AccountId: 011433970860
ContactId: 65a9041c-75f2-4416-b251-9523f104b511
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 858039 ms
Total Talk Time (AGENT): 314488 ms
Total Talk Time (CUSTOMER): 315489 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/65a9041c-75f2-4416-b251-9523f104b511_20250107T13:55_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Pro products of a claim status.
[AGENT][NEUTRAL] OK, you said you're calling from where to check the claim status?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK, and [PII], may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, sure. My contact number is [PII].
[CUSTOMER][NEUTRAL] And the member contact ID is [PII].
[CUSTOMER][NEUTRAL] Uh, alphabet M as in Mike, L as in Lima, and the number 8.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with the claim status. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The member's first and last name is [PII] and the member's date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Sure. The date of service of the claim is [PII] and the total charge is $884 even.
[AGENT][NEUTRAL] All right, thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, yeah, the name of the provider's office is Pediatrics Medical Group of Florida.
[AGENT][NEUTRAL] Alright, so I'm showing received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 350.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7485.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, as you mentioned, it is not covered under the patient plans, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh, uh, for this one, we didn't receive any UB for this one. So can you send the UB for us?
[AGENT][POSITIVE] Yes, I can fax it over to you. What's a good fax number?
[CUSTOMER][NEUTRAL] Yeah, our fax number is 1 2nd.
[CUSTOMER][POSITIVE] Yeah, thank you for patiently waiting. Our fax number is 9543333543.
[AGENT][NEUTRAL] Wait, 954, what's the next 3333?
[CUSTOMER][NEUTRAL] Uh, yeah, it's 954-4 consecutive 3543.
[AGENT][NEUTRAL] OK, hold on one second. So 333-3543. OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And do I need to put attention, Leah?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, yeah, you have saying that under the patient name.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, it's under the attention of my name. It's [PII].
[AGENT][NEUTRAL] OK, and um I'll go ahead and send this over to you now, [PII]. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Uh, yeah, and I will ask question regarding this claim for this, yeah, can we build the patient for this one?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we don't determine patient responsibility, um.
[AGENT][NEUTRAL] Because we're not a major medical. So if there is an outstanding balance, that would just be whatever your protocol is for outstanding balances.
[CUSTOMER][POSITIVE] OK, thank you so much for this one. And for my documentation, can I know your mailing address and time if you need for that one?
[AGENT][NEUTRAL] Yes, it's 180 days from the denial date.
[AGENT][NEUTRAL] And you said you needed the address?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, it's, hold on one second. So it's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][POSITIVE] Yeah, OK, thank you so much for this one, and I have other client to check with. Can you help me with that one?
[AGENT][NEUTRAL] Sure, how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, I have 3 claims on my phone.
[AGENT][NEUTRAL] OK, hold on one moment, let me note this member's policy. Hold on one second.
[CUSTOMER][POSITIVE] Sure, take your time.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Give a PO address and
[AGENT][NEUTRAL] OK, hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] Thank you for holding. I do apologize for that wait. And what's the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah. Uh, the next member policy ID is 01845835 alphabet M as in Mike, L as in Lima, and 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Oh, sure. The member's first and last name is [PII] and the member's date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Sure. The date of service is [PII] and the total charge is $230 even.
[AGENT][NEUTRAL] 250
[CUSTOMER][NEUTRAL] Uh, it's 232.
[AGENT][NEUTRAL] $232?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And would it be the same provider on this claim or would it be different?
[CUSTOMER][NEUTRAL] Uh, it's under the same provider.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I'm showing you originally received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 349.
[AGENT][NEUTRAL] 1912.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEGATIVE] We also received the claim again on [PII], but it was denied as a duplicate.
[CUSTOMER][NEUTRAL] Yeah, OK, I can find that one, for this, can we file an appe regarding this one.
[AGENT][NEUTRAL] You said can you appeal this one?
[CUSTOMER][NEUTRAL] Uh, because
[CUSTOMER][NEUTRAL] Uh, yeah, because previously we have submitted to the another insurance and they has been denied for uh as a deductible. So that's the reason we have submitted the second insurance.
[CUSTOMER][NEUTRAL] For you.
[AGENT][NEUTRAL] Wait a minute. Say that one more time.
[CUSTOMER][NEUTRAL] Yeah, uh, previously, we have submitted to, uh, like the primary insurance, we have UC and we have the UHC has been denied as full as processed as a deductible. And the patient has been mentioned as a secondary as American Public Life Insurance Company. So that's the reason we are billed to you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, but the, so the American Public Life policy and their major insurance policy has its own benefits. So from their APL policy, it's this, this is not covered when it's performed in a doctor's office or clinic. So yes, we're secondary, but they don't have office visit coverage on their policy, so it was denied.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Mhm. Yeah, OK. I can understand that one. Yeah. Thank you for this claim and I have last claim to check with. Can you help me with that one?
[AGENT][NEUTRAL] Sure, and what's that member's policy number?
[CUSTOMER][NEUTRAL] Yeah, hold on for a minute. Let me just provide that one for you.
[CUSTOMER][POSITIVE] Yeah. Thank you for patiently waiting. The next policy ID number is 1426388 alphabet ML 8.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The member's first and last name is [PII] and the member's date of birth is [PII].
[AGENT][POSITIVE] Thank you. You said [PII]?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] Can you spell the member's first name for me?
[CUSTOMER][NEUTRAL] Sure. The first name is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold because I'm not showing that member on this policy, um, but they do have an active policy, so I'm gonna see if they're on there. Do you mind if I place you on a brief hold?
[CUSTOMER][POSITIVE] Uh, yes, you can.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, now what?
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][NEUTRAL] Yes, I'm still here.
[AGENT][NEUTRAL] Thank you so much for holding. So, [PII] is not on the policy number that you gave, that policy is actually not active, but Diego is on the active policy number. Um, I can give you that policy number and then what's the date of service for the claim? I'll look and see if there's a claim here for him.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, yeah, the date of service is all.
[CUSTOMER][NEUTRAL] I'm sorry, it's [PII].
[AGENT][NEUTRAL] OK, so the policy number is 243.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0724.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah, the total bill amount is $2,642 even.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so yes, it's on the active policy. Hold on one moment, I'm pulling it for you now.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So I'm showing uh we received the claim on [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 349.
[AGENT][NEUTRAL] 7503. I'm sorry?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yeah, you can.
[AGENT][NEUTRAL] OK, so 349-7503 is the claim number?
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yeah, uh, for this one we have submitted an appeal. So can you provide me the status regarding this claim?
[AGENT][NEUTRAL] When was the when was the appeal submitted because this is the only claim we've processed for them.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh yeah, we have submitted a bill on [PII] through one mailing.
[AGENT][NEUTRAL] How is it?
[AGENT][NEUTRAL] What was the mailing address it was sent to?
[CUSTOMER][NEUTRAL] Yeah, the mailing address is [PII].
[AGENT][NEGATIVE] OK, so that um we have not received it, we haven't received anything since [PII] for this member, um.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Yeah, I mean,
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEGATIVE] [PII], we received it and then [PII] it was denied, but we haven't received anything else since [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I can again send the bill for this. Is there any fax option to submit an app here?
[AGENT][NEUTRAL] Um, it is, you do have 180 days from the denial date. Um, the fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so much for this one. And can I get a call reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Yeah, OK, thank you so much, [PII], and have a nice day.
[AGENT][POSITIVE] You're welcome. You also, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.