AccountId: 011433970860
ContactId: 6841d482-8a9b-4292-ad8a-50004d52f508
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271279 ms
Total Talk Time (AGENT): 119680 ms
Total Talk Time (CUSTOMER): 88078 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/6841d482-8a9b-4292-ad8a-50004d52f508_20250527T13:33_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] Um, I'm just calling in regards to a claim. Um, it looks like you guys covered the patient's deductible, but do you guys cover the coinsurance?
[AGENT][NEUTRAL] Um, generally, it will. I can take a look at the claim number if you have that, see what, you know, if there was anything denied on it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, I have the claim number. What, uh, you want the claim number first?
[AGENT][NEUTRAL] Yeah, you can give that to me, that's fine.
[CUSTOMER][NEUTRAL] OK, I have 356.
[CUSTOMER][NEUTRAL] 8000
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for documentation, can I grab your first name?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Thank you [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And then for verification, I will need to please get uh the patient's name and date of birth.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] and date of birth [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] It looks like everything else on the claim was denied stating, uh, policy does not provide a benefit in which it says there were no charges incurred.
[AGENT][NEUTRAL] So it looks like the bill amount that came over to us was for 239.25 and then that's what we paid. I don't see anything else.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, cause we had an office visit.
[CUSTOMER][NEUTRAL] On it as well.
[AGENT][NEUTRAL] Oh, I don't even see it.
[CUSTOMER][NEUTRAL] Let me go back. Let's see.
[AGENT][NEUTRAL] I was gonna say I don't even see that um.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] No, it can still be submitted if we, if we didn't get it. There's not a timely filing limit. Let me see if I see anything else. It was the same data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] See anything else here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I just see that one claim, [PII], it looks like and I don't see any office visit on there. I see office treatment.
[CUSTOMER][NEUTRAL] Yeah, I have the 57452 and then an office visit 99214.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I don't see that 99214 was ever sent to us.
[CUSTOMER][NEUTRAL] Oh, OK. Um, is there a way to, um,
[CUSTOMER][NEUTRAL] I guess fax the primary ELB or so that you could see that that primary EOB and what they paid.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, absolutely, um, I can give you the fax number, payer ID, and mailing address, whatever you need.
[CUSTOMER][NEUTRAL] OK, um, can I, do I have to fax the claim along with the EOB from primary or can I just fax the EOB from primary?
[AGENT][NEUTRAL] The claim with the EOB from primary, we will need both.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, what is the fax number?
[AGENT][NEUTRAL] Fax number is gonna be [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] All right. And is there a timely filing?
[AGENT][NEUTRAL] No, ma'am. Mm mm.
[CUSTOMER][NEUTRAL] OK, alright, well I will go ahead and do that and can I have your name and a reference number for the call?
[AGENT][NEUTRAL] Absolutely. Call reference is my name with my last initial and then today's date. My name is [PII] and that is [PII] My last initial is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII], for your help.
[AGENT][POSITIVE] You're welcome. Have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.