AccountId: 011433970860
ContactId: df6dd9dd-0c46-4a7e-b94a-783728e0bc33
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1456099 ms
Total Talk Time (AGENT): 302403 ms
Total Talk Time (CUSTOMER): 244526 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/2025/01/13/df6dd9dd-0c46-4a7e-b94a-783728e0bc33_20250113T14:41_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi, [PII]. This is [PII] calling from provider's office to check with the claim status.
[AGENT][NEUTRAL] OK. Um, I'm so sorry. I'm having trouble hearing you. Um, can you repeat your name?
[CUSTOMER][NEUTRAL] Yeah, this is [PII] calling from provider's office to check the claim status.
[AGENT][NEUTRAL] OK, can I get a good contact number for you?
[CUSTOMER][NEUTRAL] Is my voice OK?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Can I get a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, and what provider's office are you calling with?
[CUSTOMER][NEUTRAL] Health for Community Healthcare.
[AGENT][NEUTRAL] OK. And what is the policy number?
[CUSTOMER][NEUTRAL] The policy number is D as in Delta.
[CUSTOMER][NEUTRAL] 420
[CUSTOMER][NEUTRAL] 053
[CUSTOMER][NEUTRAL] 19
[AGENT][NEUTRAL] OK, um, that is not one of APL's policy numbers. Do you have an alternate policy number on file or the card where we can review the card?
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] It
[CUSTOMER][NEUTRAL] Um, this is the ID number which I have and it states here that this is the IMA.
[CUSTOMER][NEUTRAL] Insurance, I called IMA Insurance and they have transferred the call to American Public Life.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Since they are not a part of covering the medical.
[AGENT][NEUTRAL] OK, that's fine. Um, do you have your patient's name?
[AGENT][NEGATIVE] Because that policy number's not gonna pull up.
[CUSTOMER][NEUTRAL] Yeah, patience
[CUSTOMER][NEUTRAL] Patient's name, [PII].
[AGENT][NEUTRAL] Can you spell that for me?
[CUSTOMER][NEUTRAL] Yeah, sure. First name, [PII].
[CUSTOMER][NEUTRAL] And the last name, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, give me just one minute, let me see if I can get them pulled up.
[AGENT][NEUTRAL] OK, can you verify the name and or the date of birth? I'm sorry, I already have the name. Can you verify the date of birth for me?
[CUSTOMER][NEUTRAL] Patient's date of birth is [PII].
[AGENT][NEUTRAL] Perfect. OK, I did find that policy. Um, what is the date of service and build amount of time we need to review?
[CUSTOMER][NEUTRAL] D of service for the claim is [PII] with the total charged on $170 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I get your last name initial [PII]?
[AGENT][NEUTRAL] Yes, that's gonna be [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so it looks like I do have that claim.
[AGENT][NEUTRAL] It is claim number 352.
[AGENT][NEUTRAL] 6479.
[AGENT][NEUTRAL] Um, we received that claim on.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] We received it on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] And that claim was denied and that denied reasons.
[AGENT][NEUTRAL] Is that the calendar year maximum for outpatient office visits um has been met for that calendar year.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] You said the calendar year maximum for outpatient visit.
[AGENT][NEGATIVE] Yeah, calendar had been bad.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] May I know how many
[CUSTOMER][NEUTRAL] It's allowed for this.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Patient. And I want to know if the dollar value got matched or the visit got matched?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, so the visits are that they are allowed for physicians office visits to the, um, injury or sickness per year.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] How
[AGENT][NEUTRAL] Your
[CUSTOMER][NEGATIVE] Uh, I do apologize, [PII], you are cutting in and out and I barely understand you.
[AGENT][POSITIVE] OK, I'm so sorry.
[AGENT][NEUTRAL] So they're allowed 4.
[AGENT][NEUTRAL] Physician's office visit for calendar year?
[AGENT][NEUTRAL] In part to the time they had maxed out that number.
[CUSTOMER][NEUTRAL] Uh, what is the
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] What is the number of visits is allowed for office visit?
[AGENT][NEUTRAL] They are a lot 4 per year.
[CUSTOMER][NEUTRAL] 4 visits per year, right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Uh, can I get the
[CUSTOMER][NEUTRAL] The past date of services which
[CUSTOMER][NEUTRAL] Where the was already paid.
[AGENT][NEUTRAL] Um, unless it is in relation to your office.
[AGENT][NEUTRAL] We are not um going to be able to provide informational physician's office.
[AGENT][NEUTRAL] You can ask about other claims for this insurer or your provider, but I can't help you with other physician.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] This patient responsible for this amount?
[AGENT][NEUTRAL] Um, we do not make that determination.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] So the remaining balances will be up to the or the facility and how to handle.
[CUSTOMER][NEGATIVE] I really apologize. I couldn't hear you properly. Your voice is so noisy.
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][POSITIVE] And I just hear a blushed voices from.
[AGENT][NEUTRAL] OK, I'm so sorry. I'm not really sure what's going on, um.
[AGENT][NEUTRAL] We do not make that determination. Any remaining balances are up to the office.
[CUSTOMER][NEUTRAL] And you state the claim number is 3526479, right?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] So what we can do to support clients.
[AGENT][NEUTRAL] Sorry, what was that?
[CUSTOMER][NEGATIVE] So what we can do for this denial to get rectified.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I mean if you disagree, you can submit an appeal.
