. OK, so that one's that, um, how about 8:19?
[AGENT][NEUTRAL] OK, 819 paid.
[CUSTOMER][NEUTRAL] 822
[AGENT][NEUTRAL] This one also paid.
[CUSTOMER][NEUTRAL] 828
[AGENT][NEUTRAL] You paid.
[CUSTOMER][NEUTRAL] 8:30
[AGENT][NEUTRAL] It paid
[CUSTOMER][NEUTRAL] 93
[AGENT][NEUTRAL] Yes, this one page.
[CUSTOMER][NEUTRAL] 95
[AGENT][NEUTRAL] You pay
[CUSTOMER][NEUTRAL] 9/11.
[AGENT][NEUTRAL] It paid. Mhm.
[CUSTOMER][NEUTRAL] 9:13.
[AGENT][NEUTRAL] Paid.
[CUSTOMER][NEUTRAL] 9:17.
[AGENT][NEUTRAL] It paid. Mhm.
[CUSTOMER][NEUTRAL] Uh, 9:19.
[AGENT][NEUTRAL] Paid
[CUSTOMER][NEUTRAL] You are a saint
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] 9:24.
[AGENT][NEUTRAL] OK, I'm not showing this one. Well, let's see.
[AGENT][NEUTRAL] OK, OK, there it goes.
[CUSTOMER][NEUTRAL] OK, 926.
[AGENT][NEUTRAL] It paid. Mhm.
[CUSTOMER][NEUTRAL] 10 1 and 10 3.
[AGENT][NEUTRAL] Yeah, those both pay.
[CUSTOMER][NEUTRAL] Um, we have 10:10.
[AGENT][NEUTRAL] It paid
[CUSTOMER][NEUTRAL] 10:15.
[AGENT][NEGATIVE] OK, this one denied because your primary insurance denied it.
[AGENT][NEUTRAL] 10:15.
[CUSTOMER][NEUTRAL] Let me write that down.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Let me see, um, when that same note APL says this was denied. Let me put that as a problem for me to fix. OK, 10:17.
[AGENT][NEGATIVE] Also denied because your primary insurance denied it.
[CUSTOMER][NEUTRAL] The APL says, so we're gonna make 10:17 is also a problem I need to resolve about 108.
[CUSTOMER][NEGATIVE] It's out of order.
[AGENT][NEUTRAL] OK, 108 paid.
[CUSTOMER][NEUTRAL] How about 10:21?
[AGENT][NEGATIVE] Denied because your primary denied it.
[CUSTOMER][NEUTRAL] Let me just put that in there APL.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] OK. Um, 10:24.
[AGENT][NEUTRAL] This one paid.
[CUSTOMER][NEUTRAL] 117.
[AGENT][NEUTRAL] It paid. Mhm.
[CUSTOMER][NEUTRAL] OK. 1112.
[AGENT][NEUTRAL] OK, I'm not showing this one on file.
[CUSTOMER][NEUTRAL] OK, I'm gonna put that one. OK, how about um
[CUSTOMER][NEUTRAL] I need to put that in red. OK, 11:15.
[AGENT][NEGATIVE] This one is also not on file.
[CUSTOMER][NEUTRAL] About 11:25.
[AGENT][NEUTRAL] OK, I'm showing that we received this one, but the EOB that they sent in does not show what charges went to the co-pay, the co-insurance and deductible. So we'll need a more detailed EOB from your primary insurance.
[CUSTOMER][NEUTRAL] And you're, that's that's 11:25?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I'm sorry. I guess I was writing something else, so.
[CUSTOMER][NEUTRAL] needed, you need um EOB from Amed.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, that shows charges.
[AGENT][NEUTRAL] That went to co-pay, coinsurance, or deductible.
[CUSTOMER][NEUTRAL] OK. Can I send that over to you?
[AGENT][NEUTRAL] Yes, ma'am. You can submit it yourself.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so let me do.
[AGENT][NEUTRAL] Mm, just make sure that you include your diagnosis code and I can give that to you.
[CUSTOMER][NEUTRAL] 00 my gosh, when does it.
[CUSTOMER][NEUTRAL] Yeah not on file. It was OK.
[CUSTOMER][NEUTRAL] What was the diagnosis code?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's Z like zebra 4789.
[CUSTOMER][NEUTRAL] Z as in Zebra 47-89 or do
[AGENT][NEUTRAL] 89.
[CUSTOMER][NEUTRAL] 0.89. OK.
[AGENT][NEUTRAL] OK. And also, let me give you the claim number and just make a small note um letting us know that this is the EOB for this claim.
[CUSTOMER][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] Let me know when you're
[CUSTOMER][NEUTRAL] OK, wait a second. I got like, uh, thank you. Diagnosis code.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, clean.
[CUSTOMER][NEGATIVE] No, I don't know what that is. I don't know why you took me to home. Jeez, my fat fingers, I guess.
[CUSTOMER][NEUTRAL] Claim number, what is it?
[AGENT][NEUTRAL] It's 354.
[AGENT][NEUTRAL] 9920.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then can you give me an email to send that to? or would it, is it a fax or or is there an email?
[AGENT][NEUTRAL] Um, it's fax. We can't take them through email anymore because of HIPAA, so.
[CUSTOMER][NEUTRAL] OK, then fine, that's, I, I have your fax number. I'll have that sent to you. OK, good. OK. Um.
[AGENT][NEUTRAL] And when you fax it, just make sure that you also attention it to the claims department.
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] OK, claims department OK.
