AccountId: 011433970860
ContactId: 8d0914d6-c6cd-41de-a266-5fb36ace7ccf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 5410160 ms
Total Talk Time (AGENT): 1008178 ms
Total Talk Time (CUSTOMER): 1605807 ms
Interruptions: 6
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/8d0914d6-c6cd-41de-a266-5fb36ace7ccf_20250617T19:09_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] No you when
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi [PII], how are you? My name is [PII] from Arden Hospital.
[AGENT][POSITIVE] How can I help you today?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][POSITIVE] Yes, hi, [PII]. Yes, I can hear you. I just want your help with a cleaning status. Yeah.
[AGENT][POSITIVE] Good
[AGENT][NEUTRAL] OK, I can help you with claim status, and can you spell your name for me please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK and uh what's a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] The policy number is 02107543.
[AGENT][NEUTRAL] Give me just one moment while I look that up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date is [PII].
[AGENT][NEUTRAL] Do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] And the date of service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] I'm not showing any claims for that date of service.
[CUSTOMER][NEUTRAL] You don't? Yeah, that's the point. I'm just looking, uh, yeah, sorry, I told, I said to you [PII], yes, it's [PII], sorry, it's my mistake, that's my mistake? [PII].
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm, I'm not seeing a claim for that date of service.
[CUSTOMER][NEUTRAL] You don't have a claim. Uh, that's the point. I was looking at we don't have the OV from you, from that date from the claim. How can we send you the, the claim, the, the claim to you?
[AGENT][NEUTRAL] You can send it by fax or through mail, um.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] 10
[AGENT][NEUTRAL] Do you have a preference?
[CUSTOMER][POSITIVE] I can do it the both way by fax. If you can give me the pass number and the address and I send you the the the as fast as I can.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, our fax number you'll put attention claims department.
[AGENT][NEUTRAL] And the fax number is [PII].
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I repeat you. [PII] 580.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] 9423. Perfect.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. OK. And the address is?
[CUSTOMER][NEUTRAL] It is not that so.
[AGENT][NEUTRAL] And the address is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I confirm you. The address is [PII], right?
[AGENT][NEUTRAL] Yes, yes, ma'am.
[CUSTOMER][NEUTRAL] All right. OK, so I'm going to send you this, this claim to this to the pass number uh or to the address. Can we check another one, please? [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it for the same patient?
[CUSTOMER][NEUTRAL] Uh, yes, it's for the same patient, different date of service. It's on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, however,
[CUSTOMER][NEGATIVE] Yeah, it was not fine.
[AGENT][NEUTRAL] What is the total bill amount?
[CUSTOMER][NEUTRAL] The total bill amount is
[CUSTOMER][NEUTRAL] 231.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just one moment while I look this up, OK?
[CUSTOMER][NEUTRAL] OK, don't worry. I.
[CUSTOMER][POSITIVE] Thank you, sir.
[CUSTOMER][NEUTRAL] for
[CUSTOMER][NEUTRAL] 12002820881-01, right?
[AGENT][NEUTRAL] It looks like we received that claim on [PII].
[AGENT][NEUTRAL] It was processed.
[CUSTOMER][NEUTRAL] Wait.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] Sorry, the [PII] and process [PII].
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Do you want the claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] It's 35.
[CUSTOMER][NEUTRAL] About 8. Yes.
[AGENT][NEUTRAL] 89
[AGENT][NEUTRAL] 681.
[CUSTOMER][NEUTRAL] Yes, 681 OK.
[CUSTOMER][NEUTRAL] Um, we don't have the AOV from you. It's possible for you to send us the bypass the EOV from that, and did you pay it or do you not deny, do you, can you tell me, or?
[AGENT][NEGATIVE] It, it was denied because the services aren't covered under their policy.
[CUSTOMER][NEUTRAL] OK. It's possible for you to send us the OV or fax number?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Give me just one moment to pull that up, OK?
[CUSTOMER][POSITIVE] OK, thank you. 160.
[CUSTOMER][NEUTRAL] What about [PII]?
[CUSTOMER][NEUTRAL] [PII] as well.
