AccountId: 011433970860
ContactId: fa37efb5-037a-4263-af5b-9cf85dbd50cb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 825919 ms
Total Talk Time (AGENT): 382497 ms
Total Talk Time (CUSTOMER): 237564 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/fa37efb5-037a-4263-af5b-9cf85dbd50cb_20250328T18:17_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] calling from provider office, checking on the claim status.
[AGENT][NEUTRAL] I can help with the claim status. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Sure. The policy number is
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] Uh yeah. It's 02047977.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Sure. The member name is
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] I mean, [PII], date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII] direct line.
[AGENT][NEUTRAL] Thank you. And this is for medical or for dental?
[CUSTOMER][NEUTRAL] It's for medical
[AGENT][NEUTRAL] OK, and what date of service were we looking for from Ira?
[CUSTOMER][NEUTRAL] Sure. It's
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK. And the build amount?
[CUSTOMER][NEUTRAL] It's $31 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like your claim number on this one.
[AGENT][NEUTRAL] It's 33.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 77
[AGENT][NEUTRAL] 884
[AGENT][NEUTRAL] Uh, this is a limited benefit policy. What it does is it pays a flat rate benefit uh for very specific services, and, and once that benefit has been paid, uh, there's, there's nothing else for that day of service.
[AGENT][NEUTRAL] So it does look like we uh there were a couple of claims that came in before yours, and they would have been, uh, they would have had that benefit paid to them.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so, uh, it looks like the uh.
[AGENT][NEUTRAL] And if it was $50 and uh that was paid to a uh an earlier claim. Um, it looks like we received your claim, let's see.
[AGENT][NEUTRAL] OK um.
[AGENT][NEUTRAL] Uh looks like your claim was received on uh.
[AGENT][NEUTRAL] I'm sorry, it just take me a second because there's so many of these claims. We received your claim on [PII], and we processed it.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] On that same day, but it would have been, uh, it would have been um denied because the benefit for this, uh, for that day of service had already been met.
[CUSTOMER][NEUTRAL] Uh, actually, I have the different claim number here. It is starting with the 3373795.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so it's 337.
[AGENT][NEUTRAL] 379 5. Is that correct?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, let me see what we have here.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Cause we, we did get a
[AGENT][NEUTRAL] Now this is uh.
[AGENT][NEUTRAL] Let's see. Now, on this particular claim, we show a charge amount that is more than $31.
[AGENT][NEUTRAL] Um, this claim was actually paid.
[AGENT][NEUTRAL] I see, I'm, I'm sorry, I'm just waiting for my computer to come up.
[AGENT][NEUTRAL] We had multiple claims for that data service for this uh provider so.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, so it looks like the, the bill amount was more than $31. Now there was a, uh, there was a payment made on this.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for the uh for the provider just trying to, so there was a check that was sent to the provider, let's see.
[AGENT][NEUTRAL] Now this, as I mentioned before, this is a limited benefit, uh, policy, so there it was, there wasn't much, it was just, it was, it was now the payment was $31. The bill amount was the third amount, $31 with the payment was $31 and that check, it was a single paper check.
[AGENT][NEUTRAL] 182.
[AGENT][NEUTRAL] 1304 and that was cashed on [PII].
[AGENT][NEUTRAL] But that's the most that this policy would pay for this.
[AGENT][NEUTRAL] This data service.
[CUSTOMER][NEUTRAL] OK. Sure. Thank you. And may I know the allowed amount as well?
[AGENT][NEUTRAL] The allowed amount was $50 but uh that was.
[AGENT][NEUTRAL] Um, there was another bill that came in that that was paid out for the remaining 19.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, thank you. And may I know the claim received and the process to date for this?
[AGENT][NEUTRAL] Uh, yes, it looks like it was received on the [PII] and processed on the [PII].
[CUSTOMER][NEUTRAL] Of [PII], right?
[AGENT][POSITIVE] That's correct. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, thank you. And uh could you please send us the UOB copy of it?
[AGENT][NEUTRAL] Yes, where would you like me to fax that?
[CUSTOMER][NEUTRAL] Uh, it's [PII]. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I can do that. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Uh yeah. So may I know the pay to address as well?
[AGENT][NEUTRAL] The address that it was sent to?
[AGENT][NEUTRAL] Uh, was [PII].
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] and that was in [PII].
[AGENT][NEUTRAL] And the zip code was [PII].
[CUSTOMER][NEUTRAL] OK, thank you. And I have the last 3 more claims for the same number, the date of service. Could you please help me with those?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the next day, uh, the next day of service?
