AccountId: 011433970860
ContactId: ad5be13f-ff46-4dd8-8270-603603f44fa4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 669099 ms
Total Talk Time (AGENT): 245280 ms
Total Talk Time (CUSTOMER): 311134 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/ad5be13f-ff46-4dd8-8270-603603f44fa4_20250626T13:07_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting ATL. My name is. How may I help?
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII]. I'm calling from provider's office to check the claim status. Good morning.
[AGENT][POSITIVE] Good morning. Well, I can certainly help with the claim status. What's that policy number, please?
[CUSTOMER][NEUTRAL] Yes, uh, before going ahead, this call is being recorded for quality and training purpose. Um, the policy, uh, would you like us to continue recording?
[AGENT][NEUTRAL] I beg your pardon?
[CUSTOMER][NEUTRAL] Uh, actually, this call is being recorded for quality and training purpose. Would you like us to continue the recording?
[AGENT][NEUTRAL] Right, no, I.
[AGENT][NEUTRAL] Oh, it doesn't matter to me. Um, what is the policy number, please, that I can look up?
[CUSTOMER][NEUTRAL] OK. Uh 0241.
[CUSTOMER][NEUTRAL] 9374
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. Is there a callback number I could have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is um is there a callback number please in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, yes. Um [PII] and the extension [PII].
[AGENT][NEUTRAL] [PII]. Thank you very much. What date of service are we looking for?
[CUSTOMER][NEUTRAL] So, I'm looking for claims status.
[AGENT][NEUTRAL] Right, um, and the date that the date of service.
[CUSTOMER][NEUTRAL] OK. It will be um um [PII] and the bill amount is $500 even.
[AGENT][POSITIVE] OK, yes, I can help with that.
[AGENT][NEUTRAL] It looks like your claim number on this.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] It looks like it was submitted a couple of times that your claim number on this is 35.
[AGENT][NEUTRAL] 78.
[AGENT][NEUTRAL] 458. And if you don't mind, I'm gonna go ahead and repeat that because I'm having a little trouble with my phone. The claim number is 357-845-8.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we received that claim.
[AGENT][NEUTRAL] On the [PII], we process it on the [PII].
[AGENT][NEUTRAL] Now, this policy does not cover office visits, so this was denied due to the insured policy.
[CUSTOMER][NEUTRAL] Uh, yes, um, and by the way, um, what's your name? Uh, actually, I didn't get the starting.
[AGENT][NEUTRAL] Uh yes, my name is [PII], that's [PII] and the first initial of my last name is K.
[AGENT][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] Yes, indeed. Actually, um, previously, the claim was, you know, um, uh, denied for the primary OB, uh, what I can see on my system previously. So, uh, we have seen the primary OB on uh [PII]. So you are telling me the status, you know, after you receive the primary OB or uh just uh, you know?
[AGENT][NEUTRAL] Yes, well, that's what I was saying is that it had been submitted a couple of times. Let's go back and see because there there was one where it was submitted with another, uh, with another, um, uh, charge, uh, CPT code 446,600. Now that was paid so let me get to the claim where that was paid. Excuse me just a minute please. So one of the CPT codes was paid.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh OK, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And one of them was not and then this office visit was submitted twice and that's what I meant when I said it was it's been sent in a couple of times. So let's look at that. Let's look at uh.
[CUSTOMER][NEUTRAL] OK, OK. OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So there's another claim number, same, same charges.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, that claim number is 35.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 67.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 113.
[AGENT][NEGATIVE] Now, the the CPT code 99203 was not paid, the one for $500 that is not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, OK. Mhm.
[AGENT][NEUTRAL] The other CPT code was paid that 46,600 that was paid and we paid $60.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK. Just one moment, OK. Um, just one moment, um, [PII].
[AGENT][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] At this time verifying, you know, the CPT just one moment. Um.
[CUSTOMER][NEUTRAL] Yes, yes, uh, you are correct. Uh, I have paid the 4 CPT 46,600. And uh, so just tell me one thing, um.
[CUSTOMER][NEUTRAL] Um, [PII], uh, uh, when was you received the primary UB, the primary UB uh received date?
