AccountId: 011433970860
ContactId: fd7e5f88-02af-4123-9d7d-a6dde624f4d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1289040 ms
Total Talk Time (AGENT): 385949 ms
Total Talk Time (CUSTOMER): 671436 ms
Interruptions: 11
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/fd7e5f88-02af-4123-9d7d-a6dde624f4d9_20250211T16:47_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi, sir. My name is [PII]. I'm calling for the provider BHS physician Network.
[AGENT][NEUTRAL] OK, and how may I assist you today?
[CUSTOMER][NEUTRAL] Please note that this call will be recorded for quality and training purposes.
[CUSTOMER][NEUTRAL] I'm calling to check on a claim status.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, I can assist you with claim status then. May I have your call back number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. The callback number is [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, thank you. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Patient's policy number is 01868764.
[AGENT][NEUTRAL] OK. Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure. Patient's name is [PII] and the patient's date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Sure. Um, the date of service is [PII] and the total bill amount is $40 even.
[AGENT][NEUTRAL] OK, let me see if I can find this claim. And for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And you said it was $40. What is the procedure code?
[CUSTOMER][NEUTRAL] Just one moment please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $40 sir.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It's um.
[CUSTOMER][NEUTRAL] 99214.
[AGENT][NEUTRAL] It's $40 the total charge or that's the remaining balance.
[CUSTOMER][NEUTRAL] Um, the total charge is $298 even.
[AGENT][POSITIVE] OK. All right. Thank you.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, looks like we received that claim [PII], processed [PII], and the claim was denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, one moment, sure.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] of
[CUSTOMER][NEUTRAL] So you all that is denied on [PII]. Am I right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was.
[CUSTOMER][NEUTRAL] And may I know whether it, uh, whether the service exceeds only from the same provider or um or different providers.
[CUSTOMER][POSITIVE] Uh, thanks.
[AGENT][NEUTRAL] There's no benefits, um, so the benefits is not payable under the member member's plan.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So it's not relating to the provider of service, it's relating to the benefits of the policy, which is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And may I know whether how many services will be allowed on the day?
[AGENT][NEGATIVE] Again, it's not covered, so there's no days, there's no charges, there, there's no benefit for that type of service because it's not covered.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So that uh CPT is not covered under member's policy.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm, um.
[CUSTOMER][NEUTRAL] One moment, let me check the billing summary.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what's the insurance?
[CUSTOMER][NEUTRAL] Uh, may I know whether we can, uh, whether a corrected claim or an appeal works with this denial.
[AGENT][NEUTRAL] Um, you have 180 days from the decision date to submit any appeals.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the address to submit the appeal is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And do you require a copy of denied DOB when we resubmit the appeal?
[AGENT][NEUTRAL] No, we don't require it.
[AGENT][NEUTRAL] It's not required.
[CUSTOMER][NEUTRAL] And may I know the
[CUSTOMER][NEUTRAL] Yes, sure. And can I have, can I please have the claim number?
[AGENT][NEUTRAL] Sure, the claim number is 353-9119.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] So, I do have uh multiple claims today. Could you please help me with them?
[AGENT][NEUTRAL] How many more do you have? And are they different members?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, yes, there are different members and different providers too.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it's fine. I just need to make a note on each one before I move forward. So, um, once I finish with the note, we can continue, OK? So let me go ahead and make a note on this one. Do you, you're welcome. Do you need anything else on this one before I make the note?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, thank you. And
[AGENT][NEUTRAL] No, OK, you're welcome. OK, let me finalize the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And how do you spell your name?
[CUSTOMER][NEUTRAL] Yeah. My name is [PII].
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] And see all the call reference number is same for the, all the members or is it different?
[AGENT][NEUTRAL] It's just my name and today's date we don't have reference numbers.
[CUSTOMER][NEUTRAL] Yes, OK, then we'll go on to the next claim.
[AGENT][NEUTRAL] One moment, let me finalize the note.
[AGENT][NEUTRAL] Covered
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what is the next policy number?
[CUSTOMER][NEUTRAL] Um, policy number is 572,480.
[CUSTOMER][NEUTRAL] I'm getting ready to.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name of the patient is [PII], and the patient's date of birth is [PII].
[AGENT][NEUTRAL] Alright, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the total bill amount is $67.66.
[AGENT][NEUTRAL] OK, let me see if I can find this [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, yeah.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I don't see a claim for [PII] for this member.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh so, could you please check with the total bill amount is $280 to $280 even that charged amount.
[AGENT][NEUTRAL] Is this still [PII]?
[CUSTOMER][NEUTRAL] Yes, that's the prime, I mean total bill amount and the primary uh had paid.
