AccountId: 011433970860
ContactId: 6602e064-1905-4718-812f-128844aa1cb6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318290 ms
Total Talk Time (AGENT): 125329 ms
Total Talk Time (CUSTOMER): 100578 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/6602e064-1905-4718-812f-128844aa1cb6_20250128T19:51_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good afternoon. This is uh [PII], and I'm calling on provider office to check the claim status.
[AGENT][POSITIVE] Sure, I can assist you with current status. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure. It's 02030165.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] One minute. I'm waiting on the system.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Meanwhile, can you just spell out your name for me?
[AGENT][NEUTRAL] Sure, that's [PII].
[CUSTOMER][POSITIVE] Thank you so much for that, sir.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK. And may I have the name and date of birth of the patient? [PII]?
[CUSTOMER][NEUTRAL] Uh sure. Patient, uh, patient first name is [PII]. Last name is [PII]. With the date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Sure. Uh, date of service would be [PII] and the total charge amount $1,551 even.
[AGENT][NEUTRAL] OK. [PII] for 1,551.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Um let me see if this is your claim.
[AGENT][NEUTRAL] Let me pull this image.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. All right. So it looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And the claim was denied. Let me get the denial reason. Denial reason is, um, cover outpatient services are limited to hospital emergency room, surgery.
[AGENT][NEUTRAL] And diagnostic testing. Other charges are in a dependent lab are not covered under the policy.
[CUSTOMER][NEUTRAL] Uh, so which means this claim is not as, uh, uh, I can consider this claim is denied for non-cover services as per patient plans since we have the lab code which is 88305, which is not covered under patient plan, uh, which is limited, uh, for the patient plan, correct?
[AGENT][NEUTRAL] An uncovered service.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Correct. Correct.
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] OK. Uh, so, if you don't mind, can you just, uh, help me with the claim number?
[AGENT][NEUTRAL] Sure, the claim number is 35534007.
[CUSTOMER][NEUTRAL] OK. So, uh, so this is the only reason this claim is denied, right?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Uh, like this is the only reason this claim is denied for the non-covered charges, right?
[AGENT][NEGATIVE] That's the reason it's denied is because a non, it's a non-covered service.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, so, uh, uh, which means, I'm so sorry to ask you. So which means, uh, whenever we have a file a lab or like a lab services, uh, for this patient, it is not covered under the patient policy, correct?
[AGENT][NEUTRAL] Correct. For this patient, um, there's no coverage. Correct.
[CUSTOMER][NEUTRAL] OK. Uh, so for future reference, so, uh, I just want, uh, uh, like, uh, do you have any fax number or something if I need to do, uh, or or if I need to do send reconsideration or dispute for this claim? Do you have any fax number or something?
[AGENT][NEUTRAL] Yes, you have 180 days from the decision date to send any appeals. The appeals uh fax number is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you so much, thank you so much for the information that you provide to me. Can you just help me with the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Is there anything else I may help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] Uh, no, no. Thank you so much, sir. Have a good day and take care. Thank you.
[AGENT][POSITIVE] Welcome, you as well and thank you for calling ATL. Bye-bye, Mr. [PII].