[CUSTOMER][NEUTRAL] Oh, it's like they're.
[CUSTOMER][NEUTRAL] So I'm you know any what what would be the the best option we can go to.
[AGENT][NEUTRAL] And who do I make the attention out to?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] And my phone number is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] or fax number.
[CUSTOMER][NEGATIVE] So don't work, let's say the same.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And just to confirm for fax number [PII].
[AGENT][NEUTRAL] [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, I just sent that over to you.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, can we check another claim, please?
[AGENT][NEUTRAL] Is it for the same, um,
[AGENT][NEUTRAL] The same patient?
[CUSTOMER][NEUTRAL] No, it's not. No, this one is not for the same patient, it's another patient. One question, [PII], do you manage a different calls for all the calls or for each person or each patient?
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we don't have call reference numbers. You'll just use my name and last initial in today's date and so it's [PII] and then today's date. So give me one moment to close out this patient and then I'll be with you in just a moment for the next one, OK?
[CUSTOMER][NEUTRAL] That and
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One primary brother.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] And once we get the also for any and we get my reference phone number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] of your day.
[AGENT][NEUTRAL] And what is the next patient?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] The data of service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what was the total bill amount?
[CUSTOMER][NEUTRAL] 224.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] We processed this claim on [PII].
[AGENT][NEUTRAL] Are you ready for the claim number?
[CUSTOMER][NEUTRAL] Just a moment. 10 2020 25, claim number. Yes, I'm ready.
[AGENT][NEUTRAL] 35
[AGENT][NEUTRAL] 87702.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02, OK.
[CUSTOMER][NEUTRAL] And did you, did you pay something or you deny or what's going on?
[AGENT][NEGATIVE] It looks like this claim was denied. Um, office visits are not covered under this policy, and it looks like their primary insurance picked up the rest.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Can you send me the bypass the view of this, please?
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Same attention and same fax number?
[CUSTOMER][POSITIVE] Yes, same and fast number and same platform, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright I just sent that over to you.
[CUSTOMER][POSITIVE] OK, thank you very much. Can we check another one, please?
[AGENT][NEUTRAL] Uh, same patient or different patient?
[CUSTOMER][NEUTRAL] Different patients.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Really
[CUSTOMER][NEUTRAL] So you know you
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and the next patient?
[CUSTOMER][NEUTRAL] 02273691
[CUSTOMER][POSITIVE] I mean yeah lucky
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII], [PII] [PII]. Sorry.
[AGENT][NEUTRAL] It's OK and do you have the uh data service for this one?
[CUSTOMER][NEUTRAL] The date of service the
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, let me check.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] And what was the total bill amount?
[CUSTOMER][NEUTRAL] 158.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][POSITIVE] Yes, OK, yes, yes, thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 1759.
[CUSTOMER][NEUTRAL] OK. And it was mm.
[AGENT][NEUTRAL] And it looks like
[AGENT][NEGATIVE] It was denied because we need a copy of the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] So, I can send you to the, your fax.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Or your address, they, they will be from the primary?
[AGENT][POSITIVE] Yes, that's all we need for this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. I will send it to you attend to claim department.
[CUSTOMER][NEUTRAL] Also?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Good. Can we check another one from the same patient, please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 83813
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And it was
[CUSTOMER][NEUTRAL] Denial of pay something?
[AGENT][NEUTRAL] It looks like we paid $7.
[AGENT][NEUTRAL] Towards this claim, uh, let me see why.
[AGENT][NEUTRAL] Because it looks like everything else, uh.
[AGENT][POSITIVE] It had already been paid, there were no charges.
[CUSTOMER][NEUTRAL] You only pay $7 in this one?
[AGENT][NEUTRAL] Correct, because everything else didn't have a charge to it.
[CUSTOMER][POSITIVE] So the thing was safe.
[CUSTOMER][NEUTRAL] Can you send me uh the UV and the remittance of this to our staff, please?
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] It was paid with an electronic payment or single payment? Or, or a singular payment check, single payment check.
[AGENT][NEUTRAL] It's a single check. Let me see.
[AGENT][NEUTRAL] It looks like we uh processed the check on [PII].