[CUSTOMER][NEUTRAL] Well, let me get
[AGENT][NEUTRAL] Yeah, um, I don't see a claim for that date of service. [PII], there's no claims on file, so the amount is not, yeah, it's just the claim is not there for that date of service. Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. OK then.
[CUSTOMER][NEUTRAL] Mhm. One moment. And yeah, see, uh, may I have the patient's policy effective date and termination date?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, and it's a different policy number because the one you gave me was an old policy. So let me know when you're ready and I can give you the correct policy number.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, uh, I mean, I asked the effective date and termination date.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Yes, um, again, this is a different policy number. The one you provided to me in the beginning is an old policy. So if you want to write down the correct policy number so you can submit the claim.
[CUSTOMER][POSITIVE] Good good.
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Let me know when you're ready for that new number.
[CUSTOMER][NEUTRAL] OK. Yes, yes, please go ahead.
[AGENT][NEUTRAL] OK, the new policy number is 02.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] 03.
[AGENT][NEUTRAL] 01
[AGENT][NEUTRAL] 18.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it is active at the moment, a secondary policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So your secondary insurance to the patient.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Could you please verify the claim's mailing address and electronic payer ID?
[AGENT][NEUTRAL] The mailing address is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII] City, [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the payer ID is 60801, but this one needs to be either faxed or mail because we need the explanation of benefits attached to it.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I feel like.
[AGENT][NEUTRAL] Do you need any other information on this one, or can I make my note?
[CUSTOMER][NEUTRAL] So, uh, we can submit electronic or paper claim via mail.
[AGENT][NEUTRAL] No, you can send by fax or mail only, no electronics.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, then, uh, OK, see, I will move on to the next game.
[AGENT][NEUTRAL] Bear with me, let me make a note.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, how about back backtrack.
[CUSTOMER][NEUTRAL] You know how many we could.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] Yes, uh, the next member ID is 02496355.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm. Can you give me that number one more time? It's missing a number.
[CUSTOMER][NEUTRAL] Yes. I'll repeat that. 02496355.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Mhm. The patient's name is [PII], and the patient's date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the total charges is are $35 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if I can find this claim and that was [PII], correct?
[CUSTOMER][POSITIVE] Mhm correct.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Great
[CUSTOMER][NEUTRAL] like
[AGENT][NEUTRAL] I don't have a claim for [PII].
[CUSTOMER][NEUTRAL] Yes, one moment please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh, see, all, uh, the total bill amount was $255 and the primary insurance had paid $220.35 dollars has been left to the secondary insurance.
[AGENT][NEUTRAL] Is it for [PII]? Is that the date of service?
[CUSTOMER][NEUTRAL] Oh my gosh, I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] There's no claim on file for [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK. OK then. All right, then, can I, may I please have the patient's policy effective date and termination date.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you open like a close to the I.
[AGENT][NEUTRAL] That is um effective [PII].
[AGENT][NEUTRAL] And it is active at the moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And OK, second and rest of the details are same as the last one, am I right?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, mhm. It is a secondary, so yeah, it's gonna be the same mailing address and fax number and it cannot be sent by electronics.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, then we'll go on to the next claim.
[AGENT][NEUTRAL] OK, bear with me, let me make a note.
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][NEUTRAL] But not like.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] Mhm one moment please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] And yeah, next, uh, policy number is 01893470.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I think uh.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name of the patient is [PII], and the patient's date of birth is [PII].
[CUSTOMER][NEUTRAL] Well the reason to do that.
[AGENT][NEUTRAL] OK, what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the total bill amount is $25.76.
[AGENT][NEUTRAL] Mhm. That's [PII], correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] rain.
[AGENT][NEUTRAL] What is the total charge of the claim?
[CUSTOMER][NEUTRAL] Yes, one moment, please. The total charge is $305.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, we received the claim [PII]. We processed the claim [PII], and the claim was denied, office visits and office procedures are not covered under the members plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, one moment, please. Uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] So it's the same uh details as we uh as I received on the first claim, right?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, on the first one.
[CUSTOMER][NEUTRAL] And yes, the appeal address.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Yes, and the time refunding limit is 180 days uh from registration and no EOB denied UOB is needed to be attached.
[AGENT][NEUTRAL] OK, yes.
[CUSTOMER][NEUTRAL] And can I please have the claim number?
[AGENT][NEUTRAL] Yes, the claim number is.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] 352-261-9.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for the assistance, you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Have I
[CUSTOMER][POSITIVE] No, no thanks. I got all the details and thanks.
[AGENT][POSITIVE] You're welcome. Have a good day. Thank you for calling ATL. bye-bye. It's good.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Mm