AccountId: 011433970860
ContactId: 06662b82-8f65-40e5-98ad-4b2bdf86413f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515408 ms
Total Talk Time (AGENT): 228662 ms
Total Talk Time (CUSTOMER): 112241 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/06662b82-8f65-40e5-98ad-4b2bdf86413f_20250509T18:23_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, thank you for contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh hello [PII]. I didn't hear you the first time. Um, I'm checking on my wife's policy. I want to check on a claim that we filed, um.
[CUSTOMER][NEUTRAL] Policy number 02600010.
[AGENT][POSITIVE] OK, thank you. And with him in my, yes, sir.
[CUSTOMER][NEUTRAL] Claim
[CUSTOMER][NEUTRAL] Uh, I was gonna give you the claim number. Do you need it?
[AGENT][POSITIVE] Uh, yes, that would be fine. Thank you.
[CUSTOMER][NEUTRAL] OK, 359-506-4.
[AGENT][NEUTRAL] OK, thank you very much. If I could just verify your phone number as well?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, I appreciate that. Thank you.
[AGENT][NEUTRAL] And, and I'm sorry, I didn't catch your name. Uh, I'm sorry, I'm having a little trouble with my phone.
[CUSTOMER][NEUTRAL] My name is [PII], [PII]. Yeah, [PII], her husband.
[AGENT][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] And [PII] is her name?
[AGENT][NEUTRAL] Yes, sir. I, um, now the policy, you're going to be getting a, uh, an EOB from us. What we're looking for is the diagnosis for the, for this, uh, data service for the office visit. So whenever you go to, whenever you have an office visit, yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] She has, she did fax all that stuff over to you guys, uh, a few days ago.
[AGENT][NEUTRAL] Yes, yes, and what we need to do is we need to have the um office visit verified by the provider, so I, I see where it was written in, um, but what we need is to have it, uh, it has, it actually has to come from the provider so we can't take the diagnosis code if it's from you or from your wife, we need to have it from the, uh, the person from the Buffalo medical group and usually they will have that, uh, whenever you go to see the doctor or for an office visit.
[CUSTOMER][NEUTRAL] Well, it's, she
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] She took it out of her porthole. She, the, the one that she sent you had their information on it right out of the porthole.
[AGENT][NEUTRAL] Let's see what we have here.
[AGENT][NEUTRAL] And I'm sorry, my computer is a little bit slow, but what I'm doing is I'm pulling up the documents from that that she submitted, so let's just look at those.
[AGENT][NEUTRAL] Yes, what she, what she submitted, um, this is, uh, it shows it's almost like a receipt. Uh, it shows, um, uh, her name, it shows that, uh, a Mastercard, uh, was charged $166. Uh, it looks like she saw a, a Doctor [PII]. Mhm.
[CUSTOMER][NEUTRAL] When was
[CUSTOMER][NEUTRAL] When was that sent? You got the date that you guys got it?
[AGENT][NEUTRAL] Uh, yes, let's see.
[AGENT][NEUTRAL] Uh, it looks like we received that on the uh on the [PII]. Now we do have two things that she just recently sent and, uh, those have not have.
[CUSTOMER][NEUTRAL] That's, that's the ones, yes.
[AGENT][NEUTRAL] Right now those we have not had a chance to look at yet, uh, but let me just go over them really quickly and we'll see what we've got here.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I need have been sent to an examiner, but yeah, let's see.
[AGENT][NEUTRAL] Pa
[AGENT][NEUTRAL] And I'm, I'm just going over the, the documents now, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so those, those have not been, uh, have gone to uh.
[AGENT][NEUTRAL] To the examiner that if it's not, uh, they haven't been processed yet because we just, we just got them 3 days ago, so.
[CUSTOMER][NEUTRAL] Right, but that should be what you're looking for. That's why I waited a few days to call you, seeing if you guys checked it out yet.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. Excuse me just a moment, please. I'll be right back. Excuse me just one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, um, yes, I think it should be it. Uh, it's, uh, I see what where it's uh Doctor Job's notes, so, um, if you could just give us, uh, usually it takes about, um, about 8 to 10 business days for us to process that, but, uh, I think it, because it does look like it's the, the doctor's notes that it, it, it looks like we might be able to take this, so I don't think there'll be an issue that, uh, that will go to the, to the examiner.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And uh when, whenever they, uh, whenever they look at that, then, then they will be able to give you, you know, they'll be able to look at it more comprehensively than I can over the phone. But um it does look like it is the doctor's notes and that's what we're usually wanting.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, cause that's from the porthole from them. Um, in the past, because the doctor's office stopped accepting all independent insurances.
[CUSTOMER][NEUTRAL] Um, like yours.
[CUSTOMER][NEUTRAL] Um, and so they wouldn't send anything out. I mean how are we gonna.
[CUSTOMER][NEUTRAL] Um, I mean how are we gonna do this in the future?
[AGENT][NEUTRAL] OK, so they, you mean they won't give you the um well the walkout notes, the, the notes of your visit, they should always give you because that's, that's your health information, um, and, uh, so what you would need, what you would get from the, uh, whether they, whether they, uh, give you, um, uh, or file the claim themselves, they should always give you uh your walking out papers or your papers that show what they did, um, and what the diagnosis was.
[AGENT][NEUTRAL] And uh that is uh what we would be looking for from the doctor's office. So they should always give that to you, whether they file the claims or not, and then you should always be able to turn that in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then say that's uh faxed over to you.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, now, is there another claim on her thing cause she went to, um, for a blood draw, um, last month too. And I was wondering if that is showing on there yet.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, no, this is the only one that we have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's just a moment.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Mm well then I'm sure I heard back from them because maybe they got it sent to the wrong place too.
[AGENT][POSITIVE] Yes, yeah, it, yeah, OK, well, there's nothing else I can help with and thank you very much for contacting ATL. You a very good day.
[CUSTOMER][NEUTRAL] All right, we'll see what happens with that one.
[CUSTOMER][POSITIVE] All right. Thank you so much for your, thank you.