AccountId: 011433970860
ContactId: c885edb2-85c3-4de7-bd3c-eed8a0da38ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 487649 ms
Total Talk Time (AGENT): 121816 ms
Total Talk Time (CUSTOMER): 268463 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/c885edb2-85c3-4de7-bd3c-eed8a0da38ac_20250305T20:04_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from Pathology Laboratory Associates, and I was trying to see if I can get a claim status update.
[AGENT][POSITIVE] OK, I'll be happy to assist with claim status. I'm sorry, what was your first name?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] [PII] and [PII] if I can get a good call back number for you?
[CUSTOMER][NEUTRAL] Yes, it is [PII] is my direct line.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Yes, excuse me, it is gonna be 01457233.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, for [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active now. Were you calling for dental or medical?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] OK, I do show the policy is currently active. Effective date is [PII], and are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do the I do show the outpatient calendar, your maximum is $2500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Now are you, um, so it looks like a claim was denied. I was just looking into further notes saying that it was noncovered when performed in this place of service. I was trying to figure out what that meant.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And your tax ID?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so it looks like this.
[AGENT][NEUTRAL] Um, with an office setting and the policy covers for outpatient.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So treatment in an office or clinic setting is not covered under the policy.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, treatment in office or um what was it the setting? I'm sorry.
[AGENT][NEUTRAL] Office or clinic setting.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and I'm showing the full balance of the um 8312. It didn't look like you had any adjustments on there. So are you showing that that's the patient's responsibility?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] A full balance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this is part of their plan um that they've chosen or that they selected to have with you all.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and when you say outpatient, do you mean like outpatient surgery type outpatient?
[AGENT][NEUTRAL] Outpatient is treatment and in hospital setting, ER, urgent care, uh, surgical facility, um, MRI facility, diagnostic clinic, anything that's considered outpatient, billing with place of service 22 or 23 or 21.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3844. OK, perfect. And then um I have another one. are you able to help me with that or do I have to call back?
[AGENT][NEUTRAL] Um, one moment, let me just notate this.
[CUSTOMER][NEUTRAL] And I didn't know, [PII], do you have a separate um reference number for um each patient or one for the entire call?
[AGENT][NEUTRAL] It's just my name and today's date and time for both calls.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's that policy number?
[CUSTOMER][NEUTRAL] Yes. It's gonna be 019.
[CUSTOMER][NEUTRAL] 54452.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, it is Summer Lloyd [PII].
[AGENT][NEUTRAL] Data service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your tax ID.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm actually not showing we have a claim for that tax ID for that data service.
[CUSTOMER][NEUTRAL] OK, I had actually called back on [PII], and they said the same thing. They asked me to fax it in, so I did fax in the um claim along with the primary EOB because Blue Cross Blue Shield as primary, um, so they asked me to follow up on [PII] to check to see if you guys had received it.
[CUSTOMER][NEUTRAL] Um, can I give you the fax number to see if that's the correct fax number?
[AGENT][NEGATIVE] I can't search by fax number.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And you're still not seeing it on there?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And you faxed it what day?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] No, I'm not seeing anything.
[CUSTOMER][NEUTRAL] OK. I faxed it to and just let me know if this is incorrect, but I faxed it to [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's not our fax number.
[CUSTOMER][NEUTRAL] Oh, that might be why you haven't received it then. What is the uh correct fax number?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] I came in there.
[CUSTOMER][NEUTRAL] All right, well, I'll fax, I'll re-fax that over so that way that claim gets taken care of and I do have a question for you. I have a patient that um I couldn't find their member ID. I mean, I found the member ID, but does that match your typical member ID? Do all of your ID start with 0 and then a number or can it start with a 6?
[AGENT][NEUTRAL] Mm, um, unless it's a dental policy, it wouldn't start with a 6.
[CUSTOMER][NEUTRAL] OK, yeah, I don't know, um, are you able to do um a search on this person to see if they actually have coverage with you guys?
[AGENT][NEUTRAL] Do you have a social?
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Uh, no, we don't, no, not so I see.
[AGENT][NEUTRAL] What's her name?
[CUSTOMER][NEUTRAL] Um, it is [PII]
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] Address?
[CUSTOMER][NEUTRAL] Mhm. I have [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] We don't have anyone in our system by that name with that address.
[CUSTOMER][POSITIVE] OK, perfect. OK, thank you so much. I really do appreciate it. I'll try to reach out to the patient for that one and I'll go ahead and get that other claim and you'll be uh forwarded to you guys to the correct.
[CUSTOMER][POSITIVE] Oh, does that need to uh be attention to claims department? Oh, OK, OK, alright, I will definitely get that sent over. Thank you so much, [PII], for your help today. I really do appreciate it.
[AGENT][POSITIVE] Correct. Yes.
[AGENT][POSITIVE] Well thank you for calling APL. You have a good day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.