AccountId: 011433970860
ContactId: 3e3ec08c-fc6d-474e-8808-7678c33115a1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1832400 ms
Total Talk Time (AGENT): 407853 ms
Total Talk Time (CUSTOMER): 325246 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/3e3ec08c-fc6d-474e-8808-7678c33115a1_20250311T14:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check the claim status.
[AGENT][NEUTRAL] OK [PII], I can help you with claim status sir. Can I please get your call back number?
[CUSTOMER][NEUTRAL] My callback number is [PII].
[CUSTOMER][NEUTRAL] [PII] and my extension is [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] The member ID is 02510299.
[AGENT][NEUTRAL] OK, let me look up that policy number real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I've got the member pulled up and what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service is [PII]. The charge amount is $109 even.
[AGENT][NEUTRAL] OK, and what is the name of the facility, please?
[CUSTOMER][NEUTRAL] the same patient
[CUSTOMER][NEUTRAL] The facility name is Ohio Health Physician Group.
[AGENT][NEUTRAL] OK, and I'm gonna repeat this data service is [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII], right.
[AGENT][NEUTRAL] OK, thank you. Alright, I'm gonna put you on a brief hold while I look up this claim for you [PII] and I'll be right back.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we're looking at $109.
[AGENT][NEUTRAL] There you are.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me [PII], this is [PII] I've got the um claim up for you.
[AGENT][NEUTRAL] The claim number is 3552218.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 837.
[AGENT][NEUTRAL] And the claim was denied because this is not a covered diagnostic test under the patient's policy.
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] Not covered diagnosis under the patient's policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, for this denial, can we build the patient?
[AGENT][NEGATIVE] I can't give patient responsibility.
[AGENT][NEUTRAL] That's determined by the provider.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I can't give patient responsibility that's determined by the provider.
[CUSTOMER][NEUTRAL] So sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sir, you are telling this is not a patient responsibility. This is a providers, this is, right?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I can't
[AGENT][NEUTRAL] Give patient responsibility that is determined by the provider.
[CUSTOMER][NEUTRAL] OK. Uh, uh, sorry, you said that this one is not covered under the patient's policy, right? That's why I'm asking.
[AGENT][NEUTRAL] Right, the um claim was denied because the diagnostic test is not covered under the patient's policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. Uh, that's it for this claim, uh.
[CUSTOMER][NEUTRAL] Just to confirm, can we send an appeal for this?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't not.
[AGENT][NEUTRAL] Can you send an appeal? Absolutely, um, you have 180 days from the date the claim was initially processed and you'll need to send a letter why you want to appeal.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, and a letter why you want to appeal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Is there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Yeah, I do have uh 2 more claims. Could you please help me with that also?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Can you give me the uh next patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, before that, can I have the call reference for this claim?
[AGENT][NEUTRAL] Yes sir, it's gonna be my name [PII] in today's date and then that's what it'll be for all the all the claims.
[CUSTOMER][NEUTRAL] OK. Can you please spell your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII] and today's date, right?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][NEUTRAL] Shall we move to next time?
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, the ex claim also under the same, yeah, same patient only, same patient only.
[AGENT][NEUTRAL] Yes, what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] But different data service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, what is the data service, sir?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The date of service is [PII]. The bill amount is $245 even.
[AGENT][NEUTRAL] OK, and is it for the same facility?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] be a brief hold again [PII] while I look up this claim. I'll be right back sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] You are on
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. I've got the claim pulled up for you. The claim number is 3552247.
[AGENT][NEUTRAL] And the claim was denied non-covered?
[AGENT][NEUTRAL] And it does not cover charges made by a doctor for inpatient visits.
[CUSTOMER][NEUTRAL] Hello, sorry you are breaking up. Can you please repeat that?
[AGENT][NEUTRAL] Uh, the claim number is 3552247.
[AGENT][NEUTRAL] Claim was denied.
[AGENT][NEUTRAL] Because the policy does not cover for doctor inpatient visits.
[CUSTOMER][NEUTRAL] Policy not covered the inpatient visit.
[AGENT][NEUTRAL] Doctor.
[CUSTOMER][NEUTRAL] OK. Uh can we build the patient for this thing?
[AGENT][NEGATIVE] Again, I can't give patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But actually, this one is not covered uh under the patient's policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, shall be able to explain.
[AGENT][NEUTRAL] OK. And is it for the same patient?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] The bill amount is
[CUSTOMER][NEUTRAL] $91 even.
[AGENT][NEUTRAL] And is it for the same facility?
[CUSTOMER][NEUTRAL] Yeah, same facility only.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on hold again, [PII]. I'll be right back.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding, [PII]. I've got the claim up. It is claim number 3552219.
[AGENT][NEUTRAL] And this claim was denied because treatment in an outpatient hospital less than 18 hours is not covered by the patient's policy.
[CUSTOMER][NEUTRAL] This one is not covered under the patient's policy.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Got it. Uh
[CUSTOMER][NEUTRAL] OK, and that's it for this claim.
[CUSTOMER][NEUTRAL] May I know how many claims you can give per call?