[AGENT][NEUTRAL] But other than that,
[AGENT][NEUTRAL] There's not really that includes our participation.
[CUSTOMER][NEUTRAL] one
[CUSTOMER][NEUTRAL] I was like
[CUSTOMER][NEUTRAL] Can I get the uh mailing address?
[AGENT][NEUTRAL] Yeah, give me just one second.
[AGENT][NEUTRAL] So you're going to send it to attention.
[AGENT][NEUTRAL] Appeals
[AGENT][NEUTRAL] And that is going to be sent to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] And that is the state of [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What was the apple timely filing limit?
[AGENT][NEUTRAL] Um, we don't adhere to a strict at all.
[CUSTOMER][NEGATIVE] You don't have apple timely
[AGENT][NEUTRAL] Can you
[CUSTOMER][NEUTRAL] Uh, sorry, I, I barely I barely hear you. You say there's no time you're filing for a field, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, one moment
[CUSTOMER][NEUTRAL] Also for the same patient, I do have 2 more clients for today.
[CUSTOMER][NEUTRAL] With the different data service
[CUSTOMER][NEUTRAL] my
[AGENT][NEUTRAL] Sure, one of those states is that?
[CUSTOMER][NEUTRAL] The next date of service is on.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] to charge
[CUSTOMER][NEUTRAL] of the
[CUSTOMER][NEUTRAL] Total charged amount is $243.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do have that claim.
[AGENT][NEUTRAL] It is 354.
[AGENT][NEUTRAL] 2312.
[AGENT][NEUTRAL] Um, we received that.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] And the process on [PII].
[CUSTOMER][POSITIVE] I do apologize
[CUSTOMER][POSITIVE] Really understand your voice because your voice is so noisy.
[CUSTOMER][NEUTRAL] I'm just hearing one or two words from yours.
[CUSTOMER][POSITIVE] I, I apologize for
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] On the claim number which I
[CUSTOMER][NEUTRAL] sure does 354.
[CUSTOMER][NEUTRAL] 31
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][NEUTRAL] Um, 2312.
[CUSTOMER][NEUTRAL] 3543316. Is that right?
[AGENT][NEUTRAL] No, sir. 3542312.
[CUSTOMER][NEUTRAL] What is the claim due date?
[AGENT][NEUTRAL] Um, [PII]
[CUSTOMER][NEUTRAL] new site
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, what, what is the denial date?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. What is the denial
[AGENT][NEUTRAL] Um, maximum office visits for calendar year have met.
[CUSTOMER][NEUTRAL] Same to previous, right?
[CUSTOMER][NEUTRAL] You already said that the
[CUSTOMER][NEUTRAL] Of visit is allowed 4 visits per year, right?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] By any chance, can I get the
[CUSTOMER][NEUTRAL] Can I get for which date of service it was already paid to?
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] They help for visit.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it looks like they maxed out with that.
[AGENT][NEUTRAL] That
[CUSTOMER][NEUTRAL] Sorry, can you just come again? I couldn't stereo properly.
[AGENT][NEUTRAL] And that out for offices it's in February.
[CUSTOMER][NEUTRAL] Uh, is the office busy?
[CUSTOMER][NEUTRAL] Or 5 or 6 for you because I will check here the
[CUSTOMER][NEUTRAL] APL was paid 5 times for the office visit.
[CUSTOMER][NEUTRAL] In different date of service
[AGENT][NEUTRAL] OK, well, it's not seriously that was done in error.
[AGENT][NEUTRAL] And that would be our mistake. Um, it's not a mistake that we have found on our end. Um, they are only allowed for calendar.
[CUSTOMER][NEUTRAL] Shall we move to the last data service for the same patient?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 18 of 202
[AGENT][NEUTRAL] And that's
[AGENT][NEUTRAL] Mm mhm.
[AGENT][NEUTRAL] OK, what was that to talk about?
[CUSTOMER][NEUTRAL] Total charge of 301.
[AGENT][NEUTRAL] 80301.
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 1118 of 2024 for the total charge amount $301.
[AGENT][NEUTRAL] Yes, I do have that claim.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 353.
[AGENT][NEUTRAL] 70
[AGENT][NEUTRAL] 9
[AGENT][NEUTRAL] Um, it's the same.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] It was processed [PII].
[AGENT][NEUTRAL] the same reason.
[CUSTOMER][NEUTRAL] But
[AGENT][POSITIVE] Yeah, thank
[AGENT][NEUTRAL] Um, just send me a filter.
[AGENT][NEUTRAL] Is that what you're asking the for?
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Yes, give me just one moment.
[AGENT][NEUTRAL] OK, so the fax number is going to be.
[AGENT][NEUTRAL] 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 9 423.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] 942
[CUSTOMER][NEUTRAL] like
[CUSTOMER][NEUTRAL] Any attention
[AGENT][NEUTRAL] Um, just attention appeals.
[CUSTOMER][NEUTRAL] Can I get the call reference number for?
[AGENT][NEUTRAL] Sure, it's just gonna be my name today.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] That initial
[CUSTOMER][NEUTRAL] And today's date, right?
[AGENT][POSITIVE] Correct
[CUSTOMER][POSITIVE] Thank you. Have a great day. Bye-bye. Bye for now.
[AGENT][POSITIVE] Thank you. Have a great day and thanks for calling us here.