[CUSTOMER][POSITIVE] Uh yeah. Thank you so much. And the next date of service is
[CUSTOMER][NEUTRAL] [PII] with the bill amount $31 even. And I have the claim number. It is
[CUSTOMER][NEUTRAL] 338-388-0
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, now, if you, uh,
[AGENT][NEUTRAL] If you have that claim, then, then uh it should show that the uh
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] All the benefits for that date has already been paid out, so there were no remaining benefits that were available for this data service.
[AGENT][NEUTRAL] And it looks like we received that claim. Let me just see here.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, on this particular claim.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] We received it on the [PII].
[AGENT][NEUTRAL] And that's when we processed it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And may I know how much is the paid amount?
[AGENT][NEUTRAL] It's $50 and that's just a verification of the benefits not again to your payment, but it looks like that had already been paid out.
[CUSTOMER][NEUTRAL] OK. And pay through check, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And may I know the check number?
[AGENT][NEUTRAL] Well, there, it was paid to somebody else, [PII], so I can't give you that information.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] uh, so the pay to address is the same, right? [PII].
[AGENT][NEUTRAL] Uh, no, I don't
[AGENT][NEUTRAL] No, I, I don't know. I can't give you the information that it was paid to. I'm, I'm just.
[AGENT][NEUTRAL] Some of the, sometimes the, the insured will, will, will get the benefits, sometimes it will be the provider just depends on who turned in the uh but uh but the claim that you submitted was that uh payments had already been made by the time we received it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure. And uh could you please send us an EOB copy of this claim?
[AGENT][NEUTRAL] Uh, no, not because it didn't. I can send you the, the denial, absolutely, I can send you the denial, sure. And that's to the same uh the same uh fax number. Yeah, sure.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, please, thank you.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Just a moment, please. I'm pulling up the the next claim for this number.
[AGENT][POSITIVE] OK, I can do one more, certainly.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And the next claim is for the date of service, [PII], with the bill amount, $31 even. And the claim number is
[CUSTOMER][NEUTRAL] 338-95002.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] And this was denied for the same reason that that benefit had already been paid out by the time that we received your claim.
[AGENT][NEUTRAL] So, uh, we received that claim. Let's see.
[AGENT][NEUTRAL] We received that claim on the [PII], and that's when it was processed.
[AGENT][NEGATIVE] I can fax you the EOB on that as well, but this was also a denial.
[AGENT][NEUTRAL] Because the benefit had already been paid out to another provider.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][POSITIVE] Yes, please. Thank you. And
[AGENT][NEUTRAL] OK, I, I will go ahead and send this to you.
[CUSTOMER][NEUTRAL] Thank you. And just a moment, please. I have a last name for this number.
[CUSTOMER][NEUTRAL] And it is for the date of service.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] [PII] with the bill amount $243 even. And the claim number is 3386445.
[AGENT][NEUTRAL] OK, this particular claim.
[AGENT][NEGATIVE] I was denied because the policy that this is a wellness check.
[AGENT][NEUTRAL] And the uh the policy um doesn't cover wellness.
[AGENT][NEUTRAL] Uh, services. Now when it
[AGENT][NEUTRAL] When we receive this.
[AGENT][NEUTRAL] Uh let's see if I can find that.
[AGENT][NEUTRAL] 33386445.
[AGENT][NEUTRAL] We received that claim on the.
[CUSTOMER][NEUTRAL] Uh, I'm sorry, it's actually for 99386 procedure.
[AGENT][NEUTRAL] Right, right, but the, the diagnosis code is, is uh
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see. The diagnosis code is 00.00.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] They would consider that to be a wellness, and because it's a general checkup, they would consider that to be a wellness check.
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Uh, so you're, uh, sending back this claim for review, right?
[AGENT][POSITIVE] I can send you uh an EOB of it yes.
[CUSTOMER][NEUTRAL] Uh yes, please. Thank you. And may I know the brand name of the member?
[AGENT][NEUTRAL] It uh is a hospital indemnity policy.
[CUSTOMER][NEUTRAL] Hospital and down.
[CUSTOMER][NEUTRAL] Policy. OK. Thank you. And may I know the claim received and the process to date?
[AGENT][NEUTRAL] The, I'm sorry, the, the claim what?
[AGENT][NEUTRAL] When, when we received it.
[CUSTOMER][NEUTRAL] Claim received and the processed date, please.
[AGENT][NEUTRAL] OK, again, that was sent, uh, that was sent, uh, we received that on the um
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] [PII] and it was processed on the [PII].
[CUSTOMER][POSITIVE] OK, sure. Thank you so much. And could you please spell out your name if you don't mind?
[AGENT][NEUTRAL] It's [PII] and we're gonna use that today's date is our is our reference.
[CUSTOMER][POSITIVE] OK, sure, thank you so much [PII], and that's it for today. Have a great day bye bye.
[AGENT][POSITIVE] Thanks for contacting if you have a good day.