[AGENT][NEUTRAL] How many do you have?
[CUSTOMER][NEUTRAL] Yeah, I have 9 more claims.
[AGENT][NEUTRAL] OK, go ahead and let's move on to the next one.
[CUSTOMER][NEUTRAL] OK. Same patient only but different date of service.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me 1 2nd.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] The date of service is [PII]. The bill amount is $214 even.
[AGENT][NEUTRAL] 214.
[CUSTOMER][NEUTRAL] Yeah, 214.
[AGENT][NEUTRAL] 214 OK and same facility?
[CUSTOMER][NEUTRAL] Yeah, same facility.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again. I'm gonna look it up. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII], I got this one for you. It's claim number 3552249.
[AGENT][NEGATIVE] And this one was also denied because it does not cover the doctor visit for inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] As per the patient's policy, policy, this one is not, not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] That's it for this time. Uh, so we want to next one.
[AGENT][NEUTRAL] Yes, and all of these are for the same patient, is that correct?
[CUSTOMER][NEUTRAL] Yeah, same patient and same uh facility only.
[AGENT][NEUTRAL] OK, so
[AGENT][POSITIVE] Same facil OK, good. Alright, what is the data service?
[AGENT][NEUTRAL] And the charge amount.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEGATIVE] The charge amount is $195 even.
[AGENT][NEUTRAL] OK, let me look it up. I'll be right back sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK [PII], this claim number is 3552224.
[AGENT][NEUTRAL] And again, it's non-covered by the patient's policy for the doctor visit inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. And that's it for this thing.
[AGENT][NEUTRAL] OK, and what is the next data service?
[CUSTOMER][NEUTRAL] Shall I provide the next date of service?
[CUSTOMER][NEUTRAL] OK, next date of service is [PII]. The bill amount is $245 even.
[AGENT][NEUTRAL] OK, let me see if I can find that one real quick. I'm pulled up on that date already, so should be easy. Uh, this one is also non-covered per patient's policy for doctor visit inpatient.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, got it. Can I have the claim number?
[AGENT][NEUTRAL] Yes, sir. It is 355-2207.
[CUSTOMER][NEUTRAL] 2207, got it, got it.
[CUSTOMER][NEUTRAL] 461. Uh, shall I provide the next date of service?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] The next date of service is [PII]. The bill amount is $403 even.
[AGENT][NEUTRAL] OK, let me look on that one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3552212.
[AGENT][NEGATIVE] And denied for the same reason.
[CUSTOMER][NEUTRAL] Then it for the same reason, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next date of service is [PII].
[CUSTOMER][NEUTRAL] The bill amount is $264 even.
[AGENT][NEUTRAL] OK. I'm gonna put you on a brief hold. I'll be right back, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII], on this one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I do not find the claim on file for [PII] in the amount of $264.
[CUSTOMER][NEUTRAL] Yeah, I have a claim number for this. Uh shall I provide the claim number?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] The claim number is 355.
[CUSTOMER][NEUTRAL] 2202.
[AGENT][NEUTRAL] OK, let me see if I can find it.
[AGENT][NEUTRAL] OK, this one, the claim, the claim number that you have the 3552202.
[AGENT][NEGATIVE] was also denied for the same reason that
[AGENT][NEUTRAL] Doctor's fee for inpatient is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The next date of service is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The total bill amount is 2405.
[AGENT][NEUTRAL] November the
[CUSTOMER][NEUTRAL] No, [PII], the bill amount is $245 even.
[AGENT][NEUTRAL] OK, do they all have the procedure code 99252?
[CUSTOMER][NEUTRAL] No, the procedure code 99222.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a brief hold. I'm gonna look this one up. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII], this one is the same thing does not cover uh the doctor's visit for inpatient.
[CUSTOMER][NEUTRAL] OK. Can I have the claim number?
[AGENT][NEUTRAL] Yes, sir. It is 355-2199.
[CUSTOMER][NEUTRAL] 2199.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] The next state of services.
[CUSTOMER][NEUTRAL] [PII]. The bill amount is $183 even.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold. I'm gonna look this one up. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, this one's claim number is 3552243 and denied for the same reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The need for the same reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's it for this claim. Uh.
[CUSTOMER][NEUTRAL] The next date of service is [PII]. The bill amount is $403 even.
[AGENT][NEUTRAL] OK, I'll be right back, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], on this one, the claim number is 3,552,210 and denied for the same reason.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] They need for the same reason, OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Got it. The next data services.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] No. [PII], the bill amount is $191 even.
[AGENT][NEUTRAL] OK, alright, brief hold again. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII], on this one, the claim number is 3552204.
[AGENT][NEGATIVE] And it was also denied for the same reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In it for the same reason. OK. Doctors inpatient visit, visit is not covered as per the patient policy, right?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's it, and that's it for today.
[CUSTOMER][NEUTRAL] The call references your name and today's date, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][POSITIVE] OK. Thank you so much for providing all the information. Have a wonderful day.
[AGENT][POSITIVE] You too thank you [PII]. You have a blessed day and thanks for calling APL sir.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Yeah, thank you. Bye.