AccountId: 011433970860
ContactId: 8b94e208-12d8-4803-8875-ad880dd1a00e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 600900 ms
Total Talk Time (AGENT): 168692 ms
Total Talk Time (CUSTOMER): 146373 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/8b94e208-12d8-4803-8875-ad880dd1a00e_20250319T19:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] calling from provider office to check on the claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status, and you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and initial to my last name is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And what is your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII]. And it is a direct line?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And can I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number is 02449815. And the patient name is [PII], and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, let me pull that policy up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me read the policy number back to you. 02249815.
[CUSTOMER][NEUTRAL] No, it is 02449815.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Sure. The date of service is [PII] with the total charge amount, $277.95.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, it is $60 even.
[AGENT][NEUTRAL] And then can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Sure. The facility name was
[CUSTOMER][NEUTRAL] Texas Health Urgent Care?
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, Miss [PII], while I look up this claim and I will be right back.
[CUSTOMER][NEGATIVE] Yeah. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Ms. [PII]. I've got the claim pulled up for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3573628.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied on let me read you the remark for the denial benefits payable only only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid. So basically what we need is the explanation of benefits from the major medical showing that they paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So, in order to process the claim, you need the primary explanation of benefits, right?
[AGENT][NEUTRAL] Right, showing that the medical, the medical, the major medical insurance paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And thank you so much for that information. Could you also help me with the, can you receive it and denied it?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me look that up real quick.
[AGENT][NEUTRAL] The claim was received on [PII] and it was also processed on the same day, [PII].
[CUSTOMER][POSITIVE] Awesome. Thank you so much for that information.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So, uh, could you please send a copy of your bill through fax?
[AGENT][NEUTRAL] Yes ma'am, what is your fax number?
[CUSTOMER][NEUTRAL] Sure, one moment.
[CUSTOMER][NEUTRAL] And the fax number is [PII]. Attention would be my name, [PII].
[AGENT][NEUTRAL] OK, thank you and I'm gonna put you on hold real quick while I get that fax sent to you. I'll be right back.
[CUSTOMER][NEUTRAL] Sure thank you. You are on hold.
[AGENT][NEUTRAL] Well.
[AGENT][NEUTRAL] And I will.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you, Ms [PII] for holding for me. I've got that fax on its way to you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for that one. Could you also send me
[CUSTOMER][NEUTRAL] Sorry, could you also help me with the call reference number for this call?
[AGENT][POSITIVE] Yes ma'am you can use my name [PII] in today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, for sending the UB
[CUSTOMER][NEUTRAL] You have to send it via mail, right?
[AGENT][NEUTRAL] Yes, I've already sent it.
[CUSTOMER][NEUTRAL] Could you please help me with that mailing address?
[AGENT][NEUTRAL] Yes, the mailing address is
[CUSTOMER][NEUTRAL] For a primary explanation. Uh-huh.
[AGENT][NEUTRAL] Yes, we have mailing address [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much. Uh, do you have the fax number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. What would be the timely filing limit to submit the primary explanation of benefits?
[AGENT][NEUTRAL] We don't have one.
[CUSTOMER][NEUTRAL] There is no time limit to submit the explanation of benefits, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. And thank you so much for your assistance and patience. Have a great day.
[AGENT][NEUTRAL] You too, Ms [PII]. Anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Nothing for today and have a great day.
[AGENT][POSITIVE] OK, you too, thank you, Ms [PII]. You have a good day also thanks for calling APL.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] OK.