AccountId: 011433970860
ContactId: 053f97f7-2d86-4d26-9448-06ff93ce9e96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 680280 ms
Total Talk Time (AGENT): 191515 ms
Total Talk Time (CUSTOMER): 129642 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/053f97f7-2d86-4d26-9448-06ff93ce9e96_20250131T19:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I have a question on one of my claims.
[AGENT][NEUTRAL] OK, I can help you with your claim. Can you please give me your name and your callback number?
[CUSTOMER][NEUTRAL] Mhm. My name is [PII].
[CUSTOMER][NEUTRAL] And my number's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, Ms. [PII], what is your policy number?
[CUSTOMER][NEUTRAL] The policy number is, the outpatient is 021.
[CUSTOMER][NEUTRAL] 412
[CUSTOMER][NEUTRAL] 47
[CUSTOMER][NEUTRAL] M like Mary. L like Larry.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] OK, let me pull that policy in real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], for security reasons, can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you ma'am and then I'll also need for you to verify your address, phone number and email address that we have on file for you.
[CUSTOMER][NEUTRAL] Mhm. It's [PII].
[CUSTOMER][NEUTRAL] And the number I already gave you was [PII] and the email is my [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you Ms. [PII], I appreciate you verifying the information for me. Do you happen to have a claim number for the claim that you want me to look at?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. It's 355.
[CUSTOMER][NEUTRAL] 1035.
[AGENT][NEUTRAL] OK. And is this for yourself or is it for your dependent?
[CUSTOMER][NEUTRAL] For myself.
[AGENT][NEUTRAL] OK, let me look real quick.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Where you going?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, Ms. [PII], I do have it pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I do see the claim was denied because office visits are not covered by your policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. OK, so my question is, um, are televisits, you know, the, the video type.
[CUSTOMER][NEUTRAL] Office visits are those covered?
[AGENT][NEUTRAL] Let me pull your policy in and read it and see it's gonna be just a moment so the computer can load it for us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a second, let me read through the policy and see what I can find.
[AGENT][NEUTRAL] No, ma'am. It's not in your policy for Telemed, um.
[AGENT][NEUTRAL] It's for ER urgent care center, physical therapy facility.
[AGENT][NEUTRAL] Hospital outpatient facility or a free standing outpatient surgery center.
[AGENT][NEUTRAL] MRI imaging center or an ambulatory center.
[CUSTOMER][NEUTRAL] Um, are you able to send me a copy of the policy?
[AGENT][NEUTRAL] Yes I can I can email.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] It to you or I can just go ahead and order one to be mailed to your home address.
[CUSTOMER][NEUTRAL] You can email it that's fine.
[AGENT][POSITIVE] OK, all right, Ms. [PII], I will take care of that. Hold on real quick and I'm gonna get it right to you while we're on the phone together.
[CUSTOMER][NEUTRAL] OK, and then I have one more question when you're done with that.
[AGENT][NEUTRAL] Oh, OK, what's your question?
[CUSTOMER][NEUTRAL] Um, the other question is on another claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can give you that number.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] 354
[CUSTOMER][NEUTRAL] 784 7
[AGENT][NEUTRAL] OK, let me look on that claim real quick.
[AGENT][NEUTRAL] Is this for yourself?
[CUSTOMER][NEUTRAL] Dependent.
[AGENT][NEUTRAL] You're dependent. OK, thank you.
[AGENT][NEUTRAL] OK, so the claim I'm looking at the um the 335474 I'm sorry 7847 and it says that um.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] see
[AGENT][NEUTRAL] The claim was ineligible for that data service.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see if the if the claim was resubmitted.
[AGENT][NEUTRAL] Because they check that data service every day, um.
[AGENT][NEUTRAL] Let's see this one.
[AGENT][NEUTRAL] I do show that the claim.
[AGENT][NEUTRAL] Was paid on claim number 3547851?
[AGENT][NEUTRAL] To Nicholas Children's Hospital Pediatrics, $250.48.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so this one is just.
[CUSTOMER][NEUTRAL] Obsolete at this point.
[AGENT][NEUTRAL] Yes, so what happens because you're with Bic and you pay a week at a time, it goes by the date of service for that week, you know that you had the um had it done and if your premium comes in after the date of service they look at it to see if you had any claims outstanding and then they'll reprocess it and so that's what happened is that the premium came in the claim was reprocessed and paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um, that was all, that was all my questions. If you could just email me that policy.
[AGENT][NEUTRAL] Yes ma'am, I'm gonna put you on hold and get that done for you.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, Ms. [PII], I have a copy of that policy on its way to you by email.
[CUSTOMER][POSITIVE] OK, thanks so much for your help.
[AGENT][POSITIVE] You're very welcome you have a great weekend and thanks for calling ATL.
[CUSTOMER][POSITIVE] You too. Thank you. Bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.