AccountId: 011433970860
ContactId: 50ebdc2c-fd5c-4fbf-825e-511e9aa3ec38
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1036910 ms
Total Talk Time (AGENT): 263858 ms
Total Talk Time (CUSTOMER): 535118 ms
Interruptions: 7
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/50ebdc2c-fd5c-4fbf-825e-511e9aa3ec38_20250130T18:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is Evie. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hello, [PII]. Actually, I'm calling from provider's office regarding our claim status.
[AGENT][NEUTRAL] I'm sure I can assist you with claim status. First, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yeah, actually, uh, my, uh, first name is [PII], initial last name is [PII]. And actually callback number is [PII] with an extension of [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Yeah, policy number is 1,067,740.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] So a number of patients.
[CUSTOMER][NEUTRAL] First name is going to be?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII], and the last name is [PII], [PII]. And the date of birth is uh [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. um, now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] The services, uh, [PII] with the bill amount of $237 even.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] My name is.
[AGENT][NEUTRAL] OK, yes, we did receive that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] And this claim is denying because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] offices are not members.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Just give me a second. OK, I just wanted to make sure. Could you please tell me what my plan is.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] Uh, could you please help me with the, uh, members plan?
[CUSTOMER][NEUTRAL] Helping the member what does the member's plan is?
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] This is for um secondary gap insurance.
[CUSTOMER][NEUTRAL] OK, just give me a second. Uh, let me check whether I have any questions for this claim. Uh, AB, uh, just give me a second, please, don't mind.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, hello. Uh, could you please like, uh, help me the claim number?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes, the claim number is.
[AGENT][NEUTRAL] 3500466.
[CUSTOMER][NEUTRAL] It's 3500466. Am I right?
[AGENT][NEUTRAL] Yes, that's the claim number.
[CUSTOMER][NEUTRAL] OK, uh, just give me a second. Yeah, um, mm, OK, shall we move to another claim?
[AGENT][NEUTRAL] For the same member?
[CUSTOMER][NEUTRAL] Mm, no, it's a different number.
[AGENT][NEUTRAL] OK. What's the policy number, please?
[CUSTOMER][NEUTRAL] Just give me a second. I'll help you. The policy number, it's number details are loading.
[CUSTOMER][NEUTRAL] Yeah, this next member ID is.
[CUSTOMER][NEUTRAL] Yeah, it's uh 02337113 M as in Mike L as in Lima H.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's first name is uh
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII] [PII] [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Just give me a second. Yeah, date of service for this number is [PII] with the bill amount of 3840.
[CUSTOMER][NEUTRAL] She
[AGENT][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment, I'm still waiting on my system.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Play.
[CUSTOMER][NEUTRAL] Did I tell you about that?
[AGENT][NEUTRAL] OK, I'm not showing a claim on file with that date of service and those bill charges.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] Are you sure?
[CUSTOMER][NEUTRAL] Mm, no, actually, uh, I don't have any claim number upon checking, like we haven't submitted the claim through paper claim.
[CUSTOMER][NEUTRAL] By the way, do you have any member ID for the, uh, so payer ID for this submitting claims?
[AGENT][NEUTRAL] One moment and please repeat the bill charges, let me take another look.
[CUSTOMER][NEUTRAL] The bill amount is uh $3840 even 3840.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I found it. Um, we received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 38
[AGENT][NEUTRAL] 17171. Did you get the claim number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It's 353-18, I'm sorry, it's 3538171. Am I right?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] And let's see, this, this claim denied because we cover up to 1000 per calendar year.
[CUSTOMER][NEUTRAL] OK, go on.
[AGENT][NEUTRAL] And that was meant.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] You are stating that uh the claim was denied due to the maximum benefits has been exhausted as per dollar amount, am I right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Just give me one.
[CUSTOMER][NEUTRAL] OK, uh, may I know how much is, uh, like how much is, uh, per year, how much is the dollar amount?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] It's $1000 per year.
[CUSTOMER][NEUTRAL] Only 1000, right? OK, I was stating that previously by the day, uh, I just wanted to confirm for the data of service, uh, for which data service the maximum dollar amount has been exhaustion.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Could you please tell me the date of service once again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Actually for the same date, [PII] for the same date of service because we received the um the other claim before this claim.
[CUSTOMER][NEUTRAL] [PII] of
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] I just wanted to confirm the claim number. Is it, could you please repeat the claim number of those?
[AGENT][NEUTRAL] 35
[CUSTOMER][NEUTRAL] The dollar maximumum dollar amount is.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Like number 35.
