AccountId: 011433970860
ContactId: 097aa55e-f1de-4da2-9985-a860de452eaa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 217179 ms
Total Talk Time (AGENT): 74032 ms
Total Talk Time (CUSTOMER): 60699 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/097aa55e-f1de-4da2-9985-a860de452eaa_20250204T18:08_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to check on claim status.
[AGENT][NEUTRAL] OK. May I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And what is your callback number if we are disconnected?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 21361.
[AGENT][NEUTRAL] OK, that is not a policy number.
[CUSTOMER][NEUTRAL] Uh, let me just get the card. Hold on.
[CUSTOMER][NEUTRAL] Group number 21361.
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] Is it cert number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so, um, 01678802 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], last name [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. One moment and give me a call for claim status. I can assist you. Give me one moment please, [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, thank you. What's that date of service and the total charges amount, please?
[CUSTOMER][NEUTRAL] 917 24 $450.
[AGENT][NEUTRAL] OK, that was 9-172024, $450.01 moment.
[AGENT][NEUTRAL] And just to verify, what procedure code was billed for this service date for the member?
[CUSTOMER][NEUTRAL] 7 7681.
[CUSTOMER][NEUTRAL] 8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] That claim was received and it denied as services not covered when performed inside the doctor's office or clinic.
[AGENT][NEGATIVE] The claim was also sent in again and it was denied as a duplicate.
[AGENT][NEUTRAL] I have the initial denial claim number if you need that.
[CUSTOMER][NEUTRAL] Do you have the yeah the claim number?
[AGENT][NEUTRAL] 351-952-0
[CUSTOMER][NEUTRAL] So it doesn't cover outpatient um procedures.
[AGENT][NEUTRAL] It doesn't cover procedures, covered, I'm sorry, inside the doctor's office.
[CUSTOMER][NEUTRAL] OK, is there a call reference number?
[AGENT][NEUTRAL] No, we do not use call reference numbers now. You can use my name in today's date, and you can also check claims status by visiting our secure portal at [PII]. My last initial is [PII]. First name is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. Bye bye bye.