AccountId: 011433970860
ContactId: d9dd90b8-bb09-462d-9451-e3f541cfc541
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1498900 ms
Total Talk Time (AGENT): 378088 ms
Total Talk Time (CUSTOMER): 411082 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/d9dd90b8-bb09-462d-9451-e3f541cfc541_20250407T16:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi, [PII]. My name is [PII]. Uh, I'm calling from Pro's office to check on a claim status.
[AGENT][NEUTRAL] OK, [PII] back
[AGENT][NEUTRAL] Connected.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, I'm sorry. Your voice is breaking down. Sorry. Can you able to hear me?
[AGENT][NEUTRAL] Yes I can hear you. Can I please get your callback number in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Sure. It's uh [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh yes. I have the patient's uh name as [PII].
[CUSTOMER][NEUTRAL] Uh, and the policy number is 01221549 M as in Mike, L as in Lima, 8, and the date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK and then can you please give me the data service and the charge amount?
[CUSTOMER][NEUTRAL] It's [PII] for $365 365 dollars.
[AGENT][NEUTRAL] OK, and what's the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, it's, uh, showing $65.65 dollars 57 cents.
[AGENT][NEUTRAL] OK, and then
[CUSTOMER][NEUTRAL] Uh, I'm sorry, to, again, your voice is, um, random.
[AGENT][NEUTRAL] What was that again, please, sir? Can you repeat that facility?
[CUSTOMER][NEUTRAL] Uh, I mean like, uh, yeah, it's uh Holy Cross Medical Group.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim and I will be right back sir.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank thank you for hold [PII]. I've got the claim pulled up.
[AGENT][NEUTRAL] The claim number is 357-5458.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was denied because this is a non-covered service if performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK clinic. Uh, all right. And do you see when this claim has received and denied?
[AGENT][POSITIVE] Yes sir, let me check that for you.
[AGENT][NEUTRAL] It's gonna be just a second while I pull it up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] processed [PII].
[CUSTOMER][NEUTRAL] [PII]. All right. And you know, just one last information. If I want this UOB, where can I get the UOB?
[AGENT][POSITIVE] If you can give me your fax number, I'll send it to you right now.
[CUSTOMER][NEUTRAL] Uh yes. Uh, can you, yeah, I can provide the fax number. It's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][NEUTRAL] Uh, and also, can you add my name, uh, attention as?
[AGENT][NEUTRAL] Uh, yes, the last initial is [PII] you said?
[CUSTOMER][NEUTRAL] Uh, it's, it's [PII].
[AGENT][NEUTRAL] [PII] OK, can you spell your first name for me?
[CUSTOMER][NEUTRAL] It's uh [PII]
[AGENT][POSITIVE] OK, thank you very much. It's gonna be a quick hold and I'm gonna get that ready for you and I'll send it. I'll be right back.
[CUSTOMER][POSITIVE] Sure. Thank you.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have that fax on its way to you now.
[CUSTOMER][POSITIVE] OK. I really appreciate that and uh uh you know, I do have like 3 more claims for different members. Can you be able to help me with those claims too?
[AGENT][NEUTRAL] Yes, sir. Can you give me um the next member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sure. And uh there is one last thing regarding this claim. So since it is denying that the services is not covered, so is it showing like a member's responsibility, the balance amount?
[AGENT][NEGATIVE] We don't ever give member a call.
[CUSTOMER][NEUTRAL] OK. All right. Uh, no, no problem. Sure, sure. I'll check with this. No problem. And uh, uh, the next member name is uh [PII].
[AGENT][NEUTRAL] by the provider.
[CUSTOMER][NEUTRAL] And the date of birth is [PII]. And the member ID is 01887319 M as in Mike, [PII] as in [PII].
[AGENT][NEUTRAL] OK, let me pull that policy up real quick.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] It's uh [PII] for $599 599 dollars.
[AGENT][NEUTRAL] OK, and charges after the primary paid their part?
[CUSTOMER][NEUTRAL] Uh, it's $75.
[AGENT][NEUTRAL] OK, and is it for the same facility, [PII]?
[CUSTOMER][NEUTRAL] Uh yes, it's the same facility.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold again. I'm gonna look this one up and I'll be right back.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you, [PII]. I have this one ready for you now. The claim number is 357-539-2. Claim was received on [PII] and processed on [PII]. The claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] the patient's policy. And do you see what is the patient's policy that is?
[AGENT][NEUTRAL] It is Medlik, M E D L I N K.
[CUSTOMER][NEUTRAL] Link. All right.
[CUSTOMER][NEUTRAL] Well, then I'll check with this one and uh yeah, that's it. Yeah, I think I have all the information for this and uh can we go ahead with the next claim?
[AGENT][NEUTRAL] Yes, sir. What's the next patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh yeah. The patient's name is uh
[CUSTOMER][NEUTRAL] It's [PII]. and the date of birth is [PII]. And the member ID is uh
[CUSTOMER][NEUTRAL] 02450184 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, let me pull up that policy.
[AGENT][NEUTRAL] OK, let me repeat the policy, make sure I've got it correct. 02450184 ML8.
[CUSTOMER][NEUTRAL] Uh, yeah, ML 8, yes.
[AGENT][NEUTRAL] OK, and I've got her pulled up and then what is the date of service and the charge amount for her?
[CUSTOMER][NEUTRAL] It's uh [PII] for $459 459.
[AGENT][NEUTRAL] OK, and then after primary paid their part?
[CUSTOMER][NEUTRAL] Uh, it's $60.
[AGENT][NEUTRAL] OK. And Holy Cross again is the facility?
[CUSTOMER][NEUTRAL] Yeah, it's a, yeah, it's the same Holy Cross.
