AccountId: 011433970860
ContactId: 71202c3d-08b9-4874-95dd-0c77fdc0ba1d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 422809 ms
Total Talk Time (AGENT): 181115 ms
Total Talk Time (CUSTOMER): 104587 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/71202c3d-08b9-4874-95dd-0c77fdc0ba1d_20250408T13:55_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider service checking on claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check claim status on, is that correct?
[CUSTOMER][NEUTRAL] Oh, I have two clients, the same patient.
[AGENT][NEUTRAL] Two claims for the same patient. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, what are the last 4 numbers?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and [PII] you will use my name and today's date as your call reference number for each one. Also, any information that is provided will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of the explanation of benefits, you may print the EOB by going to our portal which is located at [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And my name is [PII]. It is spelled [PII]
[CUSTOMER][NEUTRAL] Oh, no, uh, spell out like.
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Sorry, can you spell out once more?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much for that. I got it.
[AGENT][NEUTRAL] OK, and you're welcome. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, the patient's policy number is 024.
[CUSTOMER][NEUTRAL] 75817
[AGENT][NEUTRAL] OK, thank you one moment [PII] while I get all of the members' information pulled up please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And [PII], any information as I stated before that I provide would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yeah, the uh patient's first name is [PII] and the last name is uh [PII].
[CUSTOMER][NEUTRAL] And the date of birth
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the first date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Data services.
[CUSTOMER][NEUTRAL] [PII]. And the bill amount.
[CUSTOMER][NEUTRAL] 200, ma'am.
[AGENT][NEUTRAL] I'm sorry, I didn't understand the amount.
[CUSTOMER][NEUTRAL] It is $200 even.
[AGENT][POSITIVE] 200. OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was received. It was received on [PII].
[AGENT][NEUTRAL] 2025.
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 0611.
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] Reason for the denial states office visits not covered by the above number policy. The member's plan.
[AGENT][NEUTRAL] Does not cover office, says it's John.
[CUSTOMER][NEUTRAL] OK. As for patients.
[AGENT][NEUTRAL] Patience, yes.
[CUSTOMER][NEGATIVE] Office visit will not cover.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. There is
[AGENT][NEUTRAL] And what is the next date of service? We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] It is the patient responsibility.
[CUSTOMER][NEUTRAL] And can you provide me the patient's plan?
[AGENT][NEUTRAL] Medlink.
[AGENT][NEUTRAL] Supplemental.
[AGENT][NEUTRAL] This is a supplemental policy.
[CUSTOMER][NEUTRAL] Ma.
[AGENT][NEUTRAL] M E D L I N K. This is a supplemental policy. It is not major medical insurance.
[CUSTOMER][NEUTRAL] OK. I got that.
[AGENT][NEUTRAL] OK, and what is the next data service in total bill amount?
[CUSTOMER][NEUTRAL] Yeah, I mean, uh, the patient, it is denied for the same reason. I will uh take as a this is a reference and I will be, I will take an action for action for the uh what I have to do. And, uh, oh, I don't have any other clients right on my side and uh.
[CUSTOMER][NEUTRAL] Uh, can you provide me one more thing, uh, when,
[CUSTOMER][NEUTRAL] So, what is the plan, I mean, what are the services cover as per the patient's plan?
[CUSTOMER][NEUTRAL] Only the office visits will not cover or any other services will also not covered.
[AGENT][NEUTRAL] Uh, covered outpatient services under this policy would include such things as diagnostic testing, outpatient surgeries, treatment within the office, independent labs, durable medical equipment. Those are the types of things that we can review for benefits under the outpatient.
[AGENT][NEUTRAL] But the office visit is not covered.
[CUSTOMER][POSITIVE] OK. I got it that and uh I will take care of the things. And thank you so much for that assisting as a patiently. Have a nice day.
[AGENT][NEUTRAL] Yeah, so you
[AGENT][POSITIVE] You're very welcome, [PII]. So that is all that I can help you with, and thank you again for calling ATL and I hope you have a very nice day also.
[CUSTOMER][POSITIVE] Same to you. Have a nice day.
[AGENT][POSITIVE] Thank you. Uh-huh, you too.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.