AccountId: 011433970860
ContactId: ec6fd231-8b53-4532-b178-f4c20a2abef4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1411719 ms
Total Talk Time (AGENT): 368746 ms
Total Talk Time (CUSTOMER): 217026 ms
Interruptions: 3
Overall Sentiment: AGENT=0, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/ec6fd231-8b53-4532-b178-f4c20a2abef4_20250619T14:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm checking for status on a claim please.
[CUSTOMER][NEUTRAL] Oh, I called earlier you're the same person.
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Um, is it for the same patient?
[CUSTOMER][NEUTRAL] Yeah, I wasn't able to upload, yeah, I can't let like 20 accounts go. I apologize. I was hoping to get someone else so that way we can kinda.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Go through
[CUSTOMER][NEUTRAL] Proof that anything can be. Sorry.
[AGENT][NEUTRAL] Alright, can you go ahead and re-verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Uh, it's [PII] [PII] [PII] [PII].
[AGENT][NEUTRAL] And is it for a different date of service?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, what's the next date of service?
[CUSTOMER][NEUTRAL] Trying to get
[CUSTOMER][NEUTRAL] Um, it is [PII].
[CUSTOMER][NEUTRAL] For $2,508.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Alright, and what was the total bill amount again?
[CUSTOMER][NEUTRAL] Uh, 3000, sorry, this one is.
[CUSTOMER][NEUTRAL] $508.
[AGENT][NEUTRAL] 508. OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, the total bill amount on aren't on any of these, so give me just a moment.
[AGENT][NEUTRAL] Do you have one that's for $933?
[AGENT][NEUTRAL] Maybe that would be easier. OK, because the total bill amount aren't on these for some reason, so I'll just go down one by one if that's alright with you, and I can do it that way if that's easier, OK.
[CUSTOMER][POSITIVE] Yes, I do.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, this claim number for the 933 is 42, I'm sorry, 32. 0 my gosh. Give me just a second. It is 3424146. OK.
[CUSTOMER][NEUTRAL] I tell you what, give me one second. You said that it was for the 9th. I apologize give me 1 2nd.
[AGENT][NEUTRAL] 933.
[CUSTOMER][NEUTRAL] Wait, sorry.
[CUSTOMER][NEUTRAL] All right, so one more time.
[AGENT][NEUTRAL] The claim number for the 933 is 34.
[AGENT][NEUTRAL] 24146.
[AGENT][NEUTRAL] And that claim was denied because the services were not covered. It looks like laboratory tests performed to diagnose for the treatment for illness is not covered under this policy except when performed in a physician's office and billed by the physician.
[CUSTOMER][NEUTRAL] Any way to get a copy of that or?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And again to confirm the fax number [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I just sent that over.
[CUSTOMER][NEUTRAL] What was the date that that process is on?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] It looks like we received that claim on [PII].
[AGENT][NEUTRAL] And it was processed.
[AGENT][NEUTRAL] That's weird.
[AGENT][NEUTRAL] I think it's a typo, um, I think it was processed on.
[AGENT][NEUTRAL] It says it was processed on [PII].
[AGENT][NEUTRAL] Uh let me see.
[CUSTOMER][NEUTRAL] So before the [PII] because I thought you said [PII].
[AGENT][NEUTRAL] It does let me see what's going on here.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Let me see what's going on here because yes I am showing that so I'm wondering if it's a typo.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] And this is [PII]. It's not a big deal. It's not covered anyway, so it's cool.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let's see the next one.
[AGENT][NEUTRAL] And it looks like there's another one that's diagnostic.
[AGENT][NEUTRAL] Um, it looks like it was charged the amount of $28.
[AGENT][NEUTRAL] Do you have one for that?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that one got denied because diagnostic tests are limited to MRI, CTs, and colonoscopy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know when it was processed on?
[AGENT][NEUTRAL] Looks like it was processed the same.
[AGENT][NEUTRAL] We got it on [PII] and it was processed on the [PII], and I am looking into that as well.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] And then the claim number when you get a chance.
[AGENT][NEUTRAL] OK. It is 34.
[AGENT][NEUTRAL] 238.
[AGENT][NEUTRAL] 29.
[CUSTOMER][NEUTRAL] If you can fax that whenever you can.
[AGENT][NEUTRAL] OK just a moment.
[AGENT][NEUTRAL] Alright, I got that one sent over.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and the next one, it looks like it was for the amount of $319. Does that sound right?
[CUSTOMER][NEUTRAL] It's on um I just saw it [PII] right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][POSITIVE] Thank you, yes, I have it.
[AGENT][NEUTRAL] OK, that one we received it on [PII] and it was processed the next day on [PII].
[AGENT][NEGATIVE] It looks like that one was denied.
[AGENT][NEUTRAL] Because the policy provides no benefits for charges made by a doctor for inpatient visits.
[CUSTOMER][NEUTRAL] Is there a claim number?
[AGENT][NEUTRAL] Yes, it is 34.
[AGENT][NEUTRAL] 237-71.
[AGENT][NEUTRAL] I just sent that fax over.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the next one I had is that uh 3,364.
