AccountId: 011433970860
ContactId: 54ee5b09-4263-4194-a2e3-f031860c332b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 390709 ms
Total Talk Time (AGENT): 131007 ms
Total Talk Time (CUSTOMER): 148069 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/54ee5b09-4263-4194-a2e3-f031860c332b_20250324T16:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from provider's office to check the denial status. Could you please spell out your name for my documentation?
[AGENT][NEUTRAL] [PII], I can help you with the denied claim. Can I please have a call back number?
[CUSTOMER][NEUTRAL] Uh, actually, uh, actually, your line is cutting off. Could you please come again with your spelling?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And last initial?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], correct?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] As [PII].
[CUSTOMER][POSITIVE] Oh, OK, thank you so much and uh do you need my uh phone number?
[AGENT][NEUTRAL] Yes, can I please have a callback number?
[CUSTOMER][NEUTRAL] Sure it's [PII] [PII].
[AGENT][NEUTRAL] May I have the policy number of the member you're calling about?
[CUSTOMER][NEUTRAL] Yes, I have it. Yeah, here the policy number is.
[CUSTOMER][NEUTRAL] 022262380 M as in Mary L as in Lima 8.
[AGENT][NEUTRAL] Can you repeat that policy number?
[CUSTOMER][NEUTRAL] 02262380 M as in Mary L as in Lima 8.
[AGENT][NEUTRAL] Verify the member's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, patient name is it's [PII] and the birth date is [PII].
[AGENT][NEUTRAL] Thank you for verifying the information. [PII], can you please verify the date of service you're calling about?
[CUSTOMER][NEUTRAL] Service date [PII] and the charge amount 15175.
[AGENT][NEUTRAL] Do you have the claim number?
[CUSTOMER][NEUTRAL] Yes, I have.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] Yeah, my claim number is it's 3,542,440.
[AGENT][NEUTRAL] What questions do you have on the denial?
[CUSTOMER][NEUTRAL] Um, actually I want to know the for this denial, uh, it's responsible for the patient.
[CUSTOMER][NEUTRAL] Uh, this is a non-cover service under the patient plan, right? So the patient is responsible for this.
[CUSTOMER][NEUTRAL] Charge
[AGENT][NEUTRAL] That is up to the provider. We pay, um, we process claims according to the policy, and it's up to the provider whether it's patient responsibility or provider write off. Um, [PII], is there anything else I can verify for you today?
[CUSTOMER][NEUTRAL] Uh, yes, actually I need the uh EOB.
[CUSTOMER][NEUTRAL] Could you please fax me that copy of COB?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is that fax number, please?
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] Yeah, yeah my fax number is [PII].
[AGENT][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] All right. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] And uh attention to my name, [PII].
[CUSTOMER][NEUTRAL] When I get the UP?
[AGENT][NEUTRAL] We're allowed up to 2 to 3 business days.
[AGENT][NEUTRAL] Um, let me check and see if this member is active, then you can go online and get it. Yes, this member is an active policy, um, so you can go online to [PII] and you can get that from online as well.
[AGENT][NEUTRAL] Um, the we fax EOBs if their, um, policy is not active, this policy is currently active.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK, and uh so it's not possible to um fax that copy of UB?
[AGENT][NEUTRAL] Are you, do you have access to online?
[CUSTOMER][NEUTRAL] Uh, actually, I doesn't have the, uh, access for the portal.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Uh, it means that we.
[CUSTOMER][NEUTRAL] Web portal.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, is there anything else, [PII], I can help you with today?
[CUSTOMER][NEGATIVE] Uh, yes, I want to know this is not uh uh this, this one for the responsible of patient, right? that office visitor non cover.
[CUSTOMER][NEUTRAL] As per the patient plan, correct?
[AGENT][NEUTRAL] OK, like I stated before, [PII], like I stated before.
[CUSTOMER][NEUTRAL] That was the
[AGENT][NEUTRAL] Just we process claims according to the policy. So if it's not covered, then it's up to the provider.
[AGENT][NEUTRAL] Whether they're going to do a write-off or bill it to the member. That is not something that APL tells the provider what to do.
[AGENT][NEUTRAL] You will have to get with the provider and the provider will make the decision on how that will be billed.
[CUSTOMER][NEUTRAL] OK and uh what about the call reference?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] That would be my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much [PII]. I was really happy with your system.
[AGENT][POSITIVE] You're so welcome, [PII]. Thank you. Uh-huh, thank you for calling APL. Have a good day. Bye-bye.