AccountId: 011433970860
ContactId: d0329bbf-06c4-4ee1-a98f-e283dc56a9f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 576179 ms
Total Talk Time (AGENT): 159461 ms
Total Talk Time (CUSTOMER): 194309 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/d0329bbf-06c4-4ee1-a98f-e283dc56a9f2_20250106T19:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I
[AGENT][NEUTRAL] Can I help you?
[CUSTOMER][NEUTRAL] Yeah, this is [PII] calling from Galen Medical Group and please be noted this call is being recorded for quality and training purpose. Is that OK?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] And may I please know your name? Could you please spell your name?
[AGENT][NEUTRAL] My name is
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Could you please spell that?
[CUSTOMER][NEUTRAL] [PII] and last initial?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yeah, thank you so much for that [PII] and I'm calling regarding, yeah, uh yeah, please go ahead.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Go ahead. Please continue, sir.
[CUSTOMER][NEUTRAL] I'm calling regarding a denied claim today and I'm calling regarding that. I need information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], I can help you with that. First, can I get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes, the callback number would be [PII], no extensions, that's a direct line.
[AGENT][NEUTRAL] OK, thank you, [PII], and then you need claim, uh, help with the claim that was denied. Can you please give me uh the claim reference number?
[CUSTOMER][NEUTRAL] Sure I have the reference number it's 018412777.
[AGENT][NEUTRAL] OK, let me look at that.
[AGENT][NEUTRAL] What is the name of the insured, please?
[CUSTOMER][NEUTRAL] Insured name is [PII].
[AGENT][NEUTRAL] OK, and what is the insured's date of birth?
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] What was that again, sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is the insured's policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 018412777.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what's [PII] uh date of service?
[AGENT][NEUTRAL] For this claim?
[CUSTOMER][NEUTRAL] D of service is, yeah, it's [PII].
[AGENT][NEUTRAL] And then the charge amount?
[CUSTOMER][NEUTRAL] Charge amount is $222 even.
[AGENT][NEUTRAL] OK, and what was the charge amount after primary paid their part?
[CUSTOMER][NEUTRAL] Primary has paid $61.95 and $25 was the patient responsibility from primary insurance.
[AGENT][NEUTRAL] OK. And then can you spell the name of the facility for me, please?
[CUSTOMER][NEUTRAL] Sure, facility name is.
[AGENT][NEUTRAL] That you're calling from?
[CUSTOMER][NEUTRAL] Yeah, it's Galen Medical Group.
[CUSTOMER][NEUTRAL] You want me to spell that toy?
[AGENT][NEUTRAL] Galen Medical Group. OK.
[AGENT][NEUTRAL] Alright Guru, I'm gonna put you on a brief hold. I'm gonna look that claim up and I'll be right back.
[CUSTOMER][NEUTRAL] Sure. You are on hold.
[AGENT][NEUTRAL] OK, OK, thank you for holding for me so I do have the claim pulled up and let me give you that claim number.
[AGENT][NEUTRAL] The claim number is 353-9163.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you are correct, the claim was denied.
[CUSTOMER][NEUTRAL] I do have that infoory.
[AGENT][NEUTRAL] OK, the claim was denied because office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is the balance $25 a patient responsibility now?
[AGENT][NEUTRAL] I cannot give patient responsibility that's determined by the provider.
[CUSTOMER][NEUTRAL] Yeah, and the primary has paid its spot and the patient responsibility is the secondary insurances spot now secondary insurance you have denied the claim, and that would probably be a patient responsibility, right? Office visits are not covered under the patient's plan, am I right?
[AGENT][NEUTRAL] I can't
[AGENT][NEUTRAL] Right, the office visits are not covered, but I am not able to confirm that it is the patient's responsibility that's determined by the provider.
[CUSTOMER][POSITIVE] OK, that is fine. Thank you so much for that. And may I know if this is a Medicaid plan?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Not a Medicaid plan. OK. Is this a supplement plan?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And may I know which supplement?
[CUSTOMER][NEUTRAL] Plan is this
[AGENT][NEUTRAL] It's called Medlink M E D L I N K.
[CUSTOMER][NEUTRAL] Meddling benefit of assignment, am I right?
[AGENT][NEUTRAL] It's Medlink.
[CUSTOMER][NEUTRAL] OK, and are
[CUSTOMER][NEUTRAL] Yeah, I have that info and one moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, may I know whether this plan covers co-pays for the patient from primary?
[AGENT][NEUTRAL] Yes, this plan and this is to verify benefits it's not a guarantee of payment. This plan does help with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] OK, is that because only office visits are not covered, the copay related to office visit is not covered under this plan. Am I right?
[AGENT][POSITIVE] Right, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] And just a moment, let me just check some more information.
[CUSTOMER][NEUTRAL] And yeah
[CUSTOMER][NEUTRAL] Do you have any allowed amount for this charge 99214?
[AGENT][NEUTRAL] Uh, I don't know about that because we only go by what the primary pays. So in order for us to know what's paid, we have to receive the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] OK, was this denied because there is no primary EOB at your end?
[AGENT][NEGATIVE] No, it was denied because office visits are not covered by the member's policy.
[CUSTOMER][NEUTRAL] OK, that is fine.
[CUSTOMER][NEUTRAL] And you will have a fee, you will have a fee schedule, right, sorry.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And you might have an allowed amount either for this charge. Don't you have that at your end?
[AGENT][NEUTRAL] There isn't allowed amount because it's a non-covered service.
[CUSTOMER][NEUTRAL] OK, that is fine, thank you so much for that and may I please have the call reference number?
[AGENT][NEUTRAL] Yes sir you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Yeah, thank you so much for assisting me today, [PII]. I really appreciate it and you have a wonderful rest of your day.
[AGENT][POSITIVE] You too, thank you for calling APL. You have a blessed one. You take care.