[AGENT][NEUTRAL] Do you need the claim number for the claim we're discussing or for the claim number where the maximum amount was reached?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The maximum, the amount which was reached, could you please help me with that claim number?
[AGENT][NEUTRAL] Yes, that claim number is 3531173.
[CUSTOMER][NEUTRAL] It's 353-1173. Am I right?
[AGENT][POSITIVE] Yes, you're correct.
[CUSTOMER][NEUTRAL] It's for, for, uh, could you please send me the bill amount is it?
[AGENT][NEUTRAL] The bill amount on that claim was?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] $3700.
[CUSTOMER][NEUTRAL] $3700.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is it for the same provider?
[AGENT][NEUTRAL] No, it's not. It's for a different provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, uh, by the way, I just wanted to confirm, like, uh, is there any possibility of helping with the provider's name?
[CUSTOMER][NEUTRAL] I know you don't know.
[AGENT][NEUTRAL] No, we cannot give out that information, sir. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Mhm. Nothing else, uh, for this, could you please help me the call reference and I just wanted to confirm, can you send me the copy of your dena OB through fax?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, I can fax you the ELB what's your fax number, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 777
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So that's attention. [PII] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. You should receive it in about 10 minutes. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Could you please, uh, like, uh no, uh, for this claim, no, let's share him with another claim. This is the last claim I do have.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, just give me a second. I will help you the policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the policy number is going to be, it's uh 01741.
[CUSTOMER][NEUTRAL] 604
[CUSTOMER][NEUTRAL] M as in Mike
[CUSTOMER][NEUTRAL] L as in Lima.
[CUSTOMER][NEUTRAL] Number 8
[AGENT][NEUTRAL] OK. Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] So, uh first name is [PII].
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] And the last name is [PII]. It's [PII] and the last name of uh date of birth is uh [PII].
[AGENT][NEUTRAL] OK. And what's the date of service and bill charges on the client?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah data service is.
[CUSTOMER][NEUTRAL] August I'm uh yeah, [PII] with a bill amount of $5,739 even.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, one moment while I search for the claim.
[CUSTOMER][NEUTRAL] Yeah, actually, we have been submitted the claim.
[CUSTOMER][NEUTRAL] On [PII]. Can you please check and help me with the status?
[AGENT][NEUTRAL] Sure. One moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] In here.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yes, we received this claim on.
[AGENT][NEUTRAL] We received this claim on [PII].
[CUSTOMER][NEUTRAL] I did it.
[CUSTOMER][NEUTRAL] What.
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 352.
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] 851 2.
[CUSTOMER][NEUTRAL] Uh, I'm sorry. Uh, can you repeat the claim number once again?
[AGENT][NEUTRAL] 352-851-2.
[CUSTOMER][NEUTRAL] 8512. Am I right? 35218512. Mhm. Sure, 1.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And this claim is denying because the primary EOB that was sent along with the claim?
[AGENT][NEGATIVE] It doesn't show what charges went towards the copay, the coinsurance, or the deductible.
[CUSTOMER][NEUTRAL] dollars
[CUSTOMER][NEUTRAL] OK, you're saying that you need the primary EOB.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The processing the claim.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Like previously we have been uh rebuild the claim along with the primary UB as well. Haven't you received the primary UB?
[AGENT][NEUTRAL] Yes, but the primary ELB that you're sending does not provide the information that we need.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, you're sharing that the primary which we have been, which we have sent it does not showing any information uh regarding about, uh, copay deductible and coed and so on, right.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK in this case what?
[AGENT][NEUTRAL] Do you need this EOB also?
[CUSTOMER][NEUTRAL] Uh, no, actually, in this case, what is the next step I have to do in order to get the the process for this in order to claim me to prepare we need to again refile the claims in the primary.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] We need the primary LLB that's showing the information that we're requesting.
[CUSTOMER][NEUTRAL] Sure. By the way, do you have any fax number?
[AGENT][NEUTRAL] Yes, our fax number is.
[CUSTOMER][NEUTRAL] To submit the primary.
[AGENT][NEUTRAL] Yes. Let me know when you're ready for the fax number.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII] and please attention it to the claims department.
[CUSTOMER][NEUTRAL] And the other
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Sure, could you please help me up all the senses.
[AGENT][NEUTRAL] The call reference number, you can use my name and today's date. My name is [PII]. It's spelled [PII] and my last initial is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Nothing else. Uh, it's [PII].
[AGENT][POSITIVE] Yes, you're correct.
[CUSTOMER][POSITIVE] Thank you for that information. Thank you for your assistance. Have a wonderful day ahead.
[AGENT][NEUTRAL] You do the same, um, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][NEUTRAL] No.