AccountId: 011433970860
ContactId: edb3561d-89ec-4342-a1d6-e29ed59f342b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 596000 ms
Total Talk Time (AGENT): 189252 ms
Total Talk Time (CUSTOMER): 155954 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/edb3561d-89ec-4342-a1d6-e29ed59f342b_20250407T12:13_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is Easy. How can I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII]. Good morning, calling from doctor's office calling to check a claim for a member.
[AGENT][NEUTRAL] I'm sure [PII] and I can assist you with claim status. Um, first I'll need to go call back number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Sure, it's [PII] direct line.
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] 022
[CUSTOMER][NEUTRAL] 62,380.
[CUSTOMER][NEUTRAL] I'm [PII].
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] For year, [PII].
[AGENT][NEUTRAL] And the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] [PII] for $1,058.18.
[AGENT][NEUTRAL] OK, and I'm waiting on my system. One moment, please.
[AGENT][NEUTRAL] OK, and you said that
[CUSTOMER][NEUTRAL] And uh may I have your name? Could you spell that again for me, please? Sorry.
[AGENT][NEUTRAL] Um, it's [PII]. It's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Thank you. Yes, please go ahead.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And uh what are the bill charges?
[CUSTOMER][NEUTRAL] $1,058.18.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And who's the provider?
[CUSTOMER][POSITIVE] It's done up a well.
[AGENT][NEUTRAL] OK. Yes, I'm showing that we received that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed and paid out on [PII] and it was actually paid out to the member.
[CUSTOMER][NEUTRAL] Paid to member?
[AGENT][NEUTRAL] Yes, it was paid to member. The member filed the claim and um the uh benefits were paid to the member.
[CUSTOMER][NEUTRAL] OK, uh, may I know the paid amount?
[AGENT][NEUTRAL] Yes, sir. Let's see.
[AGENT][NEUTRAL] $239.42.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So was this applied towards the patient deductible or was this uh paid to, uh, paid by the, I mean this amount was paid to patient.
[AGENT][NEUTRAL] Yeah, this amount was paid to the patient.
[CUSTOMER][NEUTRAL] Alright, and may I know why was it paid to patient instead of the provider?
[AGENT][NEUTRAL] Because we received the patient's claim first. This is for secondary gap insurance and the uh patient submitted the EOB from the primary insurance company showing which charges went towards the copay, the co-insurance, and the deductible. And um since we received the claim from the uh member first, that's where the benefits were paid out to.
[CUSTOMER][NEUTRAL] Alright, so we can build this to patients so he can pay us this deductible correct?
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Alright, may I have the claim number please?
[AGENT][NEUTRAL] Yes, the claim number is 3461155.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And when was this payment, uh payment issued to the patient?
[AGENT][NEUTRAL] OK. The payment was issued on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] What was the, was it was the mode of payment? Was it through check or any EFT?
[AGENT][NEUTRAL] It was a check.
[CUSTOMER][NEUTRAL] Uh, can I have the check number along with the
[AGENT][NEUTRAL] Well, I'm sorry. It was an EFT. I'm sorry. It was the EFT. There was no check number, right?
[CUSTOMER][NEUTRAL] Uh, check number please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, may I have the EFT number please?
[AGENT][NEUTRAL] OK. Actually, the system's not giving me that information.
[AGENT][NEUTRAL] But there is the, the claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you do not have the payment information, but the pay you are sure that the claim was paid to patient, and we can go ahead and build the bill this, uh, balance to the patient for the deductible.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Do you have an EFT clear date so we can.
[CUSTOMER][NEUTRAL] At the
[AGENT][NEUTRAL] No, sir. The system is not giving me that information either.
[AGENT][NEUTRAL] But it was paid out to the member.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Alright, and I have another one member, uh, before that, may have the call reference number for this member please.
[AGENT][NEUTRAL] The reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Alright and in oh yeah I got that.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Thank you, can we please monitor the next number that uh.
[AGENT][NEUTRAL] Yes, one moment, please.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, and the policy number, please?
[CUSTOMER][NEUTRAL] It's 0242.
[CUSTOMER][NEUTRAL] 4884 ML 8.
[AGENT][NEUTRAL] OK. Thank you. And the patient's name and uh date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] Day of service is [PII] with the total bill of $802.97.
[AGENT][NEUTRAL] You said the date of service was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm not showing a claim on file with that date of service for this member.
[CUSTOMER][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] Could you verify the patient's effective date and the time date for me please?
[AGENT][NEUTRAL] Um, yes, and just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII], and the policy is still active.
[CUSTOMER][NEUTRAL] OK, may I have the payer ID to submit the claim?
[AGENT][NEUTRAL] Yes, the payer ID is [PII].
[CUSTOMER][NEUTRAL] [PII]. All right. And what is the mailing address?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, one moment here.
[CUSTOMER][NEUTRAL] Uh, just to confirm, [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And what's the time the following moment?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And you have a fax number to submit the claim?
[AGENT][NEUTRAL] Yes, the fax number is [PII] and please attention it to the claims department.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] No problem.
[CUSTOMER][POSITIVE] That's all for now. Have a good day.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with, [PII]?
[CUSTOMER][POSITIVE] Nothing else, thank you.
[AGENT][POSITIVE] OK. I thank you again for calling ATL. You have a great day as well. Mm bye.
[CUSTOMER][NEUTRAL] Right