[AGENT][NEUTRAL] And it looks like the check cleared on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Um, can you send to our pass the UV and the check remittance of this payment?
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] I don't have the check remittance. Um, give me just a moment. It looks like my fax.
[AGENT][NEUTRAL] Died on me, so give me just a moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Alright I just sent that fax over to you um but I don't have the remittance on here just fax it.
[CUSTOMER][NEUTRAL] Oh, OK. How
[AGENT][POSITIVE] I'm just able to see where, where it was sent and then it got, uh, it was cleared.
[CUSTOMER][NEUTRAL] OK. So it's not easy for us to get that remittance?
[AGENT][NEUTRAL] Right, but I did send the EOB.
[CUSTOMER][POSITIVE] OK, perfect. Thank you.
[CUSTOMER][NEUTRAL] Can we check another one, please?
[AGENT][NEUTRAL] Same patient or different patient?
[CUSTOMER][NEUTRAL] A different patient.
[AGENT][NEUTRAL] All right, give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the next patient?
[CUSTOMER][NEUTRAL] The expiration is [PII].
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the data service for this patient?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII].
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the total bill amount?
[CUSTOMER][NEUTRAL] 224.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] You're Welcome. Thank you.
[AGENT][NEUTRAL] It looks like we pro uh we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 35.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 04818.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] And it looks like this claim was denied.
[AGENT][NEUTRAL] Because the policy had already termed.
[CUSTOMER][NEUTRAL] OK, perfect. So, can you send me the AOV of this of this claim, please, for us to process because we don't have QDOB.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] To uh, to my place.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Alright I just sent that over to you.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK, thank you, [PII]. It's my, the number of the new policy is 002544303.
[AGENT][NEUTRAL] Is this a different policy or a different patient?
[CUSTOMER][NEUTRAL] Different policy in different patients, different patients.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] OK, let me close out this patient real quick.
[CUSTOMER][POSITIVE] OK, OK, thank you. Sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what's the 5th patient?
[CUSTOMER][NEUTRAL] This patient is 02544303.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] I'm not showing any claim for that date of service.
[CUSTOMER][NEUTRAL] So we can we send you the, the claim, right?
[AGENT][NEUTRAL] Yes ma'am, you can send it to that fax number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Can we check another one, please? So the other patient, different patients.
[AGENT][NEUTRAL] OK give me just one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] In the next patient?
[CUSTOMER][NEUTRAL] And expiration is [PII].
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] The date of service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] The total bill amount is 255.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we received this payment or I'm sorry, this claim on [PII].
[AGENT][NEUTRAL] It was processed.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] The claim number is 3506965.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it was pay or denied or?
[AGENT][NEUTRAL] And it looks
[AGENT][NEGATIVE] Like it was denied because we need a copy of the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK, so, OK, so I send you the, the UV.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Can we check another one from the same patient, please?
[AGENT][NEUTRAL] The same patient? OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] The date of service is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the total bill amount?
[CUSTOMER][NEUTRAL] The total bill amount is 224.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Alright, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number is 35.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 89902.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What deny or pay?
[AGENT][NEGATIVE] And it looks like it was denied because the primary insurance paid full amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If, if primary insurance in case of there is something.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, they pay, they pay the full amount.
[CUSTOMER][NEUTRAL] They pay the full amount, but we still have the primary study, they still have.
[CUSTOMER][NEUTRAL] A copay for $60. Don't you pay that.
[AGENT][NEGATIVE] It looks like the other half of this claim was denied though because it's not a covered service.
[CUSTOMER][NEUTRAL] Do some honey.
[CUSTOMER][NEUTRAL] OK, so the other half of this one, which one is not covered for this? Which, which CPT code?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 99214.
[CUSTOMER][NEUTRAL] 99214 is not covered by you.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] So, OK. Can you send me the UV of this, please?
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] got it.
[AGENT][NEUTRAL] OK, I just sent that. Is there anything else?
[CUSTOMER][POSITIVE] Yes, can we check another one, please?
[AGENT][NEUTRAL] Same patient or a different patient? OK, give me just one moment.
[CUSTOMER][NEUTRAL] Differ patient.
