AccountId: 011433970860
ContactId: 4a11555a-4987-4531-b08a-f7fdb4dfe9b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1256930 ms
Total Talk Time (AGENT): 376646 ms
Total Talk Time (CUSTOMER): 271366 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/4a11555a-4987-4531-b08a-f7fdb4dfe9b1_20250326T12:32_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII], this is [PII], and I'm calling from the provider's office regarding a claim status.
[AGENT][NEUTRAL] OK, you said your name is [PII]. Is that correct? Can you spell it for me?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, [PII], thank you. And I'm sorry, you said your first initial to the last name was [PII]?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK thank you and you're needing time.
[CUSTOMER][NEGATIVE] I'm sorry uh your voice just cut off.
[AGENT][NEUTRAL] Status, is that correct?
[CUSTOMER][NEUTRAL] Yeah, I'm looking for a account statement, yes.
[AGENT][NEUTRAL] Did you say that you were needing claim status? Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure, the callback number will be [PII] and the extension will be [PII].
[AGENT][POSITIVE] OK thank you and I have.
[AGENT][NEUTRAL] How much, how many claims do you have to check today?
[CUSTOMER][NEGATIVE] Uh, 3 claims. I have 3 claims with me.
[AGENT][NEUTRAL] OK. Are the 3 claims for the same patient or are they 3 different patients?
[CUSTOMER][NEUTRAL] No, 3 different patients but under the same provider.
[AGENT][POSITIVE] Yes, I can help you with this, and [PII], you will use my name.
[AGENT][NEUTRAL] Along with today's date as each of your call reference numbers. Again, my name is [PII], and the first initial to my last name is also [PII]
[AGENT][NEUTRAL] Any information that I provide for you on the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And lastly, if we do have the claims on.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] File vision and you need a copy of the explanation of you may print them.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] You may print your EOB if we have the claims on file directly from our portal by going.
[AGENT][NEUTRAL] To secured. [PII].
[AGENT][NEUTRAL] And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. Uh, the first member ID is 17273.
[AGENT][NEUTRAL] OK, that's gonna be a group number. That's not the actual policy number.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Do you have a copy of the member's ID card?
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, just a second, let me just, uh, see if any other members ID.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Just a second, let me just, uh, see that. Is it possible to, uh, pull the patient's with the patient's name and, uh, date of birth?
[AGENT][NEUTRAL] I cannot search by date of birth.
[AGENT][NEUTRAL] I can try by the name, but if it's, mhm.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Uh, if, if that, uh, name, uh, search is OK, you can go ahead with the name search actually. Let me just try to see if I have the, no, I don't have the, uh, card with me. I'm sorry.
[AGENT][NEUTRAL] And what is the last name?
[CUSTOMER][NEUTRAL] Sure, uh, the patient's last name is [PII].
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] It's uh [PII]. It's [PII].
[CUSTOMER][NEUTRAL] [PII] as in
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. OK, let's do that again. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK. And I'm sorry, I'm having a little difficulty visiting with the first name.
[AGENT][NEUTRAL] Again, spell that one more time for me. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, I'm sorry. I'm sorry, I was mishearing something there. Thank you, one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Uh, no, not a problem.
[AGENT][NEUTRAL] OK, so, what is his date of birth?
[CUSTOMER][NEUTRAL] Sure, uh, the date of birth is, uh, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and what is the date of service and total build amount for him, please?
[CUSTOMER][NEUTRAL] Sure, uh, the total bill amount is $375 and the date of service is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] The correct policy number that you should have for this member first off is 21.
[AGENT][NEUTRAL] 17
[AGENT][NEUTRAL] 549.
[CUSTOMER][NEUTRAL] Uh, could you please repeat the policy number again?
[AGENT][NEUTRAL] And this policy is active.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2175439
[AGENT][NEUTRAL] The policy is active.
[AGENT][NEUTRAL] With an effective date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me a moment to check to see if this claim on file.
[AGENT][NEUTRAL] OK, so this claim was received. And one moment for me to get you that information.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 5
[CUSTOMER][NEUTRAL] I'm sorry, could you please repeat it again? Uh, your voice just, uh, got like, uh,
[AGENT][NEUTRAL] The claim is going to.
[CUSTOMER][NEUTRAL] Uh, can I get the process date again? Your voice just got broken again. I'm sorry.
[AGENT][NEUTRAL] [PII]. That is correct.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the claim number is 356-8432.
