AccountId: 011433970860
ContactId: 6025373d-1ddd-4bc2-90f9-78ffa519238a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 461880 ms
Total Talk Time (AGENT): 191655 ms
Total Talk Time (CUSTOMER): 173632 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/6025373d-1ddd-4bc2-90f9-78ffa519238a_20250501T14:18_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I just wanted to verify if the patient has eligibility.
[AGENT][POSITIVE] All right, yeah, happy to check on. No, that's all right. I can check eligibility. What's her policy number?
[CUSTOMER][NEUTRAL] With this plan?
[CUSTOMER][NEUTRAL] Oh sorry, go ahead.
[CUSTOMER][NEUTRAL] I have 02449815.
[AGENT][POSITIVE] All right, thank you, let me pull this up.
[AGENT][NEUTRAL] And for documentation, can I grab your first name and a callback number, please?
[CUSTOMER][NEUTRAL] Uh yes, first name is [PII]. It's [PII] and callback number is [PII].
[AGENT][NEUTRAL] All right, thank you. And then [PII], what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, yes, first name is [PII], and then, uh, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then date of birth?
[CUSTOMER][NEUTRAL] Oh, sorry, it's [PII].
[AGENT][NEUTRAL] No, no worries. All right. Patient is active. Effective date is [PII]. This is a secondary insurance, so this covers deductible, co-pay, co-insurance, the primary does not, it is medical.
[CUSTOMER][NEUTRAL] OK, so it is secondary. You said it covers deductible co-insurances and stuff?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh, and co-pay, yeah.
[CUSTOMER][NEUTRAL] And copay, OK, um.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And then can I verify the address for claims?
[AGENT][POSITIVE] Absolutely. What did you want me to give it to you or what do you have?
[CUSTOMER][NEUTRAL] I have [PII] [PII] and then [PII] and then [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mhm, that is correct, yes ma'am.
[CUSTOMER][NEUTRAL] OK, and then the last question I have because we've been billing some services and the patient paid them because it looks like um they have a commercial insurance as primary.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, so the secondary, um, we've been moving it down to the patient cause I, I'm assuming it's.
[CUSTOMER][NEUTRAL] Uh, for denial, can I just get claim status on one of them just to make sure, um.
[CUSTOMER][NEUTRAL] We have this right?
[AGENT][NEUTRAL] Yeah. Yeah, absolutely. Uh, is the claim for [PII]? Is that who it would be for?
[CUSTOMER][NEUTRAL] No, it would be for [PII].
[AGENT][NEUTRAL] Oh, part one, OK, let's see.
[AGENT][NEUTRAL] Here, OK, what is the date of service?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Alright, and then what was the bill amount?
[CUSTOMER][NEUTRAL] Uh, billed amount is $140.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So this claim was received for 109. Um, it looks like it was denied because the outpatient benefit max was met already.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] For the year.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Oh, OK, so once it's been met then there's um and they just have to pay everything out of pocket.
[AGENT][NEUTRAL] Yeah, so it looks like their outpatient benefit amount for the calendar year is 2000, so once they meet that, then we will not cover anything additional.
[CUSTOMER][NEUTRAL] OK, so then I would be OK with all the other dates service in [PII] after that date for patient responsibility.
[CUSTOMER][NEUTRAL] OK, and um I have one for [PII]. Can I check status on that one as well really fast?
[AGENT][NEUTRAL] Yeah, let's take a look.
[AGENT][NEUTRAL] Right, I.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Charge amount on that one is 140.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I mean
[AGENT][NEUTRAL] OK, so on this one it looks like.
[AGENT][NEUTRAL] We did, maybe we got it a second time. So it was originally denied stating that we needed an explanation of benefits from the primary. Was it for DME?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so then there's another claim. Let me look at this one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because it looks like they have a CPAP that's renting monthly and primary applied it to their deductible.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so then let me see.
[AGENT][NEUTRAL] OK, so then it looks like we did get another claim then that was reprocessed at a later time and it did pay it looks like a benefit amount of $62.34. That was the billed amount that came to us it looks like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so then I'm gonna move this one back because they have it as a patient's responsibility, but if you guys paid it, do you have any of that payment information just so I can notate so.
[AGENT][POSITIVE] Yeah, absolutely. Let me get the process date on this and then I can give you the check number, um.
[AGENT][NEUTRAL] OK, so looks like claim was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's when it would have been sent out and the check number is 2037569.
[AGENT][NEUTRAL] It was a single check and just to confirm it was sent to Goodnight Medical of Texas at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so physical check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. And then, um, do you have a claim number if I could just take that if it's possible?
[AGENT][NEUTRAL] Mhm. Claim number for that is gonna be 358.
[AGENT][NEUTRAL] 553 9.
[CUSTOMER][POSITIVE] Perfect. Alright, awesome.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And then I'll just go ahead and bill out then they have some other claims it looks like they termed out this patient's policy, so I'll go ahead and get that stuff resubmitted over and then I'll just notate this data service that it was paid for. Awesome, I appreciate your help so much. um, I didn't catch your name in the beginning. I'm so sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] No, that's OK. My name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] Perfect thank you sir I appreciate your help.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] You too. Thank you. Bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.