AccountId: 011433970860
ContactId: 09a12bb3-8a59-41a0-a272-ced057d81738
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 155059 ms
Total Talk Time (AGENT): 67462 ms
Total Talk Time (CUSTOMER): 62779 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/09a12bb3-8a59-41a0-a272-ced057d81738_20250310T16:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I was calling to check on the status of a claim.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. Um, I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] Sure sir.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then sure so, can I get
[CUSTOMER][NEUTRAL] And your name is [PII]?
[AGENT][NEUTRAL] OK, [PII] and can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Um, yes ma'am, 02551048.
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for the insured, please?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that and then uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] The data service is 102424.
[AGENT][NEUTRAL] OK, do you have that bill amount?
[CUSTOMER][NEUTRAL] Um, hold on, let me get to that. That's what I was doing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The bill amount was 400.
[AGENT][NEUTRAL] Mhm. 400 even.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK all right thank you one moment.
[CUSTOMER][NEUTRAL] Is it, is it, is it?
[AGENT][NEUTRAL] What's the provider, is this, is it uh Cerreta Wells?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, I do believe I've found it. So we did pay, well.
[CUSTOMER][NEUTRAL] It's for procedure code 4342 twice.
[AGENT][NEUTRAL] Got you. OK, yes, so there are a couple other procedure codes with this claim and we did pay those benefits, um, but we did not pay those two. Give me just a moment, let me see. They may just not have been covered procedures.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes. So those two procedures are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, so the 43, 42 are not covered procedures under the policy that he has.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alrighty, and he will have to pay for those out of pocket.
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][POSITIVE] Got you. Alrighty, thank you so much, Ms [PII]. You have a wonderful day.
[AGENT][NEUTRAL] Of course, yeah, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] Alright, thanks for calling APL have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye.