AccountId: 011433970860
ContactId: cde373f9-ee97-41ac-92e5-766d04f4e053
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1136439 ms
Total Talk Time (AGENT): 307298 ms
Total Talk Time (CUSTOMER): 275058 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/cde373f9-ee97-41ac-92e5-766d04f4e053_20250515T18:34_UTC.wav
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[AGENT][NEUTRAL] Good afternoon and give you calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from provider office looking for the claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, please give me one moment. The patient's policy number is 02322912 M as in Mike, L as in Lima, number 7.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment, [PII].
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] I'm waiting on the system. Do you mind holding for me? I'm just gonna pull another system really quick, OK?
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Ms. [PII], may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, the name is, uh, [PII], and the date of birth is on [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm perfect thank you. Alright, and what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, the date of service is on [PII] and the charge amount is $117 even.
[AGENT][NEUTRAL] OK, no worries, thank you. That's [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Let me see and you said 117.
[AGENT][NEUTRAL] What is the procedure code Mina?
[CUSTOMER][NEUTRAL] Yeah, it's 71046.
[AGENT][NEUTRAL] OK, here it is. Let me pull this EOB.
[AGENT][NEUTRAL] And for future you can check claim status online through our website at [PII] and that's just optional and let's see, it looks like we processed the claim and it was denied. um, let me get the processing date and the received date.
[AGENT][NEUTRAL] OK, so we received the claim on [PII], processed [PII], and the claim was denied.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Services not covering the office setting.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For the, what we need to do for this one?
[AGENT][NEUTRAL] OK, it's up to the provider's discretion, um, the policy doesn't cover any office, um.
[AGENT][NEGATIVE] Of service, so it was fully denied by us.
[CUSTOMER][NEUTRAL] Yeah, it is under the patient plan or providers plan.
[AGENT][NEUTRAL] Under the patient's plan.
[CUSTOMER][NEUTRAL] OK. May I know the patient plan?
[AGENT][NEUTRAL] This is the secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Yeah, it's a mutual medical, right.
[CUSTOMER][NEUTRAL] For that one, can we submit the corrected claim? Changing the CPT?
[AGENT][NEUTRAL] Again, no, we cannot tell you to do that. That's not something we can tell you to do. And it's not covered under the member's plan, so it's not a cover service under the member's plan.
[CUSTOMER][NEUTRAL] OK. Uh, if we change the CPT, it is, uh, it is impossible.
[AGENT][NEUTRAL] So again you can use that to make a deter.
[AGENT][POSITIVE] I cannot, I cannot tell you to do that. I do apologize.
[CUSTOMER][POSITIVE] Yeah, thank you for that one.
[CUSTOMER][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] Can you please provide me the mailing address?
[AGENT][NEUTRAL] Yeah just to submit claims it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] May I, I have the timely filing limit, please?
[AGENT][NEUTRAL] We don't have time final limits.
[CUSTOMER][NEUTRAL] So submit the corrected.
[AGENT][NEGATIVE] We don't have timely filing limits.
[CUSTOMER][POSITIVE] Yeah, thank you
[CUSTOMER][NEUTRAL] May I have the, uh, can you please spell out your name, please?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Yeah, thank you. Can you please provide me the caller number, please?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today if you would like, Miss [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, one moment, we'll go with the next member.
[AGENT][NEUTRAL] How many more claims do you have and how many members?
[CUSTOMER][NEGATIVE] Yeah, 4 more claims. I have with this, I have 3 claims.
[AGENT][NEUTRAL] Different members, the same member?
[CUSTOMER][NEUTRAL] No, it is under the different number. Please give me one moment. Let me pull up the account.
[AGENT][NEUTRAL] They're all different members?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment, let me make a note. I have to make a note on each one of them before I move forward to the next one, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, what is the next policy?
[CUSTOMER][NEUTRAL] Yeah, please, uh, give me one moment, huh?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, one moment. I'll provide you the uh claim number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the, uh, sorry, member's ID number, member's ID number is and
[CUSTOMER][NEUTRAL] 02322912. M as in Mike, L as in Lima, N as number 7.
[AGENT][NEUTRAL] OK, what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, uh, the name is uh [PII], and the date of birth is on [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, uh, the date of service is and
[CUSTOMER][NEUTRAL] Of [PII] and the charge amount is $613 even.
[AGENT][POSITIVE] OK, thank you. Let's see.
[AGENT][NEUTRAL] What is the procedure code?
[CUSTOMER][NEUTRAL] Yeah, one moment, let me check it out once.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, we have the two procedure codes. The procedure codes are 88333 and the second one is 88312.
[AGENT][NEUTRAL] Maybe.
[AGENT][NEUTRAL] 312.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] On it.
[AGENT][NEUTRAL] OK, Ms. [PII], I don't see those procedure codes and I don't see a claim for $613.
[AGENT][NEUTRAL] You think it, it could be another?
[AGENT][NEUTRAL] Amount or another procedure codes?
[CUSTOMER][NEUTRAL] No, the same amount.
[AGENT][NEUTRAL] Yeah, I don't see one for that amount.
[AGENT][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] I'm sorry, you're breaking up. Go ahead.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, one moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, can you please uh provide me the members effective and term rates, please?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, the effective date on the policy is [PII].
[AGENT][NEUTRAL] And it terminated [PII].
[CUSTOMER][NEUTRAL] Yeah, one moment, please.
[CUSTOMER][NEUTRAL] Yeah, thank you for that one. Can you please provide me the mailing address to submit the claim?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][POSITIVE] Yeah, thank you. Uh, we'll go with the next one.
[AGENT][NEUTRAL] OK, let me make a note on this one. You don't need any other information on this one, Ms. [PII]?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] All right. And what is the next policy number?
[CUSTOMER][NEUTRAL] Yeah, it's uh 01986724.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the member's name is uh [PII] and the date of birth is on [PII].
[AGENT][POSITIVE] Perfect. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, the date of service is an
[CUSTOMER][NEUTRAL] [PII] and the charge amount is $423 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That was [PII], correct?
[CUSTOMER][NEUTRAL] Sorry, yes.
[AGENT][NEUTRAL] OK, let me try this other policy. One moment.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] It's gonna be one more minute, OK?
[AGENT][NEUTRAL] I'm waiting on the EOB.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] I'm waiting on the EOB. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, it looks like we received the claim on [PII], processed [PII], and the claim was denied. The reason for this denial is a non-cover service.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, uh, non-cover charges under the patient plan or provider plan.
[AGENT][NEUTRAL] Patient's plan.
[CUSTOMER][NEUTRAL] Yeah, may I know the patient name, please?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can we submit the correct claim on this?
[AGENT][NEUTRAL] You can.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, thank you. The uh mailing address is the same, right? What you provided before?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, thank you for that one. can you please provide me the claim number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] That is 343-1252.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, it's 3431252, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] Thank you. We'll go with the last member.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Yeah, give me one moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, member ID number is 0182309.
[CUSTOMER][NEUTRAL] Number 5, M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, the name is uh [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you. And what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, uh, the date of service is on [PII] and the charge amount is $383 even.
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, [PII]. OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] He.
[AGENT][NEUTRAL] Claim is not on file?
[CUSTOMER][NEGATIVE] OK. One moment, please. My system was stuck.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm yeah.
[CUSTOMER][NEUTRAL] Yes, can we, uh, can you please provide me the uh member's availability dates, please?
[AGENT][NEUTRAL] Yes, uh, effective date [PII] and it terminated [PII].
[CUSTOMER][POSITIVE] Yeah, thank you for that one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, thank you. Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] You as well, Ms. [PII], and thank you for calling ATL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, bye bye.