AccountId: 011433970860
ContactId: 5484b44f-4b06-44bc-b40a-b291faf885aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 904219 ms
Total Talk Time (AGENT): 237417 ms
Total Talk Time (CUSTOMER): 292376 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/5484b44f-4b06-44bc-b40a-b291faf885aa_20250331T13:20_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Hey, this is [PII] calling from provider office checking on the claim starter.
[AGENT][NEUTRAL] See, how can I help you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Yes, I can help you with that and [PII], what is your callback number please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][POSITIVE] Thank you and how many clients
[AGENT][NEUTRAL] [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] I have only one claim.
[CUSTOMER][NEUTRAL] Oh yes, I have only one thing.
[AGENT][NEUTRAL] OK, and what is that member's policy?
[AGENT][NEUTRAL] OK, what is the policy number for the member?
[CUSTOMER][NEUTRAL] Oh, I'm sorry. Actually, I have totally two claims for this number. So the policy number is 02136485.
[AGENT][POSITIVE] Thank you. Give me a couple of moments, [PII], to get the member's information pulled up, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And then the information that I do provide for you today [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Meer name [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and what is
[AGENT][NEUTRAL] The uh first data service and total buildings.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Uh yeah. It's [PII] with the bill amount $215 even.
[AGENT][NEUTRAL] What is the first date of service and
[AGENT][NEUTRAL] And you said date of service is [PII], is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct. Yes, that's correct.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And actually I have a specific question on this claim, so please let me know when you're ready.
[AGENT][NEUTRAL] What is the claim number? Yes sir, give me the claim number.
[CUSTOMER][NEUTRAL] Uh yeah. Sure, the claim number is 3282895.
[AGENT][NEUTRAL] 328-2895. Is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, and how can I help you with that claim?
[CUSTOMER][NEUTRAL] So as I see here, our colleague mentioned that uh she called the same insurance on [PII] and spoke with the representative, I mean, [PII], and she stated that uh the claim denied as
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Office visits are not payable under the member's plan. So for the procedure code 87,430, it was denied as primary EOB is missing. So, our colleagues uh uh explained clearly that we have already submitted the primary EOB with the fax combining with 9423.
[CUSTOMER][NEUTRAL] So the representative checked and stated that they haven't received the primaryOB. So she stated to resubmit the primary. So our colleague resubmitted it again on [PII] through fax. So could you please check and let me know whether you have received it or not?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what is the code again?
[CUSTOMER][NEUTRAL] It's 487-430.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so the claim, the EOB was
[AGENT][NEUTRAL] And it was processed under claim number 3412557.
[CUSTOMER][NEUTRAL] Uh, uh, one moment, please. I'm making an offer.
[CUSTOMER][NEUTRAL] Uh, could you please repeat that claim number once again?
[AGENT][NEUTRAL] 341-2557.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on that particular code, the code was denied as being, it states the above reference claim appears to be a duplicate of previously submitted expenses. Benefit payment has been made to the insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the benefits have been paid to the insured and it was denied as the duplicate claim, right?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] That is correct, correct.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] So, could you please send us the EOB copy of it?
[AGENT][NEUTRAL] Stating that the benefit was paid to the insured.
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][POSITIVE] Yes, you, are you able to print because it's much easier if you print it directly from our portal.
[AGENT][NEUTRAL] By going to [PII]?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Now that you have the claim number.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh yes, I have that claim number. It's 3412557, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir. And can, can you print the explanation of benefits?
[CUSTOMER][NEUTRAL] Uh, no, so actually, I don't have access to it. So it would be helpful if you send it from your end through the fax number.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bear with me while it is still loading.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And it's still loading, [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And you can go ahead and give me your fax number while the information is still loading.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Sure, thank you. So the fax number is [PII]. Attention to my name, [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I shall see.
[AGENT][NEUTRAL] And again, that fax number is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, tha[PII]'s correct.
[AGENT][POSITIVE] OK. All right, well, I have just faxed that to you so provided that there's not any type of technical error, you should be receiving that very shortly.
[CUSTOMER][NEUTRAL] Sure, thank you. And may I know the claim received and the process to date for this?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] 129 2024 and
[AGENT][NEUTRAL] Processed on 131-2024.
[CUSTOMER][POSITIVE] OK, sure. Thank you so much. And uh
[AGENT][POSITIVE] You're certainly welcome.
[CUSTOMER][NEUTRAL] Mm, yeah, and just a moment please. I'm pulling up the last date of service for this number.
[CUSTOMER][NEUTRAL] All
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Oh yeah, thank you so much for being on hold. And the last date of service is [PII] with the bill amount.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $215 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you did say [PII], correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] I find uh by group.
[CUSTOMER][NEUTRAL] Uh but uh uh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And the name of the facility?
[CUSTOMER][NEUTRAL] Facility named as Mercy Clinic East Community.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] All done.
[CUSTOMER][NEUTRAL] A new
[AGENT][NEUTRAL] So this claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Processed on the same date.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3,569,520.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $10.09.
[AGENT][NEUTRAL] And that was paid on single check, 2030138.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The remarks on this, also 99214 was denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] And the benefit was paid on code 87,430.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. And may I know the plan name?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I can.
[AGENT][NEUTRAL] This is a supplemental policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Rental policy. OK, thank you so much. And could you please spell out your name if you don't mind?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] I, [PII]. And my name, and today's date.
[CUSTOMER][POSITIVE] I'm sorry, it's [PII] OK. OK, sure. Thank you so much, sir.
[AGENT][NEUTRAL] Uh-huh. And my name in today's date will be your call.
[CUSTOMER][POSITIVE] Oh yeah, sure. Thank you so much, [PII], and that's it for the day. Have a great day. Bye-bye.
[AGENT][NEUTRAL] Reference number.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Opengar.
[AGENT][POSITIVE] OK, [PII]. Well, if that's all I can help you with, thank you again for calling APL and I hope you have a great day as well.
[CUSTOMER][POSITIVE] Sure, thank you