[AGENT][NEUTRAL] And you have the information for that one still correct?
[CUSTOMER][NEUTRAL] Is that the last one we did, or?
[AGENT][NEUTRAL] Yes, that was the last one. I think we did, yes, 300 or 3,364. Yes, ma'am.
[CUSTOMER][NEUTRAL] Is that the that's the one you're gonna send over right?
[AGENT][NEUTRAL] Let's see what
[AGENT][POSITIVE] The check clear date, yes. That one should be sending um today. Yeah, yeah, that one.
[CUSTOMER][NEUTRAL] Oh yeah, send that.
[CUSTOMER][POSITIVE] Oh good thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And let's see what the next one is.
[AGENT][NEUTRAL] Looks like the next one is for $2,508.
[CUSTOMER][NEUTRAL] That's a big one. I really wanted to know. Yeah, there's two different ones, or is it just one that you see?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] One of the big ones was in that last claim. It was processed in that last claim that we just went over.
[CUSTOMER][NEUTRAL] I have 2.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Oh, yes, I am seeing two. OK, I am seeing two for about the same for about the same amount, 2508. Yeah.
[CUSTOMER][NEUTRAL] OK, whereas inpatient.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] They are this, yeah, the one doctor is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Starts with an S and the other one starts with an A.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can't pronounce it.
[CUSTOMER][POSITIVE] Well the surgery do well.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Go ahead, graphic.
[CUSTOMER][NEUTRAL] Cardioathic can't pronounce it.
[AGENT][NEUTRAL] Let me see where that one is.
[AGENT][NEUTRAL] OK, the next one I have, or the one for one of the ones I have for 2508, uh, it looks like we received it on [PII] and it was processed on [PII].
[AGENT][NEGATIVE] It looks like that claim was denied.
[AGENT][NEUTRAL] Due to the maximum amount um uh payable under the surgical, then it had been exhausted for that date of service.
[CUSTOMER][NEUTRAL] It's a claim number whenever you're ready.
[AGENT][NEUTRAL] It is 34.
[AGENT][NEUTRAL] 21895.
[CUSTOMER][NEUTRAL] And if there is um a claim number I mean an EOB that would be great if I could get that.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, I can send that one over.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, it looks like the next one is again for the $2,508.
[AGENT][NEUTRAL] We got this claim on [PII].
[AGENT][NEUTRAL] It processed on [PII].
[CUSTOMER][NEUTRAL] Is there a claim number for that one?
[AGENT][NEUTRAL] It is 3421898.
[AGENT][NEUTRAL] And it looks like we paid $400 to this claim.
[CUSTOMER][NEUTRAL] Alright, we got a payment here.
[CUSTOMER][NEUTRAL] And how much was the payment again? 400 and.
[AGENT][NEUTRAL] 400 even.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And is there a check number or?
[AGENT][NEUTRAL] The check number is 184.
[AGENT][NEUTRAL] 0263.
[AGENT][NEUTRAL] And did you wanna fax of that EOB as well?
[CUSTOMER][POSITIVE] Please, definitely.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] And that's a single check, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like we issued that check on [PII].
[AGENT][NEUTRAL] And the check cleared on [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And I'm assuming the same address, the PO box that you have on file.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Right, and that EOB has been sent.
[AGENT][NEUTRAL] Let's move on to the next one.
[AGENT][NEUTRAL] It looks like the next one or the last one I have on here is for $221. Does that sound right?
[CUSTOMER][NEUTRAL] Yes, and it's for 24-2024.
[AGENT][NEUTRAL] Um, I have it still as the first.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Give me one second, [PII], where are you?
[CUSTOMER][NEUTRAL] And you said it was 221 [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I don't show that one.
[CUSTOMER][NEUTRAL] And that date of service is.
[CUSTOMER][NEUTRAL] I'm only showing [PII].
[CUSTOMER][NEUTRAL] And 2421.
[CUSTOMER][NEUTRAL] We might have already gotten payment for that. I don't see for [PII].
[CUSTOMER][NEUTRAL] $221.
[CUSTOMER][NEUTRAL] That is weird.
[AGENT][NEUTRAL] It was a non-covered service, let me see here.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Does it have an invoice number that begins with an RDG?
[CUSTOMER][NEUTRAL] Or do y'all even use that?
[AGENT][NEUTRAL] Um, I don't have the invoice number. Let me see though.
[AGENT][NEUTRAL] This one might have gotten.
[AGENT][NEUTRAL] Moved around because I'm looking.
[AGENT][NEUTRAL] When I look into the uh EOB, it's showing it was charged $221.03 times. So it would actually be more than that.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] But whenever I first looked at it, it only gave me the one.
[AGENT][NEUTRAL] So it's that 6631.
[AGENT][NEUTRAL] Uh, I think we went over, that was the very first one that we did.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Well I appreciate your help. I'll just.
[CUSTOMER][POSITIVE] Give it some time for the web portal hopefully in the next day tomorrow we went over some big ones so.
[AGENT][NEUTRAL] OK, is there anything else I can help you with until then?
[CUSTOMER][POSITIVE] That's it thank you. I appreciate your help again today.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] You too thanks.