[CUSTOMER][NEUTRAL] Different patients.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, and the other patient?
[CUSTOMER][NEUTRAL] The other question is 02.
[CUSTOMER][NEUTRAL] 560592
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII]. I'm sorry, excuse me.
[CUSTOMER][NEUTRAL] And the date of born is [PII].
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] The service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] 224.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi this is like.
[AGENT][NEUTRAL] It looks like we received this claim on [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3591365.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And it looks like the
[AGENT][NEGATIVE] Office visits aren't covered is why it was denied. And also uh there wasn't, uh, with this policy doesn't provide a benefit for services in which no charges were incurred.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 31. OK, this is no.
[CUSTOMER][NEUTRAL] No cover tell me no cover, and OK. So can you send me the claim of this, please? It is.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][POSITIVE] 45. OK, thank you.
[CUSTOMER][NEUTRAL] For Fort Knox. It is P O R T as in summer.
[CUSTOMER][NEUTRAL] In a EU Forna Medical practice.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I think so, [PII] R T N [PII] Yes, [PII].
[CUSTOMER][NEUTRAL] And yeah.
[CUSTOMER][NEUTRAL] U F as in Frank.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 26.
[CUSTOMER][NEUTRAL] 375.
[CUSTOMER][NEUTRAL] 7202.
[AGENT][NEUTRAL] Alright I just sent that fax over to you.
[CUSTOMER][NEUTRAL] Can we check another one from the same patient please?
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] Today service is [PII].
[CUSTOMER][NEUTRAL] Same day?
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] 50 $50.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 41.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] It looks like we received this claim on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, and the claim number is?
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] 23rd.
[AGENT][NEUTRAL] 355.
[CUSTOMER][NEUTRAL] 23rd, OK.
[CUSTOMER][NEUTRAL] Yes. 10 or 100.
[AGENT][NEUTRAL] 4774.
[CUSTOMER][POSITIVE] Yes. 74, perfect. And it was paid or was it nice?
[AGENT][NEGATIVE] It was denied because we need a copy of the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK. So I
[CUSTOMER][NEUTRAL] I will send you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can we take another one for another patient?
[AGENT][NEUTRAL] A different patient?
[CUSTOMER][NEUTRAL] See different patient.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] According to the right.
[CUSTOMER][NEUTRAL] OK submitted it a couple of times electronically.
[CUSTOMER][NEUTRAL] I don't know why you have to receive that yet.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, that's right. I don't know what.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK, and what is the next patient?
[CUSTOMER][NEUTRAL] So for the providers.
[CUSTOMER][NEUTRAL] The extension is [PII].
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] I'm not, I'm not seeing a claim on file for that data service.
[CUSTOMER][NEUTRAL] So I should send you the claim, OK? OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, can we check another one please from different patient.
[AGENT][NEUTRAL] OK give me just one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, I will double check that out.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] They just went there to the plane and it looks like um there are some TPTs on there. Actually some of them were already paid by you, but
[AGENT][NEUTRAL] And what is the next number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] In the data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] It looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] to see
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 89
[AGENT][NEUTRAL] 964.
[CUSTOMER][NEUTRAL] OK. And it was.
[AGENT][NEUTRAL] And the claim was denied due to not being a covered service.
[CUSTOMER][NEGATIVE] No car service.
[CUSTOMER][NEUTRAL] OK. Can we check another one? Uh, can you send me the UOB port, please?
[AGENT][NEUTRAL] Oh, you want me some EP one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, that work.
[AGENT][NEUTRAL] Give me just one more moment.
[CUSTOMER][POSITIVE] Yes, don't worry here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] But yeah, that's.
[CUSTOMER][NEUTRAL] Wait, yeah.
[CUSTOMER][NEUTRAL] The first time, so yeah, in the the time by the limit.
[CUSTOMER][NEUTRAL] Um, pretty fast. No worries. So just the thing of things I'm, I'm, I was just taking some notes while you were explaining to me, and I don't know if you can help me with other claims for other members.
[AGENT][NEUTRAL] And what's the next patient?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Actually,
[CUSTOMER][NEUTRAL] Yeah, like for more.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] I think the next one is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 600.