[AGENT][POSITIVE] OK, thank
[AGENT][POSITIVE] Thank you. I appreciate it. I'm gonna put you on a quick hold. I'm gonna look this one up. I'll be right back.
[CUSTOMER][NEGATIVE] Yeah, thank you. You are on hold.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, [PII], I've got the results for this claim.
[AGENT][NEUTRAL] Um, status for you. The claim number is 3575509. Claim was reported on [PII] and processed on [PII], and it was denied for the same reason. Office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] The patient policy. And regarding this one also, do you see what is the patient policy player type is?
[AGENT][NEUTRAL] It's also Medlik.
[CUSTOMER][NEUTRAL] Like, yeah.
[CUSTOMER][NEUTRAL] And, and also it's, it's not showing anything, right? Is it like a patient responsibility or anything?
[AGENT][NEGATIVE] No, sir, we never give patient responsibility.
[CUSTOMER][NEUTRAL] OK. All right. I'll check with this one and uh
[CUSTOMER][NEUTRAL] Uh, can we go ahead with this last claim? I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Thank you. I'm sorry, our phone glitched out for a minute. Are you ready for the next patient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yes, I have the member's name. Uh, whenever you're ready, I can provide that.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] Uh, the date of birth is [PII]. And the member ID is 01067610.
[CUSTOMER][NEUTRAL] Uh, that's all I have actually. Uh, can you just check whether you can be able to access, I mean, like get the patient details?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] Alright, I've got him pulled up now and then what is his data service?
[CUSTOMER][NEUTRAL] Uh, actually, this data service is like, you know, on [PII]. It's like a 01302023.
[AGENT][NEUTRAL] OK, and then what's the charge amount?
[CUSTOMER][NEUTRAL] Well, $1,236.80 80.
[AGENT][NEUTRAL] OK, and then the charges after the primary insurance paid?
[CUSTOMER][NEUTRAL] Uh, and it's, that's not sure exactly, but it is showing 251.
[CUSTOMER][NEUTRAL] Dollars 22 cents.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a quick hold while I look this one up for us and I'll be right back.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you very much for holding for me. I've got this one for us now, um, the claim number is 3393334.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, let me look it up when it was received. Um, we received it on [PII] and processed it on [PII], and the claim was denied because the maximum benefit was met.
[CUSTOMER][NEUTRAL] Yeah. Uh, regarding this claim, actually, we again submitted on [PII], like a through paper. Do you see like a, if you have received this claim again after [PII]?
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEGATIVE] I do not see anything received on [PII].
[CUSTOMER][NEUTRAL] Yeah. The only claim you have is in back, back in [PII], right? Apart after that, you don't have any claim at all.
[AGENT][NEUTRAL] Well, I have a claim that was received on [PII].
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that claim number is
[CUSTOMER][NEUTRAL] Uh, is it Sundance?
[AGENT][NEUTRAL] That claim number is 3473475276.
[CUSTOMER][NEUTRAL] Yeah. Yeah, please
[AGENT][NEUTRAL] And that claim was denied because the policy does not provide benefits for service in which no charges were incurred.
[CUSTOMER][NEUTRAL] Yeah. Uh, do you, do you know exactly what does that mean, uh, the denial?
[AGENT][NEUTRAL] Means there wasn't any charges submitted on the claim, therefore there was nothing to pay.
[CUSTOMER][NEUTRAL] Yeah. All right. uh.
[CUSTOMER][NEUTRAL] Uh, can you give me a moment, just a moment. I just want to check some information.
[AGENT][NEUTRAL] Yes, go ahead.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. OK. Uh thank you for being on hold. I really appreciate that. Yeah, I have this one. no issues, and you don't see like that claim received with the bill amount at all, right, for [PII]?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] Yeah. All right. I'll check with you. And also, if I want, like uh no, what is the general, I mean like normal timely filing to submit the claim?
[AGENT][NEUTRAL] We don't have a a timely filing limit. As long as the policy was active on the date of service, you can file at any time.
[CUSTOMER][POSITIVE] Yeah. All right. I'll check with this and uh, uh, no, I'll check with this, no issues and uh.
[CUSTOMER][NEUTRAL] I think I have all the information for this um. uh, sorry, can I get like a call reference number?
[AGENT][NEUTRAL] Yes, sir. You can use my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] right.
[CUSTOMER][NEUTRAL] Uh, you know, regarding this patient to initially you said that these benefits have been maximum reached, the claim got denied, right. Do you know exactly what is the benefits has reached and do you see any other information for the denial?
[AGENT][NEUTRAL] No, this claim um was not.
[AGENT][NEUTRAL] This is the claim that uh let me look real quick.
[CUSTOMER][NEUTRAL] I mean like a
[CUSTOMER][NEUTRAL] That's uh 2023, yeah.
[AGENT][NEUTRAL] Um, let me look it up real quick.
[AGENT][NEUTRAL] OK, so this is what it says. The maximum amount payable for this occurrence has been met. Per occurrence means treatment for the same or related condition unless separated by a period of 90 days.
[CUSTOMER][NEUTRAL] OK. All right. So, but that's.
[AGENT][NEGATIVE] Treatment, so it needed to be separated by 90 days and it wasn't.
[CUSTOMER][POSITIVE] 260. OK. I'll check with this and uh you know, thank you for confirming that information. And yeah, I got all the information, really appreciate that.
[AGENT][POSITIVE] It's no problem at all. Is there anything else [PII] I can help you with before we go?
[CUSTOMER][NEUTRAL] Uh, no other information.
[AGENT][POSITIVE] OK, well you have a wonderful week and thank you for calling APL.
[CUSTOMER][POSITIVE] And you too have a great day, [PII]. Thank you. Bye now.
[AGENT][POSITIVE] Thank you. Bye-bye.