AccountId: 011433970860
ContactId: 99a3c24d-e43f-41cd-be80-92e3f9b111aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 859719 ms
Total Talk Time (AGENT): 247600 ms
Total Talk Time (CUSTOMER): 241647 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/99a3c24d-e43f-41cd-be80-92e3f9b111aa_20250113T18:10_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good afternoon and thank you for calling ATO. This is. How can I help you?
[CUSTOMER][NEUTRAL] Hi, myself Bjo. I'm calling from [PII] provided by office. I'm looking for claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status. I didn't quite catch your name. Can you repeat your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm so sorry, but you're not coming in clear. Can you repeat that?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnected Miss [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Patient policy is, first of all, give me your name, please.
[AGENT][NEUTRAL] My name is [PII]'s [PII].
[AGENT][NEUTRAL] That's the initial [PII].
[CUSTOMER][POSITIVE] Thank you, sir.
[AGENT][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] May I have
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Policy number 1281281255.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] So that's 1281255 ML 8.
[CUSTOMER][NEUTRAL] Yes
[AGENT][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] May I have the date of service and the amount of the claims?
[CUSTOMER][NEUTRAL] Date of service [PII].
[CUSTOMER][NEUTRAL] Range of uh sorry.
[CUSTOMER][NEUTRAL] [PII] charges $560.26.
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this claim. And for future, you can check claim status online through our website at [PII] and that's just optional and bear with me.
[AGENT][NEUTRAL] And the amount was 56026.
[CUSTOMER][NEUTRAL] And the amount was 526.
[CUSTOMER][NEUTRAL] 56026.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so it looks like we received the claim [PII], processed [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is that outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient calendar benefit is that right?
[AGENT][NEUTRAL] Outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. And what is claim number?
[AGENT][NEUTRAL] The claim number is 3534494.
[CUSTOMER][NEUTRAL] 354 4
[AGENT][NEUTRAL] 353-449-4
[CUSTOMER][NEUTRAL] Sorry, your voice is break. Could you repeat that?
[AGENT][NEUTRAL] 353-4494.
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you and denied it.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] November 26th.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Call reference number. I have 2 more claims, so please give me details.
[AGENT][NEUTRAL] No we don't have reference numbers, so you can use my name and today's date if you will, and I need to make a note on each one before I move forward to the next one, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] 34.
[AGENT][NEUTRAL] OK go ahead with the next policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Policy
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number is 016.
[CUSTOMER][NEUTRAL] 11745
[CUSTOMER][NEUTRAL] MM 7.
[AGENT][NEUTRAL] May I have
[AGENT][NEUTRAL] OK, may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] OK his name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Date of service [PII], Ranger [PII]. Charges $135,338.48. 13533848.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. So this one we processed twice. One is the original and the other one is gonna be the um denied as a duplicate.
[CUSTOMER][NEUTRAL] Alright, so this one we processed twice. One is the original and the other one is gonna be the, um, that I have the duplicate. Mhm.
[AGENT][NEUTRAL] OK, so the original one was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] The original one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the original one is needing the explanation of benefits from the primary insurance to continue the processing of this claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] We received another claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] 349.
[AGENT][NEUTRAL] 6646.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] Sorry, 349.
[AGENT][NEUTRAL] 6646.
[CUSTOMER][NEUTRAL] 6646
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the most recent one was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] The one.
[AGENT][NEGATIVE] And it's a duplicate because we did not receive the EOB attached to it, so we're still missing the EOB primary EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. And
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Give me your address, please.
[AGENT][NEUTRAL] The address is to make claims?
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[AGENT][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] For your information.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK. Hope you will be you will be submission mailing address, please.
[AGENT][NEUTRAL] Uh, yeah, it's gonna be the same address as the claims submission, so it's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with today with this?
[CUSTOMER][NEUTRAL] No, this claim is done. I have one more claim left, so please give me.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK. Sure. Let me go ahead and make a note on this one, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Look
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] the policy number?
[CUSTOMER][NEUTRAL] Next policy number is uh
[CUSTOMER][NEUTRAL] Just a moment. Yes, 0247.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 3482 ML 8.
[AGENT][NEUTRAL] And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] of
[CUSTOMER][NEUTRAL] Yeah. [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] What's the total charge?
[CUSTOMER][NEUTRAL] $1,376.15.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank.
[AGENT][NEUTRAL] OK, we received the claim on [PII] process [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And we need this primary EOB to process the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] be.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Give me claim number.
[AGENT][NEUTRAL] The claim number is 3501708.
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 708.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Mm.