[AGENT][NEUTRAL] And this claim was denied?
[AGENT][NEGATIVE] The reason for the denial states this service.
[AGENT][NEGATIVE] Is not covered.
[AGENT][NEUTRAL] When performed.
[AGENT][NEUTRAL] In a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, uh, it's, uh, denied under the patient's, uh, uh, policy, right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And is there any other information, [PII], that you need on this claim?
[CUSTOMER][NEUTRAL] Oh, no, uh, that's all from my side for this claim. Uh, you can go ahead with the call reference number or, uh, I can give you the next, uh, claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. As I explained to you at the beginning of our call, you will use my name and today's date as each of your call reference numbers.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, uh, shall I go over the next, uh,
[CUSTOMER][NEUTRAL] Member ID.
[AGENT][POSITIVE] Yes sir, you can go ahead
[AGENT][NEUTRAL] with that now.
[CUSTOMER][NEUTRAL] Sure, uh,
[CUSTOMER][NEUTRAL] Sure, it's 251-913-9.
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure, the patient's name is, uh, [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for her, please.
[CUSTOMER][NEUTRAL] Sure, the total bill amount is 300.
[CUSTOMER][NEUTRAL] Dollars and the date of service is [PII].
[AGENT][POSITIVE] Thank you one.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] The received date was [PII].
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] There was a benefit paid the amount of $75.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That was on single check.
[CUSTOMER][NEUTRAL] Uh just a second.
[CUSTOMER][NEUTRAL] Claim was paid for $75.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] $75. OK. Can I get the uh check number?
[AGENT][NEUTRAL] On single check.
[CUSTOMER][NEUTRAL] Can I get the check number?
[AGENT][NEUTRAL] 202.
[AGENT][NEUTRAL] 981 5.
[CUSTOMER][NEUTRAL] OK. Can I get the cash date?
[AGENT][POSITIVE] It is still outstanding.
[AGENT][NEUTRAL] At this time?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there any other information that you need on this one?
[CUSTOMER][NEUTRAL] Yeah, uh, can I get the claim number?
[AGENT][NEUTRAL] Oh, I'm so sorry, 356-860-0.
[CUSTOMER][NEUTRAL] 256-8600. Am I right?
[AGENT][NEUTRAL] The first number is
[AGENT][NEUTRAL] So 3.
[CUSTOMER][NEUTRAL] Uh, could you please repeat it again?
[CUSTOMER][NEUTRAL] 3,356,600.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] No, sir. No, let me do it one more time. 3.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] 56.
[AGENT][NEUTRAL] 8600.
[CUSTOMER][NEUTRAL] OK, the claim was paid for $75 and the
[CUSTOMER][NEUTRAL] A single check uh.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Si check payment.
[CUSTOMER][NEUTRAL] And the check number, OK. Uh, you said the check is still not cash, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and I was trying to go over the next, uh,
[CUSTOMER][NEUTRAL] Member ID.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. And the next, and your last policy?
[CUSTOMER][NEUTRAL] Sure, the last policy is uh
[CUSTOMER][NEUTRAL] 1581958
[CUSTOMER][NEUTRAL] M as in Mark, L as in Lima 7.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure, the member's name is, uh,
[CUSTOMER][NEUTRAL] My lady [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] Sure, the date of services, uh.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $375.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so this claim was also received?
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 84449.
[AGENT][NEUTRAL] And the reason for the denial on this claim?
[AGENT][NEGATIVE] states this service is not covered.
[AGENT][NEUTRAL] When performed in a doctor's office or clinic.
[AGENT][NEUTRAL] And this is also for the member's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and can I get the timely filing limit for the
[CUSTOMER][NEUTRAL] Fine.
[AGENT][NEUTRAL] Uh, for an appeal.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] An appeal must be filed in writing within 180 days from the date of the decision.
[AGENT][NEUTRAL] And sent to attention appeals department.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] No, that's all from my end and thank you for your assist. Uh, it was good talking with you.
[AGENT][POSITIVE] OK, well, it was nice speaking to you. So thank you again for calling APL and I hope you have a nice day. It's already.
[CUSTOMER][POSITIVE] Thank you take care.
[AGENT][NEUTRAL] Hello?
[AGENT][POSITIVE] OK, all right then. I hope you have a nice day.
[CUSTOMER][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] OK, yeah, fine.
[AGENT][POSITIVE] Thank you. Mm, bye, bye-bye.