AccountId: 011433970860
ContactId: f8468d88-ad22-4718-aa9d-53c3339ad33e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 557729 ms
Total Talk Time (AGENT): 156580 ms
Total Talk Time (CUSTOMER): 174081 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/f8468d88-ad22-4718-aa9d-53c3339ad33e_20250512T17:25_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling ATL this is.
[AGENT][NEUTRAL] [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh hi, this is [PII] calling from provider's office, Anderson Medical Group to check on my claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Uh, can you give me the name of the um provider one more time you're calling from?
[CUSTOMER][NEUTRAL] Mm Anderson Medical Group.
[AGENT][NEUTRAL] Anderson, OK, thank you sir and then what is your call back number?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII] with [PII] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then may I please um have the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, name of the member is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And the member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, Member policy number 021.
[CUSTOMER][NEUTRAL] 00252
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then um can you please give me the data service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, they have service is [PII].
[CUSTOMER][NEUTRAL] And the charge amount is $273.06.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Mm, OK. The remaining balance is $25 co-pay.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, [PII], while I look up this claim and I'll be right back sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so looking on data service of [PII] for [PII], I do not find a claim on file, although the policy number that you gave me is no longer active. Let me give you the good policy number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The good policy number is 2556237.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. 2556237.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. This is a new policy ID number, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. May I know the policy effective on term date?
[AGENT][NEUTRAL] Yes, the effective date is.
[AGENT][NEUTRAL] [PII] and the policy is still current and active.
[CUSTOMER][NEUTRAL] OK. The previous policy number which is
[CUSTOMER][NEUTRAL] 021 00252. May I know when it was termed?
[AGENT][NEUTRAL] Yes, sir. Let me look back at that one real quick for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That was terminated on [PII].
[CUSTOMER][NEUTRAL] October
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Thank you so much and uh just give me a moment. OK, because we, when we submitted the claim to you, we received a denial from you stating it was denied for non-covered charges.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, what is that um claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I'm just checking the claim number. Give me a moment.
[AGENT][POSITIVE] Yes sir, and I'll look it up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Con
[CUSTOMER][NEUTRAL] OK. I have a claim number here. 358.
[CUSTOMER][NEUTRAL] 568 7.
[CUSTOMER][NEUTRAL] There's no
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hold on. Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, I do see um that it was I did find that claim number um benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing the benefits were paid.
[CUSTOMER][NEUTRAL] Mm, OK. So you don't have the primary UB?
[AGENT][NEUTRAL] Not showing that the benefits were paid by the major medical insurance. This charge amount on this claim is one penny, one cent.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, I can see this uh with this claim number, the CPT code 33214 denied for non-covered service.
[CUSTOMER][NEUTRAL] So what I'm asking is, um, do you need a primary copy of the UB or it is denied as per your plan?
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] We need a uh primary copy of the EOB showing where the major medical paid their part.
[CUSTOMER][POSITIVE] OK. Thank you so much. OK. Can I have your fax number or mailing address to send the primary EOB?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, it is um.
[AGENT][NEUTRAL] The fax is [PII].
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][NEUTRAL] OK. And is there any time final limit to submit uh primary UB?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] And can I have your name?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] OK. Thank you, [PII]. And [PII], may I know the call reference number, please?
[AGENT][NEUTRAL] Yes, sir. You can use my name and today's date.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Thank you so much and have a wonderful day, [PII].
[AGENT][POSITIVE] You too, [PII]. You have a good week and thank you for calling APL, sir.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you.