[CUSTOMER][NEUTRAL] I write that down.
[CUSTOMER][NEUTRAL] Attention
[CUSTOMER][NEUTRAL] Claims department. OK. Um, next one is
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um [PII].
[AGENT][NEGATIVE] OK, this one denied because according to the ELB the primary insurance did not cover it.
[CUSTOMER][NEUTRAL] OK, so if I have EOB for that I can send those over, right?
[AGENT][NEUTRAL] Right, but make sure that the EOB shows that the primary insurance covers it and charges went towards the copay, the co-insurance, or the deductible.
[CUSTOMER][NEUTRAL] It, it did, it does. It, it, it has that on there. I had to make a huge spreadsheet because there's so much of this stuff, so it does show that. So I guess I need another diagnosis code and, and claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number? Yes, ma'am. For 12:17, just let me know when you're ready.
[CUSTOMER][NEUTRAL] OK, what was that diagnosis code?
[AGENT][NEUTRAL] It's M like Mary, 75.02.
[CUSTOMER][NEUTRAL] OK and claim number?
[AGENT][NEUTRAL] The claim number is 3562948.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right and yeah, just make sure that you include the notes in that this is the EOB for this claim and this is the diagnosis code, right.
[CUSTOMER][NEUTRAL] I have those.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, if we can go back to 11:15.
[CUSTOMER][NEUTRAL] APL 11:15 you said you don't have it on file. Can I send the EOB over to you or no?
[AGENT][NEUTRAL] Yes, ma'am. You could send us the EOB just make sure that you get the diagnosis code from your provider and write it on there or either type it on there. So we'll know.
[CUSTOMER][NEUTRAL] Oh, OK, so this one I can't, I'm not gonna do that one. I'm gonna have them do that one directly to you, so it's complete.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Um, OK, then how about
[CUSTOMER][NEUTRAL] 13 2025.
[AGENT][NEUTRAL] This one paid
[CUSTOMER][NEUTRAL] How an 11, I mean I'm sorry, 16 2025.
[AGENT][NEGATIVE] This one isn't on file.
[AGENT][NEGATIVE] We haven't received it.
[CUSTOMER][NEUTRAL] Not on
[CUSTOMER][NEUTRAL] On file. OK let me put that there.
[CUSTOMER][NEUTRAL] Not on file.
[CUSTOMER][NEUTRAL] not on file. OK. Do you have
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] 1 17 2025.
[AGENT][NEUTRAL] No, ma'am. This one isn't on file either.
[CUSTOMER][NEUTRAL] No, I'm fine.
[CUSTOMER][NEUTRAL] Boy,
[CUSTOMER][NEUTRAL] OK, so then I, so I've got.
[CUSTOMER][NEUTRAL] You OK, so I wanna go back to some on 10-8-2024, was that one not on file?
[AGENT][NEUTRAL] Um, this one paid
[CUSTOMER][NEUTRAL] Wait, 108?
[AGENT][POSITIVE] Yes, ma'am. We received it and it paid.
[CUSTOMER][NEUTRAL] How much
[CUSTOMER][NEUTRAL] It was for $100?
[AGENT][NEUTRAL] Um, it was a physical therapy um claim. Let me see how much paid out on it. Cause we received it twice. The first time we received it, it denied because we needed the primary carrier's ELB so the provider resubmitted it along with the requested documentation and then it paid and it paid out for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $81.09.
[AGENT][NEUTRAL] 8109. Mhm. Yes, ma'am.
[CUSTOMER][NEGATIVE] Oh, OK, then we could just do that then. OK, that was paid. Those were paid. This is Ane denied it.
[CUSTOMER][NEUTRAL] Admed denied admin denied AMed denied. OK, so I got 4 admin denied and and a few I gotta do. OK, and then the other ones are not on file, so I have them resubmit all of that. OK. And then, yeah, so we started with, oh, so you said you don't have anything from 7:17.
[AGENT][NEUTRAL] Let me check again. OK.
[CUSTOMER][NEUTRAL] Or 11
[AGENT][NEUTRAL] Right, that's not on file.
[CUSTOMER][NEUTRAL] 1112.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And 11 not on file.
[AGENT][NEUTRAL] Right, they're not on file.
[CUSTOMER][NEUTRAL] How about 1118 2024?
[AGENT][POSITIVE] Yes, ma'am. This one paid, it paid for $100.
[CUSTOMER][NEUTRAL] It's paid.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so then, in the, oh, there's 17 25 2024.
[AGENT][NEGATIVE] This one isn't on file.
[CUSTOMER][NEUTRAL] They never built it. This is great. I'm glad I'm doing this and I can make my calls. Can't get paid if y'all don't submit it.
[AGENT][POSITIVE] Exactly
[AGENT][NEUTRAL] And just know, and just know also the claims that you submit, um, that payment will go directly to you.
[CUSTOMER][POSITIVE] Like it.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] The same, yeah, so you'll receive those payments.
[CUSTOMER][POSITIVE] OK. OK, then let me take care of this and um hopefully we can get this.
[CUSTOMER][NEGATIVE] Done quickly. I just don't, I hate these hospitals when they just take forever and but they don't, you know, you, you're like hopeless and hopeless. You can't really do anything about it.
[AGENT][POSITIVE] Right, exactly. So you're doing the right thing.
[CUSTOMER][POSITIVE] OK, I appreciate you. You've been a saint helping me. Thank you so much.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, no problem, [PII]. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII], for calling ATL and you have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You have a blessed day. Bye bye