AccountId: 011433970860
ContactId: 6e4025d0-8e7e-4476-8af8-8086791ecb61
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1180359 ms
Total Talk Time (AGENT): 272912 ms
Total Talk Time (CUSTOMER): 215966 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/6e4025d0-8e7e-4476-8af8-8086791ecb61_20250304T14:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on the claim status for the denial reason. Could you please help me with that?
[AGENT][NEUTRAL] Sure, I can assist you with claims, Miss [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, that is [PII]. That is a direct line, no extension. May I know your name, please?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And may I have the name of the facility you're calling from for my notations?
[CUSTOMER][NEUTRAL] Yes, that is Trident Medical Center.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, the patient policy number is 02446503.
[AGENT][POSITIVE] Thank you. OK, one moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It is [PII]. And the bill amount is
[CUSTOMER][NEUTRAL] 2 $22,858 even.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me see if I can find this claim for you, and that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is this the facility charges, Ms. [PII]?
[CUSTOMER][NEUTRAL] Facility charge. Yes, it is from facility.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, it looks like we have not received the facility charges claim.
[CUSTOMER][NEUTRAL] No, actually, previously, it is rejected for
[CUSTOMER][NEUTRAL] Primary EOP.
[AGENT][NEUTRAL] OK, do you have
[CUSTOMER][NEUTRAL] Uh, do you have this bill amount, $24,434 even?
[AGENT][NEUTRAL] What is the procedure called?
[CUSTOMER][NEUTRAL] Procedure code.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm checking for that.
[CUSTOMER][NEUTRAL] I do have a diagnosis code as pain in left finger.
[AGENT][NEUTRAL] OK, so um.
[CUSTOMER][NEUTRAL] And proximal la lax of right thumb.
[AGENT][NEUTRAL] OK, that means it's gonna be the facility, facility charges. Um, yeah, we don't have the claim for the facility. We don't have any claims for the facility for that date of service, [PII], correct?
[CUSTOMER][NEUTRAL] Uh, yeah, but I do have claim number. Can I provide you that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It is uh
[CUSTOMER][NEUTRAL] 354-860-2.
[AGENT][NEUTRAL] OK, let me see what that one pulls one moment.
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] I'm still waiting on the EOB to pull up. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the date of service is [PII].
[AGENT][NEUTRAL] OK, so we had the wrong day, that's fine. OK, so let's see, um.
[AGENT][NEUTRAL] Let me see what's this denial.
[AGENT][NEUTRAL] OK, so for that day, let me pull the day [PII].
[AGENT][NEUTRAL] OK, so that's asking for an explanation of benefits. We received explanation of benefits. Let me pull the most recent claim. One moment.
[AGENT][NEUTRAL] It looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $500 to the provider.
[CUSTOMER][NEUTRAL] OK. Uh, that, it is still in process or the claim is paid.
[AGENT][NEUTRAL] The claim has been paid on [PII].
[CUSTOMER][NEUTRAL] How it is paid?
[AGENT][NEUTRAL] It's gonna be a single check, paper check.
[CUSTOMER][NEUTRAL] Let's check. May I get the check number?
[AGENT][NEUTRAL] The check number is 2029349.
[CUSTOMER][NEUTRAL] How much was the pay amount?
[AGENT][NEUTRAL] 500, which is the maximum daily benefit.
[CUSTOMER][NEUTRAL] What is the allowed amount?
[AGENT][NEUTRAL] OK, we're not the major medical. Let me see if I can find a copy of the major medical EOB because uh the only thing we do is we go ahead and we pay based on the benefits of the policy. Um, the benefits on this policy has a $500 daily benefit.
[AGENT][NEUTRAL] So that's what we apply towards the deductible.
[CUSTOMER][NEUTRAL] OK. Do you have a copy of the COB that it is paid?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Could you fax me about that?
[AGENT][NEUTRAL] Go ahead with the fax number.
[CUSTOMER][NEUTRAL] 844
[CUSTOMER][NEUTRAL] 902
[CUSTOMER][NEUTRAL] 3804. Attention to my name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And how do you spell your name?
[CUSTOMER][POSITIVE] My good
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And do you mind holding for me while I send the fax to you right now?
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] Yes. Before that, may I get the claim receive date?
[AGENT][NEUTRAL] Um, the EOB because we was waiting for the EOB and then we received the EOB. Um, it was [PII] is when we received a copy of the explanation of benefit we was requesting.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, let me go ahead and um.
[AGENT][NEUTRAL] Send that out to you. I'm gonna put you on a brief hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for Miss [PII]. I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Mm, no. But before that, is it, uh, the check is cleared?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] It was just an out not long.
[CUSTOMER][NEUTRAL] When the check is cleared and when it
[AGENT][NEUTRAL] Miss [PII], it was just processed not long ago. It was processed on [PII], that's less than a week. So I'm not even sure if they have received it yet.
[CUSTOMER][NEUTRAL] OK. It is still in process, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, the check was sent out on the next day after the [PII]. So that was what, a week ago?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so it was sent out on the [PII]. Today is the [PII], so that's about a week ago that it was sent out by mail. We don't even know if they already received that check, but it's been already sent out to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] We have to wait for 30 days uh whether it is issued or like cleared or not, right?
[AGENT][NEGATIVE] You have to wait 30 days because it's already been sent out.
[CUSTOMER][NEUTRAL] OK. It is a bulk check or single check?
[AGENT][NEUTRAL] This is a single chair.
[CUSTOMER][NEUTRAL] When is the check issue date? It is [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. I do have last one claim. Could you please check with that?
[AGENT][NEUTRAL] Is it the same number or different number?
[CUSTOMER][NEUTRAL] It's for different member.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Let me finalize the note.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] It is 01.
[CUSTOMER][NEUTRAL] 899454 M as in Mike, L as in Lima.
[CUSTOMER][NEUTRAL] Number 7.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes. The name of the patient is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And you said the first name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, can you repeat that policy number one more time? That's not how I pulled.
[CUSTOMER][NEUTRAL] OK. It is 01899454 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] And that's the policy number that I pulled up, but that's not the name on the policy.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Is the, the complete name is different?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Without that, we cannot proceed for further.
[AGENT][NEUTRAL] No, we need um the correct, either the uh the correct policy number or the correct information of the member because the policy number that you're providing me is is pulling a different person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we have to contact the patient for this?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for your time and assistance. May I get the call reference?
[AGENT][NEUTRAL] We don't have reference numbers, you can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Thank you so much. Have a great day ahead. Bye.
[AGENT][POSITIVE] You're welcome. You as well, Miss [PII]. Thank you for calling APL. Bye-bye.