[AGENT][NEUTRAL] In the date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] State of service.
[AGENT][NEUTRAL] And what's the total bill amount?
[CUSTOMER][NEUTRAL] 369.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 2024.
[CUSTOMER][NEUTRAL] 259.
[AGENT][NEUTRAL] OK, it looks like we received this claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 3572036.
[AGENT][NEUTRAL] And the claim was denied because the policy had termed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy concern.
[AGENT][NEUTRAL] 01 moment. It also says, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like this policy would, uh, it denied it because there was no benefits for treatment, um, other than sickness or injury.
[CUSTOMER][NEUTRAL] Oh, no, not the term, the termite.
[CUSTOMER][NEUTRAL] Also policy has term term.
[AGENT][NEUTRAL] The, the policy is termed now, but during the date of service, it was denied because um it wasn't an injury or an illness.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. Can you send me the overview of that to our part please?
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That for 10 minutes.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Alright I just sent that over.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK, perfect, can we take another one please? Different patient.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Just for the, the claim, the paid amount on the claim.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Thank you it was for this on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh well, are you able to send us the, the you.
[CUSTOMER][NEUTRAL] No, but because it was personally made.
[CUSTOMER][POSITIVE] Mhm. Exactly, no worries.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And well, tell me when you're ready for the other members and this other member has 3 and data services that's the the things that we need.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And the next patient?
[CUSTOMER][NEUTRAL] [PII]. I am so sorry.
[CUSTOMER][POSITIVE] No, no, no, I am so sorry. I just mixed it up here. I'm so sorry.
[AGENT][NEUTRAL] Did you say [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes. It's [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] 010279.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the date of birth is [PII]. 1 of them they are the same services for the same day. That is [PII].
[AGENT][NEUTRAL] It looks like for this claim, you'll need to call uh contact Web TPA and I have their number whenever you're ready.
[CUSTOMER][NEUTRAL] One is to.
[CUSTOMER][NEGATIVE] You know they don't wanna
[CUSTOMER][NEUTRAL] Yes please uh contact with.
[CUSTOMER][NEUTRAL] TPA and the num and the phone number is, what is the phone number? Yes, I'm ready.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes. [PII]. OK, I repeat you. The, the phone number is
[CUSTOMER][NEUTRAL] I wait a moment.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes ma'am. Yes.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Why do we, why do we have to contact them?
[AGENT][NEUTRAL] Um, because it's not a product administered by APL, it goes through, uh, it goes through them, mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, perfect, thank you. Can we check another one? Ah, from the same page or maybe the same one? Because I had another one for the same patient.
[AGENT][NEUTRAL] Uh, yeah, if it's anything regarding that, that, uh, policy number, you'll have to contact them. Yes.
[CUSTOMER][NEUTRAL] That patient
[CUSTOMER][POSITIVE] OK, perfect. OK. Can we see another one different?
[AGENT][NEUTRAL] A different patient?
[CUSTOMER][NEUTRAL] Different patients.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is the number, the policy number?
[CUSTOMER][NEUTRAL] The policy number is 256-659-9.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] I'm not showing any claims for that date of service.
[CUSTOMER][NEUTRAL] So I have to send you the claim, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, I have another.
[CUSTOMER][NEUTRAL] For the same patient?
[CUSTOMER][NEUTRAL] Different date of service.
[AGENT][NEUTRAL] OK, what's that date of service?
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[CUSTOMER][NEUTRAL] [PII]. [PII].
[AGENT][NEUTRAL] And what's the total bill amount?
[CUSTOMER][NEUTRAL] 150.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Alright, it looks like we received this claim on [PII].
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I love angle, by the way.
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 90
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 160.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this one.
[CUSTOMER][NEGATIVE] was denied, was paid, what happened with that?
[AGENT][NEGATIVE] It was denied because uh this policy does not provide a a benefit for services in which no charges were incurred and then office visits aren't covered.
[CUSTOMER][NEUTRAL] The night, OK. I don't cover, no?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you send me the UOB from that one?
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] To our
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What that.
