AccountId: 011433970860
ContactId: 7370ba87-f44b-4b65-99df-16c55f66b2b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287260 ms
Total Talk Time (AGENT): 146910 ms
Total Talk Time (CUSTOMER): 107089 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/7370ba87-f44b-4b65-99df-16c55f66b2b4_20250319T13:17_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] Uh, yes, [PII]. This is [PII] calling from provider's office to verify eligibility for the patient.
[AGENT][POSITIVE] It would be my pleasure to assist you, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] 02427782
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] Uh, [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you. And I understand you are needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Uh, no, uh, eligibility for the patient.
[AGENT][NEUTRAL] All right, I do apologize, and it would be my pleasure to assist you with that eligibility. [PII], I am showing that this policy turned on [PII].
[AGENT][NEUTRAL] No longer active.
[CUSTOMER][NEUTRAL] 728 24, right?
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] Uh, OK. 72824. OK. And uh we have uh bill the, we have a date of service but the claims are getting rejected. So I just wanted to confirm the claim address.
[AGENT][NEUTRAL] Claims address is [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] [PII], that's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] All right. And do you accept claims by mail?
[AGENT][NEUTRAL] That would be the mailing address.
[CUSTOMER][NEUTRAL] OK, no problem. So you accept only hard I mean mailing, right?
[AGENT][NEUTRAL] That's correct. Uh, we do have a payer ID is 64556.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 645-556. OK, can you check a claim status for one of the data of service?
[AGENT][NEUTRAL] Sure, what's that data service? Mhm.
[CUSTOMER][NEUTRAL] For this patient?
[CUSTOMER][NEUTRAL] Yeah, uh, [PII], the amount $59.
[AGENT][NEUTRAL] What's the facility name?
[CUSTOMER][NEUTRAL] Uh, it's a clinic medical service.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] This, um, we do have that claim on file. Let me get that received date for you. Received on [PII] and processed on [PII], and it is not a covered diagnostic test, so it was denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is a limited medical policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it does not cover, it only covers specific diagnostic tests.
[CUSTOMER][NEUTRAL] OK, so it's not covered in patient plan, right? No problem.
[AGENT][NEUTRAL] That's right. Would you like that claim number?
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] The claim number is 3451151.
[CUSTOMER][NEUTRAL] OK. We have billed the three claims for $59 for this date of service, $131. So all claims are denied.
[AGENT][NEUTRAL] Let me just go back and check that for you.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] And that was for [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and all for 59, yes, sir, they were all denied and for the same reason, and I can give you all, uh, the other two claim numbers if needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] Um, you have 345-1146.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And 3451143. Now, those were all received and processed on the same date as well.
[CUSTOMER][NEUTRAL] That was last one.
[CUSTOMER][POSITIVE] OK. Thank you for the information, [PII]. And this is uh uh patient responsibility, right?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility. We're not major medical. This is a limited indemnity policy. Patient responsibility would be determined by the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no problem. Thanks for the help and assistance and you have a wonderful day ahead.
[AGENT][POSITIVE] I hope you have a wonderful day as well [PII]. It was a pleasure to assist you with that claim status. And if there's nothing else I can help you with, I hope you have a wonderful day.