AccountId: 011433970860
ContactId: 79b7d5bd-c60f-40ce-9f70-22e397d1cbbe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 678179 ms
Total Talk Time (AGENT): 220644 ms
Total Talk Time (CUSTOMER): 350912 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/79b7d5bd-c60f-40ce-9f70-22e397d1cbbe_20250211T18:46_UTC.wav
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[AGENT][POSITIVE] Thank you, thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, hello, [PII]. I'm [PII] calling from provider's office regarding our claims.
[AGENT][NEUTRAL] What is your call back number [PII]?
[CUSTOMER][NEUTRAL] [PII] uh with an extension of [PII]. Uh, may I know the initial last name [PII]?
[AGENT][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] Go
[CUSTOMER][NEUTRAL] Thank you. The policy number is 01989438. M as in Mike. L as in Lima H. No, no. We need to resubmit the claim, right? you need to submit the claim.
[AGENT][NEUTRAL] What is your policy number? You're welcome.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] OK, what is that policy, excuse me, excuse me, verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. And the date of birth is [PII]. Yeah, all of this.
[AGENT][NEUTRAL] Thank you. What's that date of service and charge amount please?
[CUSTOMER][NEUTRAL] The services in [PII] with a bill amount of $4,103 even $4103 even.
[AGENT][NEUTRAL] 4000.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] the number one.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, the claim was received and charges were denied as non-covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know when did the claim has been issued?
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] OK, the claim was received on one moment.
[AGENT][NEUTRAL] [PII] and processed on the same day as well as denied.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] But not on a dating, uh.
[CUSTOMER][NEUTRAL] Can you help me with that in actually just one second.
[AGENT][NEUTRAL] Non-covered services.
[CUSTOMER][NEUTRAL] Uncovered services, may I know uh why these services are not covered? This patient is provided is out of network.
[AGENT][NEUTRAL] Per the patient's
[CUSTOMER][NEUTRAL] very slowly.
[AGENT][NEUTRAL] For the patient's policy does not cover procedures inside the doctor's office or clinic.
[CUSTOMER][NEUTRAL] As patient's policy does not.
[CUSTOMER][NEUTRAL] Uh, Kai.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Correct, for the patient's policy does not cover procedures or services inside the office, doctor's office.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] You got it. Uh, may I know what does the member plan has?
[AGENT][NEUTRAL] This is a supplemental excuse me, the patient had a supplemental medical policy. It did not cover office visits or services inside the doctor's office.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK, remember that supplemental medical plan, right? Medical plan policy. Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] You got it, uh.
[CUSTOMER][NEUTRAL] OK, for this, can you send me the copy of your fax.
[AGENT][NEUTRAL] You can obtain the ERB from our website at [PII].
[CUSTOMER][NEUTRAL] Mhm. Could you please share me the claim number of this in our claim?
[AGENT][NEUTRAL] Of course the claim number.
[AGENT][NEUTRAL] 3541294
[CUSTOMER][POSITIVE] will continue.
[CUSTOMER][NEUTRAL] OK, it's 3541294. OK, am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, I just wanted to make sure, uh, the CPT bill with this course, uh, the CPT bills in this claim is 883-053-12341313342. Am I right, ma'am?
[AGENT][POSITIVE] You're correct.
[CUSTOMER][POSITIVE] Thank.
[CUSTOMER][NEUTRAL] Sure, got it. OK.
[CUSTOMER][NEUTRAL] Yeah, we move to another claim it's for a different number?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] You're able to check claim status by visiting our secure portal at [PII], OK?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, I do have about 2 claims. That's it for today.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Actually I do have 2 more claims. It's for a different number, 2 different members. Can you please help me with that service? Sure, please.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Yeah the patient.
[CUSTOMER][NEUTRAL] Payment and all for paying now, but we gonna pay this.
[CUSTOMER][NEUTRAL] what's different.
[AGENT][NEUTRAL] What's that policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is uh.
[CUSTOMER][NEUTRAL] 02509520 M as in Mike L as in Lima H.
[AGENT][NEUTRAL] Thank you. What's that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Business first name is uh [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and what's that date of service and total charge amount please?
