AccountId: 011433970860
ContactId: 9c8aa5af-3912-4d90-be0c-24739eb14581
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 657030 ms
Total Talk Time (AGENT): 166620 ms
Total Talk Time (CUSTOMER): 169447 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/9c8aa5af-3912-4d90-be0c-24739eb14581_20250418T15:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider. Did you call the client status.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can you please spell your first name for me?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, what was that last?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Letter
[CUSTOMER][NEUTRAL] Why?
[AGENT][NEUTRAL] Oh, [PII], OK, thank you Ms. [PII] and then what is your callback number, ma'am just in case our call gets disconnected.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then may I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, the name of the patient is [PII], and the date of birth, [PII].
[AGENT][NEUTRAL] And what is [PII]'s policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2345798.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, let me look her up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] Date of service, [PII]. And it's for the total bill charge amount.
[CUSTOMER][NEUTRAL] 500, uh, I'm sorry, it's $928 even.
[AGENT][NEUTRAL] OK and then can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Cowell Health William Beaumont Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim, Miss [PII], and I'll be right back with you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] I don't want that.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] What
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me [PII]. I do have the claim pulled up. The claim number is 352-219-4.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The claim was denied for two reasons. Um, the policy does not provide a wellness expense benefit, so it's non-covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the medical test for the state of service is not a covered diagnostic test. Therefore, no benefit is payable, so both um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Uh, procedures on the claim were denied it is not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. In this case, we can build the patient for this one.
[AGENT][NEUTRAL] We don't give patient responsibility that's determined by the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Uh, I'm asking you that for these services, we can go ahead and bill the patient since it was patient responsibility, right? It is not covered in the patient plan.
[AGENT][NEUTRAL] We don't give patient responsibility that that's gonna be up to the provider to decide whether or not to bill the patient we do not give that information.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, got it. So the total amount is $928 is, it is the patient, uh patient is responsible.
[CUSTOMER][NEUTRAL] It was not covered under the patient plan, right? Uh, I'm asking you, it was not covered under.
[AGENT][NEGATIVE] No, we don't give patient responsibility.
[AGENT][NEGATIVE] We don't give patient responsibility.
[AGENT][NEUTRAL] Right, it was not covered for the patient's policy.
[CUSTOMER][NEUTRAL] Uh-huh, I
[CUSTOMER][POSITIVE] OK. Thank you so much for that information.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Oh, is this denied unless 01016?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's denied the denial code is there's 2 D2C 0046.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And D282078.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. So could you please fax me that UOB?
[AGENT][POSITIVE] Yes, absolutely. What's your fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, Miss [PII], while I get that fax ready and I'll be right back with you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, just a moment. Are you able to email that UB?
[AGENT][NEUTRAL] I can fax it to you. The EEOB has already been mailed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you very much, [PII], for holding for me. I do have that fax on its way to you now, ma'am.
[AGENT][NEUTRAL] Are you there, [PII]?
[CUSTOMER][POSITIVE] Yes, I do.
[CUSTOMER][NEUTRAL] Oh, I do have one more question. Uh, so I think that we do have received an OB and at the same time number which you have provided. Is that the same one which is not covered?
[AGENT][NEUTRAL] OK, so you have.
[CUSTOMER][NEUTRAL] That you will be received under the claim number 352-2194. We have received it on [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you. Thank you so much for the information provided.
[AGENT][NEUTRAL] You're welcome. Is there anything?
[AGENT][POSITIVE] You're very welcome, Miss [PII].
[CUSTOMER][NEUTRAL] No, thank you. Can I get the call reference?
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome, Miss [PII]. I hope you have a wonderful weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you. You too have a wonderful weekend. Bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you, bye.