[CUSTOMER][NEUTRAL] I mean right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] That you are able.
[CUSTOMER][NEUTRAL] Uh, for these two type of services of the year.
[AGENT][NEUTRAL] Alright, I sent that EOB to you.
[CUSTOMER][NEUTRAL] OK, thank you. Can we have check another one for the same patient please? Different date. Oh, from the the same date of service.
[CUSTOMER][NEUTRAL] This the same patient for for the same date of service.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was [PII], correct?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2025.
[AGENT][NEUTRAL] And the total build amount?
[CUSTOMER][NEUTRAL] It's 344.
[AGENT][NEUTRAL] It looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 90157.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 7.
[CUSTOMER][NEUTRAL] And what pay what deny, uh, what, what was the, the resolute.
[AGENT][NEGATIVE] Uh, it was denied.
[AGENT][NEGATIVE] It was denied because office visits aren't covered and um it's the same reason. uh no, it doesn't provide a benefit. It doesn't provide a benefit uh for charges uh not incurred.
[CUSTOMER][NEUTRAL] The same as the other one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. Can you send me the EOV or that one to our fast please?
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] And well, there's only one little service missing, but remember that is [PII].
[CUSTOMER][NEUTRAL] And the amount is 253. Mm.
[AGENT][NEUTRAL] Alright I just sent that fax over.
[CUSTOMER][NEUTRAL] OK, can we take another one for different patient please?
[AGENT][NEUTRAL] Give me just one moment while I close out this patient.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Do you know how many other patients you have?
[CUSTOMER][POSITIVE] Oh yes, I'm going to tell you.
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] 3 of the same patient and just a moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I had
[CUSTOMER][NEUTRAL] 9.
[AGENT][NEUTRAL] 9 more after this.
[CUSTOMER][NEUTRAL] T3 same patient.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yes, with this 19. There are 3 from the same patient now and another 3 for other other patient but the same patient and 2 for 1 patient, so I think it's 8, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] The name of this, OK.
[CUSTOMER][NEUTRAL] Um, and what was the amount for patient deductible?
[CUSTOMER][NEUTRAL] Oh, that would be a loan amount.
[CUSTOMER][POSITIVE] Oh, and actually I don't know if you can send me the UOB as well if that's all for today. Thank you.
[CUSTOMER][NEUTRAL] Sorry yes remind me have a phone number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Some, uh, but it would be something to me that that you'll be right.
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][NEUTRAL] Alright, and the next patient?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify this patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In the total bill amount?
[CUSTOMER][NEUTRAL] Total bill amount is 224.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] I'm sorry, could you repeat that date of service one more time?
[CUSTOMER][NEUTRAL] The service is [PII].
[AGENT][NEUTRAL] It looks like we received this claim on [PII]. We processed this claim on [PII].
[AGENT][NEUTRAL] The claim number is 356-562-8.
[CUSTOMER][NEUTRAL] 356-562-8, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, uh, how, what was the result of this one?
[AGENT][NEGATIVE] It looks like office visits are not covered. It, it was denied because this policy does not provide a benefit uh for services in which no charges were incurred.
[CUSTOMER][NEUTRAL] But then I was saying.
[CUSTOMER][NEUTRAL] OK. The same as the other one, no?
[AGENT][NEUTRAL] So there's no charges.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Can you send me the AOV please?
[AGENT][NEUTRAL] OK. Give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I just sent that out to you.
[CUSTOMER][NEUTRAL] OK, great. Can we check the other one from the same patient, different data of service.
[AGENT][NEUTRAL] And what is the next date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we received this claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like this claim, the claim number is 3579.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 308
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Looks like it was denied because office visits aren't covered.
[AGENT][NEUTRAL] And uh this policy does not provide a benefit for services in which no charges were incurred.
[CUSTOMER][NEUTRAL] OK, can you please send me the UB also to our fast please.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, I sent that fax over.
[CUSTOMER][POSITIVE] OK, perfect. Can we check another for the same patient?
[AGENT][NEUTRAL] For the same patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the data service?
[CUSTOMER][NEUTRAL] The date of service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3603.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 437.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What? Deny your pay?