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] Uh, the, uh, data service is [PII] with the bill amount of.
[CUSTOMER][NEUTRAL] $542 even.
[AGENT][NEUTRAL] Thank you. The claim was received and denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, may I know when did you receive the claim?
[AGENT][NEUTRAL] [PII] and the claim was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Well they should they been in one of the park.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] [PII], just give me one second. OK, may I know what the member's plan has? Could you please tell me the member's plan name?
[AGENT][NEUTRAL] Supplement supplemental medical policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Supplemental medical costs.
[AGENT][NEUTRAL] Yes, yes, and it did not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Supplemental medical policy, right? Medical.
[AGENT][NEUTRAL] Supplemental medical policy.
[CUSTOMER][NEUTRAL] She got it OK. For this also, can you, is there any possible can you please help me the claim number?
[AGENT][NEUTRAL] Of course, the claim number is 3541203.
[CUSTOMER][NEUTRAL] 41 35414.
[AGENT][NEUTRAL] No, no, no, 3541203.
[CUSTOMER][NEUTRAL] 3541203. OK, sure, got it. OK. I do have 11 more claim. That's it for today. But is there any possibility of sending a copy of COB for this claim to fax?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Again, those ELBs are available on the website and you'll be able to get that with that claim number. OK, what's that policy number please, [PII]?
[CUSTOMER][NEUTRAL] Sure, got it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The policy number is in the next numbers it's 017.
[CUSTOMER][NEUTRAL] 4160.
[CUSTOMER][NEUTRAL] 4 M as in Mike. L as in Lima 8.
[AGENT][NEUTRAL] Thank you. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is going to be uh.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] [PII], yes. Member's member's first name is going to be [PII] and the last name is [PII]. It's [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you sir and what is that charge, excuse me, date of service and charge amount please.
[CUSTOMER][NEUTRAL] So, the date of service is?
[CUSTOMER][NEUTRAL] [PII] with a bill amount of $5,739 even.
[AGENT][NEUTRAL] $39. OK, thank you. Give me a moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, 5000.
[AGENT][NEUTRAL] Can you verify the procedure codes, please, [PII]?
[CUSTOMER][NEUTRAL] Yeah, the procedure codes here is 453804325145385143239.
[AGENT][NEUTRAL] [PII], would you repeat those procedure codes for me?
[CUSTOMER][NEUTRAL] Sure. The procedure codes are, uh,
[CUSTOMER][NEUTRAL] 45380454325145385 and 43239.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, thank you very much for that information. It shows that we are requesting the explanation of benefits, a more detailed explanation of benefits for this particular claim. Give me one second to get that information as to when it was received and processed, OK? Give me one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, the claim was received on [PII] and processed.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] We are requesting a more detailed explanation of benefits that shows charges applied to the deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, I was requesting the primary you'll be of primary insurance to process the claim, right?
[AGENT][POSITIVE] Yes. Correct, correct.
[CUSTOMER][NEUTRAL] Sure, OK, uh, in this case, uh, I I just wanted to confirm that I will refile the claim along with the primary ACN number. Is it OK? The primary OB, I mean.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] That is correct. That's all we need the primary EOB. Let me provide that claim number to you, [PII].
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, are you ready?
[CUSTOMER][NEUTRAL] Yeah, give me again, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please help me the claim number for this claim, that's it all I need.
[AGENT][NEUTRAL] Yes, 352-851-2.
[CUSTOMER][NEUTRAL] OK 352-851-2 and I just need a little more information. Can you please help me the member effective and termination. That's it, please.
[AGENT][NEUTRAL] OK, the member is effective as of one moment please. [PII] and currently the policy is active.
[CUSTOMER][NEUTRAL] OK, [PII] and still currently active, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, sure. OK.
[CUSTOMER][NEUTRAL] Got it. Mhm.
[AGENT][POSITIVE] OK, and thank you so much for calling APL. You have a great day, Mr. [PII], OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Call reference, is it, please?
[AGENT][NEUTRAL] My name and today's date. My last initials [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. Uh, that's the information I need. Thank you for assistance.
[AGENT][POSITIVE] You're welcome sir you have a great day thank you.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Mhm.