[AGENT][NEUTRAL] Uh, we received the primary EOB.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I, and I do apologize. Like I said, my computer's so, so for that, for the prime, you know, we had originally asked for the primary EOB we received it on [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And we processed it and paid that one CPT code on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2025. So we received that claim.
[AGENT][NEUTRAL] On [PII], right, but then, but then somebody sent in the, the office again and that's when we denied it again.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, OK. So, actually, uh, I just need, need the status, you know, for the CPT 992033. So only, we are, we will, uh, I just need the status of that uh code, you know, 99203. So you said you received the primary will be on [PII] and uh on [PII], you denied the claim because I made does not cover any office visits as per the member's plan, right?
[AGENT][NEGATIVE] But we did, but we pay, yes, but we paid the, the other, the other charge. So yes, the 9999203, the status of that is that it's always going to be denied.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] Because it's not covered.
[CUSTOMER][NEUTRAL] OK, OK. So, um,
[CUSTOMER][NEUTRAL] Yes, indeed, but uh as I said, uh, you know, I, I don't need uh the status of the paid claim. Uh, yes, we, we are working on, you know, the denied claim. So no need to um
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes, yes. So, OK, just one moment. So, uh for the CPT code 99203, the claim number is 3567113. Am I right?
[AGENT][POSITIVE] Uh, that is right, yes.
[CUSTOMER][NEUTRAL] OK. And you see the primary will be on [PII]. And uh what was the denial date uh when, when you denied the claim on [PII]?
[AGENT][NEUTRAL] That was, it was, uh, [PII].
[CUSTOMER][NEUTRAL] OK, OK. Just, thank you, thank you. Just one moment, OK? And just tell me the patient plan name, uh, uh, patient plan name.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] It's called um Meddling, [PII].
[CUSTOMER][NEUTRAL] At.
[CUSTOMER][NEUTRAL] OK. Actually, I was, uh, you know, I, I think uh I was unable to hear it clearly. Just, could you repeat again, uh, just go slow while telling the uh plan name.
[AGENT][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] It's called [PII], and I'll spell that out for you. It's um [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. [PII], you said, [PII].
[AGENT][POSITIVE] That, that's right.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um, could you spell, um, um, [PII], or just the last time. Could you spell the plain name? I think I have missed 11 or two words, that's why.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, of course, um.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Need like
[CUSTOMER][NEUTRAL] OK. [PII]. OK. [PII]. OK, OK, got it, got it.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, as per this member's plan, the uh office will not cover as per the member's plan. Um, so this should be patient responsibility, I think. Um, OK.
[CUSTOMER][NEUTRAL] So, um
[CUSTOMER][NEUTRAL] Just one moment, I'm almost done. OK.
[CUSTOMER][NEUTRAL] [PII], just one moment, OK? I'm almost done. I just need the call reference number, then you will uh just disconnect, just one moment.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, just let me know when you're ready.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] And [PII], I have, and the last question.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So, uh, 44 99203.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] We have transferred uh the copay amount or the deductible amount, because I, I am unable to see, just one moment, OK?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 78
[CUSTOMER][NEUTRAL] But uh I have one question, uh, [PII], I have one question. I think uh you have paid uh uh one moment. OK, one moment. Uh OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm, I'm done. Just uh tell me the call reference number, [PII].
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] That's [PII] and we're gonna use that in today's date, the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and today's date, right?
[AGENT][POSITIVE] That's correct, yes. That's right.
[CUSTOMER][NEUTRAL] Your name and today's date.
[CUSTOMER][NEUTRAL] OK. Uh, uh, I was asking.
[AGENT][NEUTRAL] Is there anything else that I can help you?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes, this is, this is your last question. OK. So, uh, uh, we have a transfer $371 to uh American public. It, it is, it was deductible copay, um, [PII], could you see from your side?
[AGENT][NEUTRAL] And, and how much was it again?
[CUSTOMER][NEUTRAL] Uh, 371.20. So it is, it was a copy or dicable. Uh, I'm just cross-checking, uh, you know.
[AGENT][NEUTRAL] It looks like a coca
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, it was coy. OK, thank you. Thank you. Bye, [PII]. Have a great day.
[AGENT][POSITIVE] OK, well thank you for contacting ACL. You have a very good day.