[AGENT][NEUTRAL] And it's
[AGENT][NEGATIVE] It's the same denial reason, uh, office visits aren't covered.
[AGENT][NEUTRAL] And the policy does not provide a benefit in which no services were incurred or no charges were incurred.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. Can you send me the AOV please to our fast?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] No CBC.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, I sent that EOB to you.
[CUSTOMER][NEUTRAL] Thank you. Can we check another one different patient? The other 3?
[AGENT][NEUTRAL] OK, give me
[CUSTOMER][NEUTRAL] On the same patient?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] A different patient?
[CUSTOMER][NEUTRAL] Different patients, yes.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] All
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the next patient?
[CUSTOMER][NEUTRAL] I couldn't.
[CUSTOMER][NEUTRAL] 02462
[CUSTOMER][NEUTRAL] 880.
[CUSTOMER][NEUTRAL] Yeah, alright.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $45.
[AGENT][NEUTRAL] Alright, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I, sorry, just a moment, received on [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. OK, and processed on February.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 4 2025. OK, thank you.
[CUSTOMER][NEUTRAL] The client number is?
[AGENT][NEUTRAL] 3559219
[CUSTOMER][NEUTRAL] OK, and it was
[CUSTOMER][NEUTRAL] So say deny or what happened with that?
[AGENT][NEGATIVE] It's denied because we need a copy of the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm going to send you this one.
[CUSTOMER][POSITIVE] OK, perfect. Can we check another one from the same patient, please?
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm not seeing any claim on file for [PII].
[CUSTOMER][NEUTRAL] OK, so I need to send you the.
[CUSTOMER][NEUTRAL] The, the, the claim.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, no plane no flight.
[CUSTOMER][NEUTRAL] OK, can we see another one from the same patient?
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[AGENT][NEUTRAL] I'm not seeing a claim on file for [PII] either.
[CUSTOMER][NEUTRAL] Either, all right. Can we check another one for other data service, please?
[AGENT][NEUTRAL] Same patient?
[CUSTOMER][NEUTRAL] Yes, same patient.
[AGENT][NEUTRAL] OK, what's the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Yes, yes, [PII], yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] It looks like we received this claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was processed.
[CUSTOMER][NEUTRAL] OK, just a moment. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And process on April.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Claim number is 35.
[CUSTOMER][NEUTRAL] The claim number
[AGENT][NEUTRAL] 96591.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like this claim was denied due to office visits not being covered.
[CUSTOMER][NEUTRAL] the office not being covered?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, the night, um Thursday.
[CUSTOMER][NEUTRAL] Can we check the last two for other patients, please?
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you give me the, can you send me the AOB sorry?
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][POSITIVE] Oh, please. Thank you.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] OK, don't worry here.
[AGENT][NEUTRAL] And what's the next patient?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you verify this person's name and date of birth for me please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] Potato service is [PII].
[AGENT][NEUTRAL] What's the total bill amount?
[CUSTOMER][NEUTRAL] 2440.
[AGENT][NEUTRAL] Right, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 3543371.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I was
[CUSTOMER][NEUTRAL] Pay or no?
[AGENT][NEUTRAL] And it looks like it was denied because we need a copy of the uh explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK, we need to send, send the UOB from primary.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Wait, wait, wait, wait, I'm OK just a moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Primary. OK, I will send you. And can we see the last one, please?
[AGENT][NEUTRAL] Same patient or different patient?
[CUSTOMER][NEUTRAL] Same patient, same patient?
[CUSTOMER][NEUTRAL] The date of serve is [PII].
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] [PII], yes, [PII].
[AGENT][NEUTRAL] I'm not, I'm not seeing a claim for that data service.
[CUSTOMER][NEUTRAL] OK, so I send you the claim to
[CUSTOMER][NEUTRAL] To your facts.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] OK, [PII], thank you very much for your patience and all your help.
[CUSTOMER][NEUTRAL] I think we had finished.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's all for today. You have, you have been helpful to me.
[CUSTOMER][POSITIVE] Have a great rest of the day.
[AGENT][POSITIVE] Thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye. See you. Bye.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] 12, my bad.